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Technician Course MOD F > MOD F TECH 50 Acute Abdominal Problems > Flashcards

MOD F TECH 50 Acute Abdominal Problems Flashcards

1
Q

Abdominal pain

A

The most common complaint dealt with by accident and emergency departments.

When the term ‘acute abdomen’ is used it is generally referring to the more-serious type of abdomen pain and not just minor benign conditions

Ambulance personnel need to be aware of the organs of the abdomen in order to appreciate the many problems which have to be dealt with

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2
Q

Gastro-Intestinal

A

Component organs

Stomach

Small bowel

Large bowel

Gall bladder

Liver

pancreas

Signs and symptoms

Pain

Nausea

Vomiting

Haematemesis

Diarrhoea

Constipation

Malaena

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3
Q

Urinary

A

Component organs

Kidneys

Ureters

Bladder

Signs and symptoms

Back and side pain

Painful urination

Frequent urination

Haematuria

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4
Q

Female reproductive

A

Component organs

Ovaries

Fallopian tubes

Uterus

Signs and symptoms

Pain

Mentrual irregularities

Vaginal discharge/bleeding

Pain during intercourse

Signs of pregnancy

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5
Q

Male reproductive

A

Component organs

Prostate

Seminal ducts

Signs and symptoms

Changes in urinary stream

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6
Q

Vascular

A

Component organs

Aorta and it’s branches

Inferior vena cava and it’s sources

Signs and symptoms

Pain of a leaking aortic aneurism

Abdominal angina

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7
Q

Abdominal Boundaries

A
  • Diaphragm above
  • Pelvic inlet below
  • Abdominal muscles to the anterior
  • Lower ribs, muscle, iliac bones laterally
  • Lumbar vertebrae and illium to the posterior
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8
Q

Peritoneal Abdomen

A

Peritoneal Abdomen

  • Spleen
  • Liver
  • Stomach
  • Gall bladder

Bowel

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9
Q

Retroperitoneal Abdomen

Organs posterior to the peritoneal lining

A
  • Kidneys
  • Ureters
  • Bladder
  • Reproductive organs
  • Inferior vena cava
  • Abdominal aorta
  • Pancreas
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10
Q

Pelvic Abdomen

A
  • Rectum
  • Ureters
  • Femoral arteries
  • Femoral veins
  • Pelvic skeletal structures
  • Reproductive organs
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11
Q

Causes of abdominal pain

A

The causes of abdominal pain are endless. Ambulance personnel need to recognise and manage the more-serious conditions appropriately

These are identified on the following slides

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12
Q

Internal bleeding

A

Clues in the history may include :

  • Vomiting blood,
  • Materials resembling coffee grounds (haematemesis )
  • Melaena
  • Profuse vaginal bleeding
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13
Q

Diverticulitis

A

Caused by faecal material seeping through the thin walled diverticula, which causes inflammation and possible abscesses

Signs and symptoms

  • Irregular bowel habits
  • Alternating constipation / diarrhoea / fever
  • Pain, mild, getting worse, becoming constant
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14
Q

Abdominal aortic aneurysm

A
  • Weakening and dilation in the artery wall
  • May initially be leaking with no signs
  • Often the skin over the abdomen appears mottled and the legs look paler than the rest of the body

AAA Signs and symptoms may include

  • Localised lower back or abdominal pain radiating to buttocks, sudden onset
  • If blood is leaking into the retro-peritoneum, the patient may want to defecate
  • Pale legs and mottled skin below the aneurysm
  • Episodes of syncope at onset
  • Palpable pulsating mass
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15
Q

Kidney stones

A

Pain occurs as the stones begin to move down the ureter stretching its wall, causing great distress to patient.

The pain can be known as renal colic

Pain is usually in the side radiating to groin and is often associated with nausea and vomiting

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16
Q

Ectopic pregnancy

A

Acute abdo pain in a female of childbearing age, accompanied by signs and symptoms of shock.

An Ectopic pregnancy should be assumed until otherwise proven.

This is a medical emergency!

