Acute Abdomen

1
Acute Abdomen

• Temple College
• EMS Professions

2
Acute Abdomen

• General name for presence of signs, symptoms of
  inflammation of peritoneum (abdominal lining)

3
Acute Abdomen

• Determining exact cause irrelevant in
  pre-hospital care
• Important factor is recognizing acute abdomen is
  present

4
History

• Where do you hurt?
• Know locations of major organs
• But realize abdominal pain locations do not
  correlate well with source

5
History

• What does pain feel like?
• Steady pain - inflammatory process
• Crampy pain - obstructive process

6
History

• Was onset of pain gradual or sudden?
• Sudden perforation, hemorrhage, infarct
• Gradual peritoneal irrigation, hollow organ
  distension

7
History

• Does pain radiate (travel) anywhere?
• Right shoulder, angle of right scapula gall
  bladder
• Around flank to groin kidney, ureter

8
History

• Duration?
• gt 6 hour duration ? surgical significance
• Nausea, vomiting? Bloody? Coffee Grounds?

Any blood in GI tract
Emergency until proven otherwise
9
History

• Change in urinary habits? Urine appearance?
• Change in bowel habits? Appearance of bowel
  movements? Melena?

10
History

• Regardless of underlying cause vomiting or
  diarrhea can be a problem because of associated
  volume loss

11
History

• Females
• Last menstrual period?
• Abnormal bleeding?

In females, abdominal pain Gyn problem
until proven otherwise
12
Physical Exam

• General Appearance
• Lies perfectly still ? inflammation, peritonitis
• Restless, writhing ? obstruction
• Abdominal distension?
• Ecchymosis around umbilicus, flanks?

13
Physical Exam

• Vital signs
• Tachycardia? ? Early shock (more important than
  BP)
• Rapid shallow breathing? peritonitis

Tilt test should be done with non-traumatic
abdominal pain
14
Physical Exam

• Palpate each quadrant
• Work toward area of pain
• Warm hands
• Patient on back, knee bent (if possible)
• Note tenderness, rigidity, involuntary
  guarding,voluntary guarding, masses

15
Physical Exam

• Bowel Sounds
• Listen 1 minute in each quadrant
• Listen before feeling
• Absent bowel sounds ? ileus, peritonitis, shock

Auscultating bowel sounds has no pre-hospital
value in trauma patients
16
Management

• Airway
• High concentration O2
• Anticipate vomiting
• Anticipate hypovolemia
• Nothing by mouth
• No analgesics, sedatives

17
Management

• In adults gt 30, consider possibility of referred
  cardiac pain.
• In females, consider possible gyn problem,
  especially tubal ectopic pregnancy

18
Appendicitis

• Usually due to obstruction with fecalith
• Appendix becomes swollen, inflamed gangrene,
  possible perforation

?
19
Appendicitis

• Pain begins periumbilical moves to RLQ
• Nausea, vomiting, anorexia
• Patient lies on side right hip, knee flexed
• Pain may not localize to RLQ if appendix in odd
  location
• Sudden relief of pain possible perforation

20
Duodenal Ulcer Disease

• Steady, well-localized epigastric pain
• Burning, gnawing, aching
• Increased by coffee, stress, spicy food, smoking
• Decreased by alkaline food, antacids

21
Duodenal Ulcer Disease

• May cause massive GI bleed
• Perforation intense, steady pain, pt lies
  still, rigid abdomen

22
Kidney Stone

• Mineral deposits form in kidney, move to ureter
• Often associated with history of recent UTI
• Severe flank pain radiates to groin, scrotum
• Nausea, vomiting, hematuria
• Extreme restlessness

?
23
Abdominal Aortic Aneurysm

• Localized weakness of blood vessel wall with
  dilation (like bubble on tire)
• Pulsating mass in abdomen
• Can cause lower back pain
• Rupture shock, exsanguination

?
24
Pancreatitis

• Inflammation of pancreas
• Triggered by ingestion of EtOH large amounts of
  fatty foods
• Nausea, vomiting abdominal tenderness pain
  radiating from upper abdomen straight through to
  back
• Signs, symptoms of hypovolemic shock

25
Cholecystitis

• Inflammation of gall bladder
• Commonly associated with gall stones
• More common in 30 to 50 year old females
• Nausea, vomiting RUQ pain, tenderness fever
• Attacks triggered by ingestion of fatty foods

26
Bowel Obstruction

• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias, fecal
  impactions, tumors
• Crampy abdominal pain nausea, vomiting (often of
  fecal matter) abdominal distension

27
Esophageal Varices

• Dilated veins in lower part of esophagus
• Common in EtOH abusers, patients with liver
  disease
• Produce massive upper GI bleeds