Chapter 26 | Abdominal Emergencies Flashcards
• Understanding the nature of abdominal pain or discomfort • Becoming familiar with abdominal conditions that may cause pain or discomfort • How to assess and care for patients with abdominal pain or discomfort
Define:
peritoneum
(per-ih-toe-NEE-um)
thin membrane lining the abdominal cavity and covering each organ
Define:
parietal peritonium
thin membrane lining the abdominal cavity
Define:
visceral peritoneum
thin membrane lining each organ in the abdominal cavity
List:
abdominal organs in extra-peritoneal space
3 points
- kidneys (behind peritoneum)
- pancreas (behind peritoneum)
- bladder (inferior to peritoneum)
Define:
extra-peritonial space
space within abdomen outside of the parietal peritoneum
Define:
visceral pain
“dull” or “achy” abdominal pain originating from visceral peritoneum
(from each organ)
Define:
colic pain
intermittent abdominal pain
Fill in the blank:
Colic pain may result from [BLANK] and/or [BLANK].
Colic pain may result from distention and/or contraction of hollow organs.
Fill in the blank:
Persistent/constant abdominal pain often originates from [BLANK].
Persistent/constant abdominal pain often originates from solid organs.
Define:
parietal pain
sharp abdominal pain that is severe, constant, and localized to a specific area
Define:
referred pain
perception of pain in skin/muscles at distant locations
Define:
tearing pain
pain originating from aorta through separation of layers of blood vessel caused by AAA
(AAA is abdominal aortic aneurysm)
Define:
appendicitis
infection of appendix
(typically indicates appendectomy)
Describe:
primary sign/symptom of appendicitis
persistent RLQ pain
Describe:
primary sign/symptom of rupture of appendix
sudden relief… followed by sudden and severe increase in RLQ pain
Define:
peritonitis
irritation of peritoneum
Fill in the blank:
Peritonitis is usually caused by [BLANK].
(what triggers infection)
Peritonitis is usually caused by foreign material in peritoneal space.
(like blood and bacteria and fungi and stuff)
Fill in the blank:
Parietal peritoneum is sensitive, especially to [BLANK].
Parietal peritoneum is sensitive, especially to acidic substances.
Fill in the blank:
Peritonitis causes [BLANK].
(body reaction)
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.
Describe:
primary sign/symptom of peritonitis
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.
Define:
PD
peritoneal dialysis
Define:
cholecystitis
inflammation of gallbladder
Fill in the blank:
Cholecystitis is typically caused by [BLANK].
Cholecystitis is typically caused by the blockadge of gallbladder outlet by gallstones.
Fill in the blank:
The symptoms of cholecystitis are often worsened by [BLANK].
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
List:
signs/symptoms of cholecystitis
2 points
- sharp RUQ or epigastric pain
- pain often referred to shoulder
Define:
pancreatitis
inflammation of pancreas
Fill in the blank:
Pancreatitis is common in patients with [BLANK].
Pancreatitis is common in patients with chronic alcohol abuse.
Describe:
primary sign/symptom of pancreatitis
epigastric pain
often referred to back or shoulder
Define:
gastrointestinal (GI) bleeding
hemorrhage within lumen of GI tract
True or false:
GI bleeding can be described as “minor” to “severe”.
true
Answer:
What happens to the blood from a patient with GI bleeding?
eventually exits out mouth or rectum
True or false:
GI bleeding is often painless.
true
True or false:
GI bleeding is often very painful.
false
Fill in the blank:
Gastric ulcers can cause severe pain and [BLANK].
(condition)
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)
Define:
gastric ulcers
holes in GI system from highly acidic gastric juices
List:
signs/symptoms of GI bleeding
4 points
- dark/tarry stool (maroon-black)
- frank blood from rectum (hemorrhoid)
- vomiting “coffee ground” appearing blood or frank blood
- absent-to-severe pain
Define:
AAA
abdominal aortic aneurysm
Define:
abdominal aortic aneurysm (AAA)
weakness of inner wall of aorta
(tears and separates from outer layers)
Define:
hernia
hole in abdominal wall that allows tissues or parts of organs (commonly intestines) to protrude under skin
Fill in the blank:
A hernia may be precipitated by [BLANK].
(action right before)
A hernia may be precipitated by heavy lifting.
Fill in the blank:
A hernia may cause [BLANK] or [BLANK].
A hernia may cause strangulation of tissue or bowel obstruction.
Fill in the blank:
A hernia may require [BLANK].
(treatment you can’t give)
A hernia may require surgical repair.
Define:
renal colic
severe pain caused by kidney stones travelling down ureter
True or false:
An associated symptom of renal colic may be nausea/vomiting.
true
List:
potential GI symptoms caused by myocardial infarction
2 points
- nausea/vomiting
- epigastric pain
indigestion also possible
List:
OB/GYN conditions that may cause GI symptoms
5 points
- ectopic pregnancy
- ovarian cysts
- pregnancy
- menstrual cramps/pain
- pelvic inflammatory disease (PID)
Define:
frank blood
blood not mixed with anything else
(like sputum or mucus or other stuff)
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
B
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.
A
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
D
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
A
abdominal muscle spasms can be caused by peritonitis — not a cause of peritonitis
True or false:
Parietal pain is usually intermittent in nature.
false
parietal pain is sharp, severe, and constant
True or false:
Parietal pain is generally localized to a particular area.
true
localized to the abdomen
True or false:
Parietal pain is often described as “crampy” or “colicky.”
false
parietal pain is sharp and constant
visceral pain or colic pain is dull or intermittent
True or false:
Parietal pain arises from solid organs.
false
parietal pain arises from organs in the parietal peritoneum
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
D
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
D
Choose:
Which of the following categories does GI bleeding from diverticulosis belong to?
A. Anatomic.
B. Vascular.
C. Inflammatory.
D. Neoplastic.
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.
Define:
hematemisis
vomiting blood
