ACUTE ABDOMINAL EMERGENCIES

• Abdominal Anatomy and Physiology

• Abdominal pain and distress

• Abdominal conditions

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

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

• LiverBile secretion for breakdown of fats

• GallbladderStores bile before release into the intestine

• PancreasReleases enzymes that breakdown food into

absorbable molecules. Takes place in the small intestine

• Reproductive

• Endocrine

Produces hormones ie insulin

• Regulatory

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.

• 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.

Retroperitoneal Space

Abdominal Pain and Distress

Abdominal Quadrants

RUQ

• Liver

• Gall Bladder

• Duodenum

• Pancreas

• Colon

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

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

• Gastritis

• Pancreatitis

• AMI

• Pneumonia

• Gastritis: Inflamation of the lining of the stomach

• Common causes

Excessive alcohol consumption

Prolonged use of NSAIDS such as Ibuprofen and ASA

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

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

• 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).

LLQ

• Part of descending colon

• Sigmoid colon

• Left ovary and Fallopian tube

• Ruptured ectopic pregnancy

• Ovarian cyst

• PID

• Kidney stones

• Diverticulitis

• Enteritis

• Abdominal abscess

Midline

• Bladder infection

• Aortic aneurysm

• Uterine disease

• Intestinal disease

• Early appendicitis

• Diffuse Pain

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

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

Visceral Pain

• Dull and persistent

Usually originating from solid organs

• Intermittent, crampy, or colicky

Pain comes from hollow organs

Parietal pain

• Also called peritoneal pain

• May be caused by internally bleeding

• May be sharp and localized

• May worsen when patient moves

Tearing pain

• AAA

tearing pain in the back

Referred pain

• Felt somewhere other than where it originates

• MI-indigestion

Assessment and Care

• Scene Size-up

Protect yourself from vomit

Odors

Shock

MOI

• Initial AssessmentLOCABCsSigns of shock

AMSAnxietyPaleCool, moist skinRapid pulse and respirations

Position of patientO2

• 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

Female patients

• Where are you in your menstrual cycle?

• Period late?

• Vaginal bleeding?

• If menstruating, is flow normal?

• PMHx

• Is pregnancy possible?

Ectopic pregnancy is a priority pt., rapid transport.

Geriatric

• Decreased ability to perceive pain

• Medications for HTN or heart conditions that would prevent increased pulse when in shock

• Beta Blockers

Stimulation of β1 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

Physical Exam of the Abdomen

• Inspect

Distension

Bloating

Discoloration

Protrusions

Palpate

• Localize pain prior to palpating

palpate that area last

• Observe for guarding

• Carefully palpate a mass ONCE

VS

Serial vs

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

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

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

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