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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Kathy Haase Group 60
Abdominal Anatomy and Physiology
I.
Acute Abdomen-Abdominal A & P
Cognitive Objectives:
1)
2)
Discuss the structures and their functions involved in the process of digestion
Discuss abdominal structures and their functions involved in processes other than digestion
3)
Discuss abdominal accessory structures and their functions in relation to abdominal organs
4)
Discuss abdominal structures placement within the human body, and significance of placement
5)
Review of history taking in the patient who c/o abdominal pain
6)
Review OPQRST assessment in the patient who c/o abdominal pain
Affective objective:
1)
The student will offer support to the patient with c/o abdominal discomfort
Psychomotor Objective:
1)
For every patient with abdominal concerns, the student will become proficient in history taking skills
Required Reading: Mosby Text: pages 196-205, 321
Recommended websites:
www.endoatlas.com
www.gastrointestinalatlas.com
www.anatomyexpert.com/structure
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Abdominal A & P
Approximately 10 liter of food, fluids and secretions enter the GI tract each day, yet only 1 liter reaches the
large intestine, where does the rest go??
A. Primary organs of Digestion:
Structure:
The alimentary canal is a hollow tube for digestion that
Begins at the mouth and ends at the anus.
The total length of the structure of the digestive tract is approximately 25 feet
Function of the digestive system:
Ingest
Propel
Secrete
Digest
Mechanical
Chemical
Absorb- Produces body water
Excrete- Eliminates waste
** motility of GI tract is regulated by hormones and ANS**
1. Mouth-Oral Cavity: Primary Function:
Moistens food
Begins food breakdown
Jaw:
Mechanics
Teeth:
( 32 permanent in the adult)
Cut
Chops and grinds the food-mastication
Saliva:
(3 pairs of salivary glands)
Body produces about 1liter/day of saliva
Taste- and smells- initiates salivation
Stimulates ANS system- Feed/ Breed, Rest/Digest
Stimulated by parasympathetic cholinergic fibers and also sympathetic beta adrenergic
fibers-no hormone involvement here.
Moistens the food
Secretes enzymes that begin to break down food
Saliva contains mucous, H2O, Na, HCO3, Cl-, K+, salivary amylase
Constant washing of the mouth helps to prevent bacterial infection
pH of 7.4- neutralizes bacterial acids
Also contains Immunoglobulin A- infection prevention
The food that is now chopped and moistened is called a bolus
Tongue: Contains 1000’s of chemo receptors- taste buds
Taste and odors can initiate salivation
The tongue pushes the food bolus into the pharynx-Swallowing-voluntary
Swallowing complex in RAS and other brain regions
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Pharnyx:
Pharyngeal muscles contract, the epiglottis covers the trachea,
the upper esophageal spincter opens and the food bolus is propelled through into
the esophagus.
2. Esophagus: 25cm long-Primary Function:
To propel food boluses into the stomach via Peristalsis-involuntary swallowing
Peristalsis is stimulated by change in esophageal wall tension
The lower esophageal sphincter (cardiac sphincter) relaxes and food bolus
enters the stomach
The esophagus is frequently in contact with rough and abrasive
foodstuffs
Mucin is secreted within the esophagus
so the food bolus continues to be lubricated as the bolus travels
along the esophagus and enters the stomach through the
lower esophageal sphincter
Also functions to prevent reflux
**Movement in partially controlled by the Vagus nerve
3. Stomach: 10” long- Primary Function: mixes, secretes, stores, propels
The stomach can distend to accommodate 1.5 liters (4l food and
fluids)
The stomach is divided into 3regions:
Fundus,
Body
Pylorus.
The stomach also has a greater curvature and lesser curvature
These regions
Contract and churn the food bolus,
Mixing the bolus with gastric juices, gastric acids and gastric
enzymes. This food mixture is now called Chyme,
Chyme, is semi solid, partially digested food.
