1. Abdominal Emergencies
Chapter 12
Abdominal Emergencies

2. Lesson Objectives List the abdominal organs by quadrants.
Know how to assess and manage abdominal injuries, including open and closed injuries and hernias.
Know how to assess and manage abdominal illnesses, including pain, appendicitis, nausea and vomiting, diarrhea, constipation, bloody stools, and hemorrhoids.
List the evacuation guidelines for abdominal problems.

3. Anatomy of the Abdomen

4. Abdominal Injuries (1 of 12)
Closed: No break in skin
Open: Penetration of the peritoneal cavity
Both open and closed injuries can cause internal bleeding or leakage of intestinal contents that cause irritation and infection.

5. Abdominal Injuries (2 of 12)
Closed injuries
Organs can be injured by a direct blow.
Solid organ injuries usually result in significant bleeding.
Hollow organ injuries are more likely to cause peritonitis.

6. Abdominal Injuries (3 of 12)
Closed injuries
What to look for:
Mechanism of injury
Bruising or abrasions of the abdominal wall or lower chest
Abdominal pain and tenderness

7. Abdominal Injuries (4 of 12)
Closed injuries
What to look for:
Possible spleen injury: Signs of shock, pain in right upper abdomen
Possible kidney injury: Pain in the flank; blood in urine; signs of shock; enlarged, tight abdomen; increasing pain; fever; nausea and vomiting

8. Abdominal Injuries (5 of 12)
Closed injuries
What to do:
Have victim rest completely, allow only sips of water.
Record observations frequently.
Evacuate if signs of shock or peritonitis appear.

9. Abdominal Injuries (6 of 12)
Open injuries
What to look for:
Protruding bowel or fat
External bleeding from a laceration of the abdominal wall
Signs similar to closed injury

10. Abdominal Injuries (7 of 12)
Open injuries
What to do:
For penetrating injury with medical help close by, leave object in place.
Might be necessary to remove object for evacuation.
Consider shortening a long object.
Treat as for closed injuries.

11. Abdominal Injuries (8 of 12)
Open injuries
What to do:
Protruding bowel that is not torn can be returned to the abdominal cavity if help is far away.
If help is close, cover with a moist cloth.
If bowel has torn, do not return to abdominal cavity.

12. Abdominal Injuries (9 of 12)
Hernia
Loops of intestine protrude through a weak spot in the abdominal wall.
More common in men than in women.
Most common site is the groin.
Rarely require surgery.
Occasionally blood supply to the protruding loop of intestine is cut off requiring emergency medical care.

13. Abdominal Injuries (10 of 12)
Hernia
What to look for: Unstrangulated hernia
Bulging in the groin that is easier to see when the victim is straining and coughing
Swelling, usually soft and painless
Soreness
Burning
Feeling of pressure

14. Abdominal Injuries (11 of 12)
Hernia
What to look for: Strangulated hernia
Hernia that will not reduce
Firm bulge with rapidly increasing pain and tenderness
Pain spreading to the abdomen
Possibly vomiting

15. Abdominal Injuries (12 of 12)
Hernia
What to do:
Attempt to reduce a possible strangulated hernia.
Evacuate if there is increasing pain and you are unable to reduce the hernia.

16. Abdominal Illnesses (1 of 17)
Pain
Often difficult to determine exact cause.
Decision to evacuate hinges on determining course of illness, difficulty in obtaining help, and the number of people in the group.

17. Abdominal Illnesses (2 of 17)
Pain
What to look for:
Signs of shock
SAMPLE history
Location of the pain
Diarrhea and vomiting

18. Abdominal Illnesses (3 of 17)
Pain
What to look for:
Signs of dehydration
Whether others in the party have the same problem
Ingestion of potentially poisonous plants or unpurified water
Diabetes or pregnancy
Painful, rigid, swollen abdomen

19. Abdominal Illnesses (4 of 17)
Pain
What to do:
Perform initial check and assess vital signs
Allow sipping of clear, non-caffeinated fluids.
Provide an antacid.
Apply heat.
Be prepared for vomiting.
Allow victim to assume most comfortable position.

