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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

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 AM P LE
OPQRST
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 1 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.
Beta Blockers
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