The chyme is then propelled through the pyloric sphincter and into
the first part of the small intestine, the duodenum.
Note that the pH of gastric acid is 1.5-2.
Mucin is continuously secreted to protect the stomach lining from
the gastric acids, pepsin, and HCL, and enzymes.
Approximately 2-3 liters of gastric secretions are produced daily.
The stomach also has a very rich vascular supply, to the point that
almost all of the arterial supply would have to be occluded before
ischemic changes occur in the stomach wall.
Only few substances are directly absorbed through the
stomach: alcohol and ASA are 2 of those
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Gastric Emptying: dependent upon volume, osmotic pressure and chemical composition of gastric
contents, and also the duodenums ability to neutralize incoming contents.
4. Small Intestine: (20 ft)
Primary Function: secrete its own digestive juices that continue
the breakdown of foods
Begins the process of the absorption of nutrients.
Hangs freely in the abdomen on mesentery
Three Portions of the small intestine:
a)
Duodenum-10”
As food enters the duodenum, it stimulates the release of
digestive pancreatic juices.
Fat will stimulates the release of bile from the gall
bladder, which is where bile is stored after being produced
by the liver.
The duodenum secrets mucous, water and
electrolytes, which work to lubricate the intestinal
wall and increase the pH
Moves into Jejunum at Treitz ligament
b)
Jejunum-8ft
Mixing of the food diminishes
Absorption of nutrients begins
suspensory Ligament of Treitz
c)
Ileum- 12ft
Further continuation of absorption of nutrients
Ileocecal valve from ileum nito large intestine, prevents
reflux
5. Large Intestine: 4-5 feet in length
Primary Function: To absorb water, electrolytes and digestive
juices. Secrete mucin
Bacteria begin to work on chyme to produce feces, releasing
vitamins and more nutrients.
Synthesiszes Viit K, which is then absorbed into bleed
There are Six Portions of the Large Intestine:
1. Cecum & Appendix,Ascending
Chyme from the ileum empties into a pouch –cecum, then travels up the
Ascending colon
When cecum is distended-sphincter closes and decreases movement
from small intestine
2. Transverse
3. Descending
4. Sigmoid- forms stool
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
5. Rectum-stores stool-distention produces defecation reflex
6. Anal Canal-increase in abdominal cavity during defecation
6.
The linings of the alimentary canal
From innermost to outermost:
Mucosa- exocrine cells and smooth muscle
Submucosa-connective tissue
Muscularis-both longitudinal and circular smooth muscle
Serosa-connective tissue (adventitia)
Vary in thickness with nerves and vessels running through
Within the mucosa and submucsa of the small intestine are:
Folds
Villi
Microvilli
7.
Bacterial flora
Increases in number from stomach to distal colon
Not present at birth
B. Assessory Organs of Digestion:
1. Gallbladder: Hollow Organ.
Primary Function: concentrates and stores bile secreted by the liver.
When chyme containing fat enters the duodenum, the gallbladder is
stimulated to contract, and releases bile through the common bile duct
into the duodenum. Bile emulsifies fats.
2. Pancreas: Is a solid encapsulated retroperitoneal organ
Primary Function: The pancreas has both endocrine and exocrine glands.
It secretes the hormones, insulin and glucagon, which are responsible
for regulation of blood glucose levels.
The digestive juices and enzymes released from the pancreas are
responsible for neutralizing the acids in chyme and to continue digestion.
Amylase is the major enzyme released by the pancreas.
The pancreatic juices are released to the duodenum through the common
bile duct.
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
3. Liver:
A solid encapsulated organ, and the largest organ in the body.
The liver is divided into right and left lobes.
The right lobe is larger than the left lobe
The right lobe is divided into 3 portions.
The liver is extremely vascular.
The liver receives about 25% of the cardiac output and holds the
greatest blood reserve of any body organ.
The liver receives blood from the hepatic artery and the portal vein.
