Nursing the Acute Abdomen Patient

Question 1

Define an acute abdominal emergency.

Answer 1

Any intra-abdominal disease process that leads to an acute onset of clinical signs
E.g. inflammation of organ, leakage of fluid from damaged organ, entrapment of organ

Question 2

What clinical signs can we see in abdominal emergency patients?

Answer 2

Increased RR and effort
Increased HR with thready/poor peripheral pulses
Pale tacky MMs with prolonged CRT (hypovolaemic shock)
Injected MMs with rapid CRT (sepsis)
Hypotension, hypothermia
Collapsed/obtunded
Hypersalivation, nausea
Regurgitation, retching, vomiting
Abdominal pain, distended abdomen
Arrhythmias

Question 3

What are the consequences of a GDV?

Answer 3

Reduced blood flow to GI tract and spleen - necrosis and septic peritonitis
Hypovolaemic shock, CVS effects, respiratory effects, GI effects
Reduced venous blood flow due to compression of vena cava - reduced CO and systemic hypotension

Question 4

Why do GDV patients go into shock?

Answer 4

Hypovolaemic (most common) - decreased circulating volume, decreased venous return, decreased SV and CO
Distributive - vasodilation, leaky vessels and activation of coagulation, decreased venous return, decreased SV and CO (can lead to SIRS/sepsis)
Cardiogenic - heart unable to pump, decreased contractility, decreased CO
Obstructive - physical impediment to blood flow in vessels, decreased venous return, decreased SV and CO

Question 5

How can we initially stabilise a GDV patient?

Answer 5

Administer oxygen therapy
Place IV catheters as big as possible, ideally 2, ideally not hindlegs
Opioid analgesia!
IVFT - shock rate bolus
Blood samples - haem, biochem, blood gas analysis
Consider catecholamines e.g. noradrenaline/dobutamine

Question 6

How can we diagnose GDV?

Answer 6

Abdominal ultrasound
Abdominal X-rays (GD vs GDV)
Thoracic X-rays to check for aspiration pneumonia

Question 7

How can gastric decompression worsen shock?

Answer 7

If done quickly - sudden release of endotoxins and inflammatory markers

Question 8

Describe oro-gastric decompression.

Answer 8

Stomach tube placed down oesophagus
Allow fluid to run out

Question 8

Describe percutaneous decompression.

Answer 8

Removes gas and not fluid
Place catheter/needle through abdominal wall, need to go to theatre quickly after this

Question 8

What equipment do we need for GDV surgery?

Answer 8

Crash trolley
Stomach tubes
Suction unit
IV fluids, warmed for abdo lavage
Monitoring equipment
Large surgical kit and lap swabs
Self-retaining retractors
Elevated trough
Scrubbed assistant and float nurse

Question 9

What anaesthetic considerations should we have for GDV patients?

Answer 9

Hypotension
Hypoxia / hypoxaemia
Metabolic acidosis
Hypothermia
Arrhythmias, commonly VPCs
Regurgitation

Question 10

What should we monitor post-GDV surgery?

Answer 10

HR, RR, MMs and CRT
Hydration status
Bloods and BP
ECG - arrhythmias common
IVFT, analgesia, nutrition
Urine output
Signs of sepsis/SIRS/DIC or aspiration pneumonia