ACUTE ABDOMINAL EMERGENCIES

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ACUTE ABDOMINAL EMERGENCIES
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• Abdominal Anatomy and Physiology
• Abdominal pain and distress
• Abdominal conditions

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• Function of organs
• Digestion
• Stomach
• Small intestine
• Large intestine (colon)
• Liver
• Gallbladder
• Pancreas

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• Digestion
• Stomach Hollow organ expands as it fills with
  food
• Small intestine Hollow organ where food
  absorption takes place Divided into 3 parts
  Duodenum, jejunum, ileum
• Large Intestine hollow organ removes water from
  waste products

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• Liver
• Bile secretion for breakdown of fats
• Gallbladder
• Stores bile before release into the intestine
• Pancreas
• Releases enzymes that breakdown food into
  absorbable molecules. Takes place in the small
  intestine

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• Reproductive
• Endocrine
• Produces hormones ie insulin
• Regulatory

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• Peritoneum
• forms the lining of the abdominal cavity or the
  coelom it covers most of the intra-abdominal
  (or coelomic) organs. It is composed of a layer
  of mesothelium supported by a thin layer of
  connective tissue. The peritoneum both supports
  the abdominal organs and serves as a conduit for
  their blood and lymph vessels and nerves.

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• The outer layer, called the parietal peritoneum,
  is attached to the abdominal wall.
• The inner layer, the visceral peritoneum, is
  wrapped around the internal organs that are
  located inside the intraperitoneal cavity.
• The potential space between these two layers is
  the peritoneal cavity it is filled with a small
  amount (about 50 ml) of slippery serous fluid
  that allows the two layers to slide freely over
  each other.

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• Retroperitoneal Space

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• Abdominal Pain and Distress

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• Abdominal Quadrants

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• RUQ
• Liver
• Gall Bladder
• Duodenum
• Pancreas
• Colon

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• Gall Stones
• Hepatitis
• Liver Disease
• Pancreatitis
• Appendicitis
• Peforated Ulcer
• AMI
• Pneumonia

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• Left Upper Quadrant
• Stomach
• Spleen
• Left lobe of Liver
• Body of Pancreas
• Left Kidney
• Colon
• Parts of Transverse and Descending Colon

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• Gastritis
• Pancreatitis
• AMI
• Pneumonia

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• Gastritis Inflamation of the lining of the
  stomach
• Common causes
• Excessive alcohol consumption
• Prolonged use of NSAIDS such as Ibuprofen and ASA

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• Right Lower Quadrant
• Cecum
• a pouch, connecting the ileum with the ascending
  colon of the large instestine.
• Appendix
• Right ovary and Fallopian tube
• Right ureter

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• Appendicitis
• Ruptured ectopic pregnancy
• Pregnancy
• Enteritis
• PID
• Ovarian cyst
• Kidney stones
• Abdominal abscess
• Strangulated hernia

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• Enteritis
• Enteritis is an inflammation of the small
  intestine caused by a bacterial or viral
  infection. The inflammation frequently also
  involves the stomach (gastritis) and large
  intestine (colitis).

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• LLQ
• Part of descending colon
• Sigmoid colon
• Left ovary and Fallopian tube

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• Ruptured ectopic pregnancy
• Ovarian cyst
• PID
• Kidney stones
• Diverticulitis
• Enteritis
• Abdominal abscess

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• Midline
• Bladder infection
• Aortic aneurysm
• Uterine disease
• Intestinal disease
• Early appendicitis

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• Diffuse Pain
• The word "diffuse" means "widespread" and refers
  to pain that is more or less all over, or at
  least in many areas.

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• Pancreatitis
• Peritonitis
• Appendicitis
• Gastroenteristis
• Disecting/rupturing aortic aneurysm
• Diabetes
• Ischemic bowel
• Sickle cell crisis

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• Visceral Pain
• Dull and persistent
• Usually originating from solid organs
• Intermittent, crampy, or colicky
• Pain comes from hollow organs

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• Parietal pain
• Also called peritoneal pain
• May be caused by internally bleeding
• May be sharp and localized
• May worsen when patient moves

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• Tearing pain
• AAA
• tearing pain in the back
• Referred pain
• Felt somewhere other than where it originates
• MI-indigestion

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• Assessment and Care
• Scene Size-up
• Protect yourself from vomit
• Odors
• Shock
• MOI

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• Initial Assessment
• LOC
• ABCs
• Signs of shock
• AMS
• Anxiety
• Pale
• Cool, moist skin
• Rapid pulse and respirations
• Position of patient
• O2

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• S A M P L E
• O P Q R S T
• Time How long have you had the pain
• Has it changed over time

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• Female patients
• Where are you in your menstrual cycle?
• Period late?
• Vaginal bleeding?
• If menstruating, is flow normal?
• PMHx

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• Is pregnancy possible?
• Ectopic pregnancy is a priority pt., rapid
  transport.

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• Geriatric
• Decreased ability to perceive pain
• Medications for HTN or heart conditions that
  would prevent increased pulse when in shock

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• Beta Blockers
• Stimulation of ß1 receptors by epinephrine
  induces a positive chronotropic(changes heart
  rate) and intropic(force of muscular
  contractions) effect on the heart and increases
  cardiac conduction velocity and automaticity.
• Beta Blockers
• Atenolol
• Metoprolol

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• Physical Exam of the Abdomen
• Inspect
• Distension
• Bloating
• Discoloration
• Protrusions

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• Palpate
• Localize pain prior to palpating
• palpate that area last
• Observe for guarding
• Carefully palpate a mass ONCE
• VS
• Serial vs

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• Care
• ABCs
• O2
• Transport decision
• Position of comfort
• Ongoing assessment q 5 min.
• Alert for vomiting suction
• Calm
• Nothing by mouth
• AMS or unresponsive left lateral recumbent
• Elevate legs for shock

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• Appendicitis
• Nausea and sometimes vomiting
• Persistent pain RLQ
• Gallstones
• Sudden epigastric/RUQ pain
• May rotate to shoulder or back
• May worsen by eating food high in fat

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• Pancreatitis
• Pain may radiate to back and shoulders
• Can be present with signs of shock
• Internal bleeding
• Digestive tract coffee ground emesis
• Rectal black, tarry stools
• Paritoneal cavity abd pain and tenderness

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• AAA
• Sharp, tearing pain radiating to the back
• Shock
• Difference between femoral and pedal pulses
• Hernia
• Painful protrusion
• Kidney stones
• Severe flank pain radiating to anterior groin
• Nausea and vomiting