The portal vein provides about 1200mls of blood /minute-rich in nutrients
Hepatic artery delivers 500mls/minute of oxygenated blood
The round ligament in liver isleft over from ductus venosus
Functions: Many!!!
a)
Detoxification of drugs and other matters in the circulating plasma,
a line of defense against toxic by products of metabolism
b)
Stores Blood Clotting Factors
Removes damaged or aged RBCs,
Produces plasma proteins, which assist in the osmotic regulation of fluid
in the blood
c)
Stores and releases glycogen and other agents that assist in metabolizing
fats, carbohydrates & proteins.
a. Assists in Iron metabolism
b. Secretes about 600-1200ccs of bile per day
c. Maintains normal blood glucose concentrations
d)
Assists in Immune Responses-produces antibodies
e)
Stores fat soluble vitamins: A D E K
f)
Because of it many functions, the liver demands a large blood supply
1)
The hepatic artery
Branches off of the abdominal aorta
2)
The portal vein
Receives venous blood from the superior and inferior
mesenteric veins
Receives blood from the splenic vein
3)
Can store and release blood to maintain systemic volume
Points to Ponder:
How is the digestion process different in the aging person? The pregnant person? The young child?
Meds affecting the GI tract are many: acid production, protection from acid, flatulent, nausea, anti
diarrheal, anti constipation, absorption- Can you name some?
If the liver is damaged how will that affect drug detoxification and other liver functions?
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
C.
Abdominal Organs with functions other than digestion:
1. Spleen: A very vascular solid organ, but fragile.
Is part of the Lymphatic System.
Blood from the splenic artery branches from the descending aorta
Primary Functions: a lymphoid organ ( link hematologic and immune systems)
a)
Blood Reservoir
In times of stress vessels are stimulated to vasoconstric and
release stored blood into circulation
b)
Phagocytes filter foreign particles & bacteria from blood
c)
Lymphoctes that mount an immune respons to to blood born microorganisms
2. Urinary System
Kidneys: Retroperitoneal solid organs.
The right kidney is lower than the left kidney due to the liver on the
right side.
Each Kidney is encapsulated and embedded in fat
The kidney is divided into an outer cortex and inner medulla.
The cortex contain glomeruli and portions of tubules
The medulla contain renal pyramids: proximal and distal tubules and
collecting ducts
The primary functional unit of the kidney is the nephron
Approx 1.2 nephrons per kidney, a tubular structure with subunits that
form urine
Renal arteries arise from a branch of the aorta,
receive about 25% of CO every minute.- 1200mls
Functions of the kidneys: Many!!
a. Forms urine.
b. Maintains the proper volume of blood, water and electrolytes,
by filtration and reabsorption.
c. Controls arterial blood pressure
d. Detoxifies
Ureters: Retroperitoneal hollow ducts that drains urine from the kidney to the
bladder.
The length of the ureter is approximately 25cm.
A thin muscular wall lining the ureter limits the ability of the ureter to
distend.
Bladder: Is a retroperitoneal hollow organ.
The size of the bladder is dependent on the volume of urine
Primary Function: Store Urine
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Urethra: A hollow duct
Carries urine from the bladder to the exterior of the body.
Shorter in women than in men.
Urine regulation is dependant upon, hormonal, autoregulation and SNS innervations
3. Male Reproduction:
Testes:
Male gonads. Produces sperm
Epidydemis:
Coiled tube; lies on & behind testes. Sperm matures here
Vas Deferens: (ductus deferens)
Allows sperm to exit epidydemis thru ejaculatory tract
Seminal Vesicle:
Produce about 60% of seminal fluid
Prostate:
Just below the bladder. Secretion is part of seminal fluid-30%
Urethra:
Drains urine from bladder. Also Path for semen
Penis:
External reproductive organ of the male
Scrotum:
Sac of skin that contains testes
4. Female Reproduction:
Ovaries:
Female gonads bilaterally in lower abdomen
Fallopian Tubes:
Carries eggs from ovaries to uterus.
