WEEK 5 - Abdominal Pain

Question 1

Causes of a do complaints

Answer 1

• nausea and vomiting
• appendicitis
• pancreatitis
• gastroenteritis
• inflammatory bowel disease
• bowel obstructions
• ectopic pregnancy
• kidney stones

Question 2

There are numerous causes of nausea and vomiting and these symptoms may be due to the following:

Answer 2

Acute gastritis - caused by something that irritates the lining of the stomach such as an infection, peptic ulcers, GORD and alcohol and smoking.

Central causes - in which signals from the brain directly cause nausea and vomiting. E.g. headache, inner ear issues (labrynthitis, vertigo), increased ICP (trauma, tumours, infection), pregnancy (hormone changes), and noxious stimulants (certain smells or sounds).

Other illnesses - not due to stomach problems, and include heat-related illness, diabetes, sepsis, eating disorders, cardiac complications, and digestive organ diseases (e.g. pancreatitis, crohn’s disease, renal issues, bowel obstructions).

Medications and medical treatments - many medications may irriate the stomach, and commonly result in nausea and/or vomiting, and include opioids, anti-inflammatory drugs, steroids, and antibiotics. Anti-cancer medications and radiotherapy frequently cause abdominal complaints.

Question 3

Treatment of nausea and vomiting

Answer 3

Ondansetron 4mg

Question 4

What is appendicitis?

Answer 4

Appendicitis is an inflammation of the appendix

Question 5

Symptoms of Appendicitis:

Answer 5

• Pain - Appendicitis pain often occurs in the RLQ of the abdomen. The first sign, however, is typically discomfort near the umbilicus, which then moves to the lower abdomen. The pain may also get worse on movement, coughing and sneezing. Once the pain is in the lower part of the abdomen, it can be very intense and increase in severity quickly.
• Rebound tenderness - occurs when you push on the lower-right part of your abdomen and then pain is felt when releasing the pressure (a classic sign).
• Rovsing’s Sign - If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis. In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac fossa.
• Low-grade fever and chills
• Nausea and vomiting
• Loss of appetite
• Constipation or diarrhoea
• Gas and bloating

Question 6

Treatment of appendicitis

Answer 6

Your treatment may include analgesia (methoxyflurane/morphine/fentanyl) and an antiemetic (maxolon/ondansetron)
+++ ask if they have had their appendix removed

Question 7

What is pancreatitis?

Answer 7

Pancreatitis is inflammation of the pancreas and occurs when pancreatic enzymes (mainly trypsin) that digest food are activated in the pancreas instead of the duodenum.

Question 8

What causes pancreatitis?

Answer 8

• gallstones (most common for acute)
• alcohol (most common for chronic)
• Infectious agents
• some medications may also cause pancreatitis and include corticosteroids, anti-cancer and HIV drugs, cholesterol-lowering statins and anti-hyperglycaemic agents.

Question 9

Signs and symptoms include:

Answer 9

• Severe upper abdominal (LUQ) pain
• Burning abdominal pain radiating to the back
• Nausea and vomiting which worsens with eating
• Fever
• Jaundice
• Swollen abdomen
• Weight-loss (when digestion is hindered)
• Possible indications of internal bleeding

Question 10

Prehospital treatment of pancreatitis

Answer 10

In the prehospital setting it is difficult to create a provisional diagnosis, as with many abdominal complaints, and all patients with suspcted pancreatitis should be transported to hospital with the appropriate symptom management as required.

Question 11

What is gastroenteritis?

Answer 11

a non-specific term for various pathologic states of the gastrointestinal tract, mainly inflammation of the mucous membranes

Question 12

What are the primary manifestations of gastroenteritis?

Answer 12

diarrhoea, but it may be accompanied by nausea, vomiting, and abdominal pain

Question 13

Symptoms of gastroenteritis include:

Answer 13

nausea and vomiting
diarrhoea
bloody stools/faeces (in some cases)
stomach pain/cramps
fever
generally feeling unwell, including lethargy and body aches

Question 14

Prehospital treatment of gastro

Answer 14

In the prehospital setting any patient who experiences both vomiting and diarrhoea is deemed to have gastroenteritis and should be managed as such, including wearing appropriate PPE because it is highly contagious. Depending on the severity of the patient’s condition the paramedic must decide whether the patient is better managed in the comfort of their own home (proximity to toilet), or requires hospitalisation (risk of cross-infection). Patients will routinely receive anti-emetics and fluid therapy.

