1. ACUTE ABDOMINAL EMERGENCIES

2. Abdominal Anatomy and Physiology
Abdominal pain and distress
Abdominal conditions

4. Function of organs
Digestion
Stomach
Small intestine
Large intestine (colon)
Liver
Gallbladder
Pancreas

5. 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

6. 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

7. Reproductive
Endocrine
Produces hormones ie insulin
Regulatory

8. 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.

9. 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.

10. Retroperitoneal Space

11. Abdominal Pain and Distress

12. Abdominal Quadrants

13. RUQ
Liver
Gall Bladder
Duodenum
Pancreas
Colon

14. Gall Stones
Hepatitis
Liver Disease
Pancreatitis
Appendicitis
Peforated Ulcer
AMI
Pneumonia

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

16. Gastritis
Pancreatitis
AMI
Pneumonia

17. Gastritis: Inflamation of the lining of the stomach
Common causes
Excessive alcohol consumption
Prolonged use of NSAIDS such as Ibuprofen and ASA

18. 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

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

20. 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).

21. LLQ
Part of descending colon
Sigmoid colon
Left ovary and Fallopian tube

22. Ruptured ectopic pregnancy
Ovarian cyst
PID
Kidney stones
Diverticulitis
Enteritis
Abdominal abscess

23. Midline
Bladder infection
Aortic aneurysm
Uterine disease
Intestinal disease
Early appendicitis

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

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

26. Visceral Pain
Dull and persistent
Usually originating from solid organs
Intermittent, crampy, or colicky
Pain comes from hollow organs

27. Parietal pain
Also called peritoneal pain
May be caused by internally bleeding
May be sharp and localized
May worsen when patient moves

28. Tearing pain
AAA
tearing pain in the back
Referred pain
Felt somewhere other than where it originates
MI-indigestion

29. Assessment and Care
Scene Size-up
Protect yourself from vomit
Odors
Shock
MOI

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

31. 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

32. Female patients
Where are you in your menstrual cycle?
Period late?
Vaginal bleeding?
If menstruating, is flow normal?
PMHx

33. Is pregnancy possible?
Ectopic pregnancy is a priority pt., rapid transport.

34. Geriatric
Decreased ability to perceive pain
Medications for HTN or heart conditions that would prevent increased pulse when in shock

35. 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

36. Physical Exam of the Abdomen
Inspect
Distension
Bloating
Discoloration
Protrusions

37. Palpate
Localize pain prior to palpating
palpate that area last
Observe for guarding
Carefully palpate a mass ONCE VS
Serial vs

38. 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

39. 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

40. 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

41. 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