Uterus:
Hollow female organ for reproduction
Cervix:
Lower part of uterus
Vagina:
Forms a canal to cervix
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
D. Accessories Vital to Abdominal Organs:
1. Peritoneum: serous membranes
Parietal Peritoneum: Lines the surface of the abdominal cavity
Parietal pain
Intense
Localized
More nociceptors
Visceral Peritoneum: Lines surface of abdominal organs
Visceral pain
Dull
Difficult to localize
Low number of nociceptors!
2. Mesentery:
Connective tissue that holds parietal organs in place
Suspends the bowel from the posterior surface of the abdominal wall.
The mesentery fans out from the main membrane to hold the small
intestine.
A double fold of the peritoneum that contains blood and lymph vessels,
nerves and fatty tissues.
Provides the bowel with circulation, innervations and as a source of
attachment.
3. Omentum:
An additional fold of mesentery, which covers, insulates and protects the
abdominal wall.
The size of the omentum varies with the percentage of body fat of
the individual.
4. Vasculature:
5. Nerve innervations:
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
E. Abdominal Landmarks:
1. Which Organ Lay Where?
RUQ:
1)
2)
3)
4)
5)
Liver
Gallbladder
Head of the pancreas
Hepatic flexure of the colon
Part of the ascending and transverse colon
1)
2)
3)
4)
5)
Cecum
Appendix
Right ureter
Right ovary and fallopian tube
Right spermatic cord
1)
2)
3)
4)
5)
6)
Left lobe of the liver
Stomach
Spleen
Body and tail of the pancreas
Splenic flexure of the colon
Part of the Transverse and descending colon
1)
2)
3)
4)
5)
Part of the descending colon
Sigmoid colon
Left ureter
Left ovary and fallopian tube
Left spermatic cord
1)
2)
3)
Abdominal aorta
Uterus if enlarged
Bladder if distended
RLQ:
LUQ:
LLQ:
Midline:
2)
Abdominal Cavities
Abdominal
Pelvic
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
3)
Abdominal Spaces
Peritoneal
The space between visceral and parietal peritoneums
Contains the majority of abdominal organs
This space is open in women where the distal ends of the fallopian
tubes enter the peritoneal cavity
Retroperitoneal:
Kidneys
Ureters
Part of pancreas
Duodenum
IVC
Abdominal Aorta
Significance of retroperitoneal organs
4)
Regions of the Abdomen:
Epigastric
Periumbilical
Hypogastric
Abdominal History:
Open ended questions such as:
Abdominal Assessment:
dml revised/2012
11
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Acute Abdomen- Part II
Infectious and inflammatory conditions that cause abdominal discomfort
Cognitive Objectives:
1)
2)
Discuss infectious and inflammatory processes in the structures involved in the process of
digestion
Discuss signs and symptoms of infectious and inflammatory processes in the abdominal structures
involved in the process of digestion
3)
Discuss infectious and inflammatory processes in the abdominal structures involved in processes
other than digestion
4)
Discuss signs and symptoms of infectious and inflammatory processes in the abdominal structures
involved in processes other than digestion
5)
Review of SAMPLE history taking in the patient who c/o abdominal pain
6)
Review OPQRST assessment in the patient who c/o abdominal pain
Affective objective:
1)
The student will offer support to the patient with c/o abdominal discomfort
Psychomotor Objective:
1)
For every patient with abdominal concerns, the student will be proficient in history taking skills
Required Reading: Mosby Text: pages 887-904, 321
dml revised/2012
12
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
II. Infectious and inflammatory conditions in structures of digestion
1. Gastric Esophageal Reflux Disease (GERD)
Inflammation in the distal portion of the esophagus that
occurs from regurgitation of gastric acids through the esophageal sphincter.