20. Abdominal Illnesses (5 of 17)
Appendicitis
What to look for:
Intermittent pain in midabdomen that moves to the lower right abdomen. Pain increases over 6 to 24 hours, becomes constant.
Tenderness over right lower abdomen.

21. Abdominal Illnesses (6 of 17)
Appendicitis
What to look for (continued):
Intermittent vomiting.
Loss of appetite.
Low-grade fever.
Pain and tenderness throughout abdomen, indicating ruptured appendix.

22. Abdominal Illnesses (7 of 17)
Appendicitis
What to do:
Place victim in most comfortable reclining position.
Let victim sip fluids.
Evacuate.

23. Abdominal Illnesses (8 of 17)
Nausea and vomiting: What to look for
Abdominal pain
Blood or brown, grainy material in vomit
Diarrhea
Chills and fever
Signs of dehydration
Others in group with similar symptoms
Recent head injury
Ingestion of wild plants/mushrooms or unpurified water

24. Abdominal Illnesses (9 of 17)
Nausea and vomiting: What to do:
Provide clear fluids, clear soups, flat soda, juice
If victim can keep fluids down, offer carbohydrates, but no milk products.
Have victim rest.
Evacuate if vomiting persists more than 48 hours.

25. Abdominal Illnesses (10 of 17)
Diarrhea: What to look for
Bloody mucus or pus in stool
Dehydration
Cramping abdominal pain
Lack of bowel control
Fever
Others in group with similar symptoms

26. Abdominal Illnesses (11 of 17)
Diarrhea: What to do
Provide clear fluids and monitor urine output to assess for dehydration.
If victim can keep fluids down, gradually return to normal diet.
Provide pink bismuth, if available.
Provide loperamide HCL or diphenoxylate atropine if diarrhea persists, but not if there is fever or blood and pus in stools.

27. Abdominal Illnesses (12 of 17)
Constipation
What to look for:
Painful, hard bowel movements
Infrequent bowel movements

28. Abdominal Illnesses (13 of 17)
Constipation
What to do:
Eat high-fiber foods.
Maintain adequate fluid intake.
Try to have a bowel movement.
Use stool softeners.
Avoid laxatives, alcohol, and constipation-causing foods.

29. Abdominal Illnesses (14 of 17)
Bloody stools and hemorrhoids
What to look for:
External hemorrhoid: Lump next to anus, bleeding with passage of stool, red blood and clots extruding from the lump or swelling
Internal hemorrhoid: Soft swelling that may protrude from rectum during or after bowel movement; bleeding with passage of stool.

30. Abdominal Illnesses (15 of 17)
Bloody stools and hemorrhoids
What to look for (continued):
Fissure: Painful crack at margin of anus.
Signs of serious bowel bleeding: Painless bowel movements with large quantities of blood; signs of shock.

31. Abdominal Illnesses (16 of 17)
Bloody stools and hemorrhoids
What to do: For minor hemorrhoids and fissures
Adjust diet to soften stool
Warm baths to soothe and cleanse.
Wear cotton underwear or loose clothing.
Apply cold compresses, zinc oxide, or petroleum jelly

32. Abdominal Illnesses (17 of 17)
Bloody stools and hemorrhoids
What to do: For minor hemorrhoids and fissures (cont’d)
Apply hemorrhoid suppositories
If cluster or swelling protrudes from rectum, have victim try to slip the tissue back inside by applying manual pressure.
What to do: For major bleeding
Have victim walk, if possible.
Evacuate.

33. Evacuation Guidelines for Abdominal Problems (1 of 2)
Serious injury
Persistent abdominal pain or pain with high fever
Unable to drink or retain fluids for more than 24 hours
Pregnant with abdominal pain
Painful, rigid, swollen abdomen

34. Evacuation Guidelines for Abdominal Problems (2 of 2)
Pain that increases with cough or movement
Signs and symptoms of appendicitis
Vomiting and diarrhea with severe pain, vomiting with severe headache, or diarrhea with fever and stools containing bloody mucus
Signs of internal bleeding
Signs of severe dehydration or shock