Question 15

IBD interferes with a person’s normal body functions and signs and symptoms can include:

Answer 15

• pain in the abdomen
• weight loss
• diarrhoea (sometimes with blood and mucus)
• tiredness
• constipation
• malnutrition
• nausea
• delayed or impaired growth in children.

Question 16

What is a bowel obstruction?

Answer 16

A bowel obstruction is the significant mechanical impairment or complete arrest of the passage of contents through the intestine.

Question 17

signs and symptoms of a bowel obstruction are:

Answer 17

abdominal pain
abdominal distension
nausea and vomiting (faecal vomit)
constipation
inability to pass wind
decreased or no bowel sounds on auscultation

Question 18

Prehospital management

Answer 18

Paramedics in the prehospital setting need to obtain an appropriate history and perform a thorough assessment to determine any chances/risks of bowel disease or obstruction. Patients’ symptoms should be managed, but with extreme caution when considering analgesia and anti-emetics due to the affect they have on the GIT. Again, all patients should be transported for further assessment.

Question 19

What is an ectopic pregnancy?

Answer 19

is a condition in which a fertilised egg settles and grows in any location other than the inner lining of the uterus.

Question 20

What is the major health risk associated with ectopic pregnancy?

Answer 20

Rupture leading to internal bleeding

Question 21

Risk factors for an ectopic include:

Answer 21

Prior history of an EP (greatest risk factor)
Disruption to anatomy of fallopian tubes (surgery leading to scarring)
Endometriosis, pelvic infections (narrowing of the fallopian tubes or damage to cilia disrupting egg transportation)
Multiple sexual partners (increases risk of pelvic infections)
Cigarette smoking
Use of intrauterine devices (IUDs)

Question 22

The classic signs and symptoms of ectopic pregnancy are the triad of:

Answer 22

abdominal pain,
the absence of menstrual periods (amenorrhea), and
vaginal bleeding or intermittent bleeding (spotting).

Question 23

Prehospital treatment of an ectopic pregnancy

Answer 23

Paramedics should transport all potential cases of an ectopic pregnancy (bearing in mind the patient may not believe she is pregnant) and treat associated symptoms as they arise. Reassessment should occur to detect any signs of hypovolaemia and shock, with IV fluid and rapid transport instigated in this situation.

Question 24

What are kidney stones?

Answer 24

The kidneys filter blood and remove waste and fluid as urine. Occasionally these wastes can form crystals that clump together to make small stones

Question 25

There are four main types of kidney stones:

Answer 25

Stones formed from calcium combined with oxalate or phosphate (calcium oxalate most common type)
Struvite stones (from excess magnesium and often horn-shaped and quite large)
Uric acid stones (often softer than other forms)
Cystine stones (rare and hereditary and appear as crystals)

Question 26

The signs and symptoms of kidney stones are:

Answer 26

Severe ‘gripping’ pain in the back below the ribs (renal colic)
Severe pain in flanks and groin (likened to intensity of child birth)
Haematuria
Nausea and vomiting
Shivers, sweating and fever
Cloudy pungent urine (if associated infection)
‘Gravel’ in the urine, which is made of small uric acid stones
Urgency to urinate

Question 27

Prehospital treatment of kidney stones

Answer 27

In the prehospital setting paramedics will often be confronted by the challenge of managing a patient’s pain with this condition, and need to perform a thorough assessment to be able to come up with a provisional diagnosis. At times it may be completely obvious, but with mixed symptoms it will be more difficult!

Question 28

When focusing your questioning on abdominal complaints, consider asking the following:

Answer 28

when did you last eat or drink?
do you feel nauseous?
have you vomited?
have you opened your bowels? Consistency?
are you passing urine normally? no pain/strange smells or blood?
are you pregnant/sexually active?