pHof the distal end of esophagus is 6-7
repeated exposure to gastric secretions can lead to esophageal erosion
disease is graded according to the extent abd number of leasions
Causes:
Inappropriate relaxation of the Lower Esophageal Sphincter (LES)-NG tubes
Ingestion of large meal
Recumbant position
Certain food s and medications
Conditions that cause delayed gastric emptying, or increase n intra abdominal pressure:
Pregnancy, Obesity
Symptoms:
Epigastric , Substernal burning that increases with swallowing
Pain is worse when lying flat or bending over
Can have weight loss, foul breath, Nausea and emesis
Affects up to 20% of total population
Diagnosis: Based on Sx, endoscopy
Treatment:
Diet, no eating for several hours before going to bed
sleep with the head elevated
Lay on right side
Medications
Antacids
Histamine receptor antagonists
** Proton pump inhibitors**
Inhibit gastric acid secretion
Endoscopic therapies
Surgery
dml revised/2012
13
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
2.
Hiatal Hernia ( diaphragmatic hernia)
Protrusion of the stomach through the esophageal hiatus in the diaphragm
Causes:
Muscle weakening in the esophageal hiatus
Congenital
Trauma
Obesity
surgery
Symtoms=same as those for GERD
Affects predominantly men- up to 20% of total population
Diagnosisi
Same as for GERD
Treatment
Conservative-same as for GERD
Surgical procedures for reinforcement of LES
3. Gastritis
Inflammation of the gastric mucosa
Break in the protective barrier
Scattered or localized
Erosive-stress ulcers
Non erosive- chronic
With progression of the disease
Atrophy of stomach walls
Decrease in acid secreting cells
Decrease in intrinsic factor- necessary for absorption of B12
Persistent inflammation = an increased risk of gastric Ca
Hemorrhage
Possible causes:
Hyperacidity
Bacteria- elicobacter pylori
Penetrates the mucosal layer
Alcohol ingestion
ASA and NSAIDS ingestion
Caffeine
Cyto toxic agents
Radiation
Cortico steroids
Symptoms:
Epigastria pain and tenderness with palpation, nausea and emesis,
Abdominal tenderness
hematemesis
Melena
2.7 million US citizens
dml revised/2012
14
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Diagnosis: Endoscopic
Treatment:
Treat the symptoms
Treat the cause
Diet
Medications
Surgery
4. Acute Gastro Enteritis (AGE)
Acute inflammation of the stomach and intestines with an acute onset of nausea vomiting and
diarrhea.
Causes are many:
Bacterial-travel,ecoli
Viral
Toxins, algae, botulism?
Parasitic
Allergies
Immune disorders
Diagnosis:
Patient history
Stool cultures
Blood work
Treat the cause-antibiotics
Treat the symptoms-dehydration, nausea, diarrhea
5.
Irritable Bowel syndrome
Chronic disorder-spastic contractions of the colon
Causes an impairment of the motor sensory function of GI tract
Sx Diarrhea, constipation, abdominal pain, bloating
Appears in young adulthood
Etiology-unknown
More common in women than men
Dx by history
Tx- diet therapy, drug therapy
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
6. Crohn’s disease
Is inflammation along any part of the GI tract,
The terminal ileum the most common site of inflammation.
The inflammation is transmural leading to extensive bowel wall destruction
Narrowing of the lumen can occur & ulcerations mingled with nodular submucosal thickening,
leading to a cobble stone appearance of the bowel
Strictures and fistulas can occur.
Etiology is unknown. ? bacterial predisposition
? family predisposition
There is thought to be genetic factors and possible infectious or
immunological
causes.
Onset is before the age of 30 with episodes of exacerbation and remission.
Malabsorption leading to nutritional deficits
Symptoms: vary greatly
Diarrhea-fatty stools
Abdominal pain
Fever
Weight loss
Nutritional deficits
Diagnosis: symptoms, history
Treatment: nutrition
Fluid and electrolyte replacement
Surgery
7.