Occurs in the 5th – 6th week after the last cycle

Rupture may lead to massive bleeding

Signs and symptoms

  • Localised pain, may be confused with appendicitis
  • Intermittent, colicky, visceral pain
  • Fallopian tube either ruptures or aborts the embryo, both cause severe pain
  • Pain may become diffuse thro the abdomen
17
Q

Pelvic inflammatory disease (PID)

A

Common cause of abdominal pain in females but rarely presents as an acute collapse

The severe forms of pelvic infection with the formation of tuboavarian abscess are rare but can present with features of systemic sepsis and abdominal pain

A history of PID predisposes to ectopic pregnancy

18
Q

Appendicitis

A

Is frequently misdiagnosed and up to one third of women of child-bearing age with appendicitis are considered as having pelvic inflammatory disease or UTI

19
Q

Immunosuppressed patients

A

For example, human immunodeficiency virus (HIV) and alcoholics can present atypically

20
Q

History taking - OPQRSTA

A
  • Onset – sudden? gradual?
  • Provokes or palliates - does any thing make it better/ worse?
  • Quality - sharp / stabbing / dull
  • Radiates - where does it go?
  • Severity 1 – 10
  • Timing - when did it start?, constant? Intermittent?, how long between pain?
  • Associated signs and symptoms
21
Q

Associated signs and symptoms

A

•Nausea / vomiting,

–frequency, type

•Bowel habits,

–constipation, diarrhoea

  • Chest pain / dyspnoea
  • Menstrual history
  • Painful urination
22
Q

History taking - S.A.M.P.L.E.

A
  • Signs and symptoms
  • Allergies
  • Medications
  • Past medical history inc. surgery (especially abdominal)
  • Last oral intake
  • Events leading up to illness
23
Q

An alternative acronym used to assist in history taking is SOCRATES; the following slides give examples of signs and symptoms, which point to possible diagnoses for abdominal pain using SOCRATES

A
24
Q

SOCRATES

A
25
Q

SOCRATES
character

A

•Sharp, worsened by movement (peritonitis)

•

•Tearing pain (dissecting aneurysm)

•

•Dull ache (appendicitis, diverticulitis, pyelonephritis)

•

•Similar to previous pain suggests recurrent problems such

as ulcer disease, gallstone colic, diverticulitis, or

mittelschmerz (ovulation pain)

26
Q

SOCRATES
radiates

A
27
Q

SOCRATES
associated symptoms

A
28
Q

SOCRATES
timings

A
29
Q

SOCRATES
exacerbating/relieving factors

A
30
Q

SOCRATES
severity

A
31
Q

Physical assessment

A
  • ABC’s, position, distress
  • Skin, sweating / pallor, restlessness
  • Vital signs, i.e. signs of shock
  • If time critical - load and go, pre alert.
  • Treat on route, including ECG

If not time critical, perform a thorough assessment, including

  • Pain, using pain score to assess
  • Assess temperature
  • Gently palpate all four quadrants for gauging, tenderness, spasm, mass, distension
  • Manage pain agressively
32
Q

Abdominal Assessment

A
  • Can be carried out in under 1 minute
  • Inspect for scars, discolouration, masses, pallor
  • Should be round and symmetrical
  • Symmetrical distension may be from obesity, entangled organs, fluid, gas
  • Asymmetrical distension may be from hernias, tumours, bowel obstruction

Things to look for

  • A flat abdomen is common in athletic adults
  • Convex abdo’s are common in children and unfit adults
  • Umbilicus should be free from swelling, bulges and inflammation
  • Abdominal movement during respiration should be smooth and even
  • Visible pulsations may be normal in thin adults
  • Remember marked pulsating masses may indicate A.A.A.
33
Q

Palpating

A
  • Is useful in detecting fluid, air or solid masses
  • Warm hands, avoid sharp movements, steady even pace
  • Systematic approach either side to side or clockwise, concentrate feeling with fingertips, or the two handed technique may be used
  • Note : rigidity, tenderness, skin temperature

•

  • Observe patients face for signs of discomfort
  • Examine the painful quadrant last to prevent guarding
34
Q

Remember

A

•20-25% of patients with abdo pain will have serious condition.

•

•Both ends of age spectrum require more vigilance.

•

•Elderly patients with internal bleeding have a higher mortality rate

•

•Adopt a high level of suspicion, obtain ECG’s

•

•Suspect AAA’s in anyone over 50 with back pain

Technician Course MOD F (18 decks)

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