1. Acute Abdomen

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. Any blood in GI tract = Emergency until proven otherwise
History
Duration?
> 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. In females, abdominal pain = Gyn problem until proven otherwise
History
Females
Last menstrual period?
Abnormal bleeding?
In females, abdominal pain = Gyn problem until proven otherwise

12. Physical Exam General Appearance Abdominal distension?
Lies perfectly still  inflammation, peritonitis
Restless, writhing  obstruction
Abdominal distension?
Ecchymosis around umbilicus, flanks?

13. Tilt test should be done with non-traumatic abdominal pain
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. Auscultating bowel sounds has no pre-hospital value in trauma patients
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 > 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