Chapter 26 | Abdominal Emergencies

Question 1

Define:

peritoneum

(per-ih-toe-NEE-um)

Answer 1

thin membrane lining the abdominal cavity and covering each organ

Question 2

Define:

parietal peritonium

Answer 2

thin membrane lining the abdominal cavity

Question 3

Define:

visceral peritoneum

Answer 3

thin membrane lining each organ in the abdominal cavity

Question 4

List:

abdominal organs in extra-peritoneal space

3 points

Answer 4

• kidneys (behind peritoneum)
• pancreas (behind peritoneum)
• bladder (inferior to peritoneum)

Question 5

Define:

extra-peritonial space

Answer 5

space within abdomen outside of the parietal peritoneum

Question 6

Define:

visceral pain

Answer 6

“dull” or “achy” abdominal pain originating from visceral peritoneum

(from each organ)

Question 7

Define:

colic pain

Answer 7

intermittent abdominal pain

Question 8

Fill in the blank:

Colic pain may result from [BLANK] and/or [BLANK].

Answer 8

Colic pain may result from distention and/or contraction of hollow organs.

Question 9

Fill in the blank:

Persistent/constant abdominal pain often originates from [BLANK].

Answer 9

Persistent/constant abdominal pain often originates from solid organs.

Question 10

Define:

parietal pain

Answer 10

sharp abdominal pain that is severe, constant, and localized to a specific area

Question 11

Define:

referred pain

Answer 11

perception of pain in skin/muscles at distant locations

Question 12

Define:

tearing pain

Answer 12

pain originating from aorta through separation of layers of blood vessel caused by AAA

(AAA is abdominal aortic aneurysm)

Question 13

Define:

appendicitis

Answer 13

infection of appendix

(typically indicates appendectomy)

Question 14

Describe:

primary sign/symptom of appendicitis

Answer 14

persistent RLQ pain

Question 15

Describe:

primary sign/symptom of rupture of appendix

Answer 15

sudden relief… followed by sudden and severe increase in RLQ pain

Question 16

Define:

peritonitis

Answer 16

irritation of peritoneum

Question 17

Fill in the blank:

Peritonitis is usually caused by [BLANK].

(what triggers infection)

Answer 17

Peritonitis is usually caused by foreign material in peritoneal space.

(like blood and bacteria and fungi and stuff)

Question 18

Fill in the blank:

Parietal peritoneum is sensitive, especially to [BLANK].

Answer 18

Parietal peritoneum is sensitive, especially to acidic substances.

Question 19

Fill in the blank:

Peritonitis causes [BLANK].

(body reaction)

Answer 19

Peritonitis causes involuntary contraction of abdominal muscles.

Pain to palpation is the most characteristic sign of peritonitis, to both deep and superficial touch. Initially, there is voluntary guarding; subsequently, the muscular wall undergoes an involuntary and severe spasm. Bowel sounds may or may not be present, and they may resemble an early ileus.

Question 20

Describe:

primary sign/symptom of peritonitis

Answer 20

abdominal pain/rigidity

Pain to palpation is the most characteristic sign of peritonitis, to both deep and superficial touch. Initially there is voluntary guarding; subsequently the muscular wall undergoes an involuntary and severe spasm. Bowel sounds may or may not be present, and they may resemble an early ileus.

Question 21

Define:

PD

Answer 21

peritoneal dialysis

Question 22

Define:

cholecystitis

Answer 22

inflammation of gallbladder

Question 23

Fill in the blank:

Cholecystitis is typically caused by [BLANK].

Answer 23

Cholecystitis is typically caused by the blockadge of gallbladder outlet by gallstones.

Question 24

Fill in the blank:

The symptoms of cholecystitis are often worsened by [BLANK].

Answer 24

The symptoms of cholecystitis are often worsened by the ingestion of fatty foods.

gallbladder may hurt because the body secretes more bile after large or high fat meals to break down fats and absorb them

the gallbladder contracts significantly in response to fatty food

contraction of gallbladder can cause pain in combination with blocked ducts

Question 25

# List: *signs/symptoms* of **cholecystitis** | 2 points

Answer 25

* sharp RUQ or epigastric pain * pain often referred to shoulder

Question 26

# Define: pancreatitis

Answer 26

inflammation of pancreas

Question 27

# Fill in the blank: Pancreatitis is common in patients with **[BLANK]**.

Answer 27

Pancreatitis is common in patients with **chronic alcohol abuse**.

Question 28

# Describe: primary *sign/symptom* of **pancreatitis**

Answer 28

epigastric pain | often referred to back or shoulder

Question 29

# Define: gastrointestinal (GI) bleeding

Answer 29

hemorrhage within lumen of GI tract

Question 30

# True or false: GI bleeding can be described as "minor" to "severe".

Answer 30

true

Question 31

# Answer: What happens to the blood from a patient with GI bleeding?

Answer 31

eventually exits out mouth or rectum

Question 32

# True or false: GI bleeding is often painless.

Answer 32

true

Question 33

# True or false: GI bleeding is often very painful.

Answer 33

false

Question 34

# Fill in the blank: Gastric ulcers can cause severe pain and **[BLANK]**. | (condition)

Answer 34

Gastric ulcers can cause severe pain and **peritonitis**. ## Footnote: gastric ulcer enables the bacteria that live in stomach to escape and infect the lining of abdomen (peritoneum)