Ulcerative Colitis [UC]
Inflammatory condition that affects the mucosa and submucosal lining of the colon and rectum.
Rectum to cecum
Usually occurs between the ages of 15-30 yo
Episodes can be mild to severe
Flare-ups and remission
Etiology is unknown.
Sx:
Frequent emptying of the colon, with cramping and profuse bloody diarrhea,
15-20x per day
Fatigue, weight loss, anorexia, rectal bleed.
Nutritional status?
dml revised/2012
16
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Dx:
is by history and exam.
Tx:
drug therapy
surgery
8.
Diverticulosis
An out pouching in the wall of the large intestine, most commonly in the sigmoid colon
Usually associated with diets low in fiber.
The out pouchings develop because of high pressure within the sigmoid colon
contractions that move stool into the rectum.
due to the
These outpouchings are thin walled and can allow bacteria in leading to
Diverticulitis.
Is an inflammation in small pockets of the colon
Perforation of the bowel can occur, this is painless, but BRB occurs, and
follows
Sx:
diarrhea, fever, LLQ pain.
Dx:
WBC, xray
Tx
diet and drugs
Surgery for extreme cases
peritonitis usually
9. Appendicitis:
The lumen to the Appendix can become obstructed,
blood supply becomes impaired and bacteria invade.
The appendix can become infected and at time gangrenous. Can then rupture into the
peritoneum and the patient will have peritoneal signs with involuntary
guarding and rebound
tenderness.
Symptoms-can be non specific at first with nausea, anorexia, vomiting, and fever.
Pain starts outs as diffuse peri umbilical discomfort and localizes to
“Mc Burney’s Point”, in the RLQ.
Patient has pain with movement and will walk with his heel off of the floor.
These patients will seek a position of comfort, usually on their side with their knees bent. It is
very uncomfortable for these patients to lie flat on their backs.
Rebound tenderness
Diagnosis: Patient Exam and history, blood work, CT of the abdomen
Treatment: Surgery
dml revised/2012
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
III. Infectious and inflammatory processes in the abdominal structures involved in processes other
than digestion
10. Cholecystitis
Inflammation of the gall bladder, often associated with gall stones.
Affects mostly female at ages 30-50 “fair, fat, fertile and forty”, post partum.
Symptoms:
Sudden onset of pain, gripping and sharp.
Pain is in RUQ, epigastric area and often radiates or goes around into
back, or referred to the right shoulder. Belching, nausea.
Painful episodes are associated with recent ingestion of fried/fatty foods
Diagnosis: Ultrasound
Treatment: eventually surgery to remove gallstone
11. Pancreatitis
Inflammation of the pancreas, often an auto immune disorder, pancreas attacks itself. This
disease is associated with chronic alcohol intake.
Symptoms: Pain is epigastria mild to severe.
Can include nausea, emesis, abdominal distention and abdominal tenderness,
and sign of shock.
Pain can radiate from mid-umbilicus to shoulder and back.
fever
Diagnosis: Blood work, patient exam and history
Treatment: is meds, fluid replacement, stop alcohol intake
12. Hepatitis-[covered in detail in infectious disease lecture]
Type A
Fecal Oral transmission
Type B
Parenterally transmitted
Type C
From a single stranded RNA Virus
Those at risk are patients that receive blood products, IV drug abusers and health care workers.
[HCW]
Type D Delta hepatitis virus
Similar to Hepatitis B
Risks to those receive blood products and IV drug abusers, exposure to infected blood.
Hepatitis E
Enteric and waterborne transmission, similar to Hepatitis A.
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UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
13. Cirrhosis
Scarring of the liver
Caused by toxins, metabolic and genetic diseasaes
Complications: Many!!
