1. Chapter 33 Abdominal Pain

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Anatomy Review  Causes of Abdominal Pain  Assessment  Management  Transport

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Anatomy Review  Abdomen contains several organ systems –Digestive organs Stomach, small intestine, large intestine, liver, gallbladder, pancreas –Genitourinary system Kidneys, ureters, bladder –Hematologic system Spleen and blood vessels

4. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Causes of Abdominal Pain  Gastrointestinal: Peptic ulcer disease –Stomach acids can cause injury to the wall of the stomach and duodenum –If there is blood vessel involvement, serious bleeding can occur –Pain is typically in the middle of the upper abdomen

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6. 6 Causes of Abdominal Pain  Gastrointestinal: Esophageal varices –Distended or ruptured veins running through the esophagus –Results in severe bleeding

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Causes of Abdominal Pain  Gastrointestinal: Gastroenteritis –Viral irritation of the stomach –Vomiting, diarrhea, abdominal pain, and fever –Can lead to dehydration and shock

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Causes of Abdominal Pain  Gastrointestinal: Bowel obstruction –Narrowing or blockage can prevent passage of wastes –Can cause distension, resulting in pain or vomiting

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Causes of Abdominal Pain  Gastrointestinal: Gallbladder disease –Gallstones accumulate and block flow of bile –Results in distension and pain in the gallbladder –Fever, right upper abdominal pain, vomiting, jaundice –Surgical removal is usually necessary

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11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Causes of Abdominal Pain  Gastrointestinal: Appendicitis –Becomes obstructed, which causes distension and possible rupture –Right lower abdominal pain, poor appetite, nausea, fever –Surgical removal is required

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Causes of Abdominal Pain  Gastrointestinal: Diverticulitis –Sacs in the large bowel become obstructed, distended, and inflamed and can perforate –Abdominal pain and red blood in stool

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14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Causes of Abdominal Pain  Gastrointestinal: Pancreatitis –Ducts that secrete enzymes become blocked, resulting in distension and inflammation –Upper abdominal pain, vomiting

15. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Causes of Abdominal Pain  Genitourinary: Renal stones –Particulate matter that crystallizes in urine –Can become lodged in the ureter –Severe flank pain, which can radiate to the groin –Vomiting is also common

16. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Causes of Abdominal Pain  Genitourinary: Pyelonephritis –Infection of the kidneys –High risk of spreading infection into the bloodstream –Pain over one or both flanks, vomiting, high fever

17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Causes of Abdominal Pain  Genitourinary: Ectopic pregnancy –Implantation of fetus outside the uterus –Danger of the fallopian tube rupturing, which may result in extensive bleeding –Lower abdominal pain with or without vaginal bleeding

18. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Causes of Abdominal Pain  Vascular: Abdominal aortic aneurysm –Weakened walls of the arteries may balloon out, leading the wall to leak or rupture –May cause massive bleeding and death if undetected

19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Causes of Abdominal Pain  Extra-abdominal –Pain felt in the abdomen when cause of pain is not in the abdomen –Acute coronary syndrome and pneumonia will present with abdominal pain

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Stop and Review  Name the common diseases that present with abdominal pain.  What is extra-abdominal pain?  What disease processes can cause extra-abdominal pain?

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Assessment  Initial assessment –Treat any life threats first  Focused history –Use OPQRST and SAMPLE  Focused physical examination –Visually inspect and palpate the abdomen

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Assessment  Vital signs –Repeated sets of vital signs are important to note the progression of the patient’s condition

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Management  Abdominal pain has many causes  Assume serious disease process and assess thoroughly  Manage ABCs and transport patient to definitive care

24. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Transport  Initiate as soon as possible  Allow patient to assume a position of comfort during transport  Consider calling ALS  Continue to observe the patient en route through the ongoing assessment

25. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Stop and Review  Why is the patient with abdominal pain treated as a high-priority patient?  What is the focus of the EMT’s assessment of the patient with abdominal pain?