ACUTE ABDOMINAL EMERGENCIES

Abdominal Anatomy and Physiology Abdominal pain and distress Abdominal conditions

Function of organs Digestion 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 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

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

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

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. 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 pulses Hernia Painful protrusion Kidney stones Severe flank pain radiating to anterior groin Nausea and vomiting