Question 35

# Define: gastric ulcers

Answer 35

**holes in GI system** from highly *acidic gastric juices*

Question 36

# List: *signs/symptoms* of **GI bleeding** | 4 points

Answer 36

* dark/tarry stool (maroon-black) * frank blood from rectum (hemorrhoid) * vomiting "coffee ground" appearing blood or frank blood * absent-to-severe pain

Question 37

# Define: AAA

Answer 37

**a**bdominal **a**ortic **a**neurysm

Question 38

# Define: abdominal aortic aneurysm (AAA)

Answer 38

weakness of inner wall of aorta | (tears and separates from outer layers)

Question 39

# Define: hernia

Answer 39

**hole in abdominal wall** that allows tissues or parts of organs (commonly intestines) to protrude under skin

Question 40

# Fill in the blank: A hernia may be precipitated by **[BLANK]**. | (action right before)

Answer 40

A hernia may be precipitated by **heavy lifting**.

Question 41

# Fill in the blank: A hernia may cause **[BLANK]** or **[BLANK]**.

Answer 41

A hernia may cause **strangulation of tissue** or **bowel obstruction**.

Question 42

# Fill in the blank: A hernia may require **[BLANK]**. | (treatment you *can't* give)

Answer 42

A hernia may require **surgical repair**.

Question 43

# Define: renal colic

Answer 43

severe **pain caused by kidney stones** travelling down ureter

Question 44

# True or false: An associated symptom of renal colic may be nausea/vomiting.

Answer 44

true

Question 45

# List: potential *GI symptoms* caused by **myocardial infarction** | 2 points

Answer 45

* nausea/vomiting * epigastric pain | indigestion also possible

Question 46

# List: **OB/GYN conditions** that may cause *GI symptoms* | 5 points

Answer 46

* ectopic pregnancy * ovarian cysts * pregnancy * menstrual cramps/pain * pelvic inflammatory disease (PID)

Question 47

# Define: frank blood

Answer 47

blood not mixed with anything else | (like sputum or mucus or other stuff)

Question 48

# Choose: Your patient is a 60-year-old male who is complaining of severe epigastric abdominal pain and difficulty breathing. He is pale, sweaty, and pleads with you, "Don't let me die, I think I'm going to die." **Which of the following measures is *not* part of your initial treatment of this patient?** ## Footnote **A:** Placing the patient in a position of comfort **B:** Applying the defibrillator pads to his chest **C:** Giving 15 lpm of oxygen by nonrebreather mask **D:** Determining whether you should assist the patient in taking nitroglycerin

Answer 48

**B**

Question 49

# Choose: You respond to the scene of a 50-year-old male complaining of severe abdominal pain. He has a history of alcohol and drug abuse. His vital signs are stable and he presents with epigastric pain that radiates to the back. He has guarding and point tenderness in the upper quadrants. **What do you suspect?** ## Footnote **A:** pancreatitis. **B:** gastroesophageal reflux disease (GERD). **C:** myocardial infarction. **D:** cholecystitis.

Answer 49

**A**

Question 50

# Choose: When the gallbladder is diseased, the pain is not only felt in the right upper quadrant (RUQ) but also in the right shoulder. **What type of pain is this?** ## Footnote **A:** visceral pain **B:** tearing pain **C:** parietal pain **D:** referred pain

Answer 50

**D**

Question 51

# Choose: Which of the following is *not* a cause of parietal pain? ## Footnote **A:** Muscle spasm **B:** Inflammation **C:** Infection **D:** Bleeding into the abdominal cavity

Answer 51

**A** ## Footnote abdominal muscle spasms can be *caused by* peritonitis — not a cause of peritonitis

Question 52

# True or false: Parietal pain is usually intermittent in nature.

Answer 52

false | parietal pain is sharp, severe, and constant

Question 53

# True or false: Parietal pain is generally localized to a particular area.

Answer 53

true | localized to the abdomen

Question 54

# True or false: Parietal pain is often described as "crampy" or "colicky."

Answer 54

false ## Footnote: *parietal pain* is sharp and constant *visceral pain* or *colic pain* is dull or intermittent

Question 55

# True or false: Parietal pain arises from solid organs.

Answer 55

false | parietal pain arises from organs in the parietal peritoneum

Question 56

# Choose: Your patient is a 35-year-old female with abdominal pain. **Which of the following findings *cannot* be attributed to the patient experiencing pain?** ## Footnote **A:** Increased heart rate **B:** Shallow respirations **C:** Increased respiratory rate **D:** Decreased level of consciousness

Answer 56

**D**

Question 57

# Choose: You are treating a 38-year-old female patient with abdominal distress. The patient's vital signs are stable and you are getting ready to transport. **What is the *best* position to transport the patient?** ## Footnote **A:** Supine **B:** Right lateral **C:** Semi-Fowler's **D:** Position of comfort

Answer 57

**D**

Question 58

# Choose: Which of the following categories does GI bleeding from diverticulosis belong to? ## Footnote **A.** Anatomic. **B.** Vascular. **C.** Inflammatory. **D.** Neoplastic.

Answer 58

**A** ## Footnote *GI bleeding from diverticulosis is grouped in the anatomic category. The physical outpouchings in the intestine are what is responsible for the bleeding. While this may seem similar to vascular bleeding, vascular instead refers to abnormalities in the blood vessels and not the wall of the intestine itself. The inflammatory category refers to conditions involving inflammation of the intestines, while neoplastic refers to cancerous growths.*

Question 59

# Define: hematemisis

Answer 59

vomiting blood