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.

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

abdominal aortic aneurysm

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?

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?

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?

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?

A: Muscle spasm

B: Inflammation

C: Infection

D: Bleeding into the abdominal cavity

Answer 51

A

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

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?

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?

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?

A. Anatomic.

B. Vascular.

C. Inflammatory.

D. Neoplastic.

Answer 58

A

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