Portal hypertension increase in pressure within the portal vein-blood
backing into spleen –splenamegoly,
backing into esophagus- esophageal varices, ( thin wall veins increase in
size due to portal hypertension) these varices can bleed-life threat!!
inablility of the liver to produce albumin for oncotic pressure
ascites – free fluid within the peritoneal cavity
coagulation deficits due liver and spleen damage
jaundice
encephalopathy, due to elevated ammonia levels from the liver not being
able to detoxify byproducts from the intestine
renal failure due to lack of bloodflow
14. Pyelonephritis
Inflammation of the kidney
Cause Bacteria-most common
Sx: LBP, fever/ chills, lethargy, N & V, hematuria
Dx: history, UA
Tx: antibiotics, hospital admission
15. Cystitis
Inflammation of the bladder- common nosocomial infection
Causes:
Bacteria-most common
Viral
Fungi
Parasites
More common in women
Sx: frequency, burning, and urgency of urination, hematuria
Dx: history, UA
Txt: Treat the cause and the symptoms
dml revised/2012
19
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
17.
Female reproductive states due to inflammation/ infection
18.
Male reproductive inflammation/ infection
19.
Sexually Transmitted Diseases
Syphilis
Herpes
Gonorrhea
Chlamydia
Hepatitis
HIV
Trichomonas
Pelvic Inflammatory disease
Infectious process
Spread from lower genital tract into ovaries, fallopian tube, uterus,
peritoneal cavity
20. Miscellaneous
parasites- tape worms
food poisonings
21. Peritonitis
Infection secondary to direct contamination or direct bacterial vascular
supply
Sx:
Pain
Abdominal distention
Patient lies still, knees up
Patient “looks” ill
Anorexia, N, V
Fever
Lack of bowel sounds
Dx
history, exam, blood work, xray
Tx:
Treat the cause
dml revised/2012
20
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
IV. Abdominal Hemorrhagic conditions - Non Trauma conditions
A. Upper GI bleed
1. Esophageal Varices-covered with cirrhosis
2. Peptic Ulcer Disease (PUD)
Lesion in stomach or duodenum
gastric mucosal defenses become impaired
H pylori for stomach
Hyper secretion and H pylori for duodenal
Stress- due to hospitalization
Complications:
Hemorrhage
Perforation- trough the wall of somach or duodenum, contents into
peritoneal cavity-rigid abdomen
Obstruction- from scarring
Sx
Pain-relationship to oral intake
Vomiting-hematemesis
Dx
Scope
Tx
Drug therapy for pain control
Eradicate H pylori
Antacids
Mucosal barriers
Diet
Endoscopic therapy
Surgery
B. Lower GI Bleed
1.
2.
Hemorrhoids
Bleeding from inflammatory processes in the colon, black, tarry stool
C. Ectopic Pregnancy - Will cover in detail during OB -GYN
D. AAA - Abdominal Aortic Aneurysm
“not a club you want to be a memer of”
E. Splenic Rupture- will cover in abdominal trauma
Causes: Trauma, Sickle Cell, Mononucleosis and other infections
F. Other Hemorrhagic causes of abdominal pain?
dml revised/2012
21
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
V. Obstructive conditions of organs associated with digestion
1. Esophageal obstruction
2. Bowel Obstruction
Causes-intestinal contents accumulate above the are of obstruction
Peristalsis increases, stimulates more secretion
Increase in abdominal distention
Inflammatory response with leakage into peritoneal cavity
Hypo volemia-fluid and electrolyte problems
Mechanical vs Non mechanical=ileus
Sx
pain, N & V, fecal breath, constipation or diarrhea
Dx
XRAY
Tx
NPO
Ng
Replace fluid and electrolytes
Medications for pain and infection
Complication: bowel infarction and subsequent necrosis,
peritonitis
3.
Cholelithiasis-gall stones
4.
Urolithiasis =Renal Calculi “Kidney Stones”
hypercalcemia?
Familial predisposition?
Sx:
“renal colic:flank pain that moves as stone moves
N & V pallor, diaphoresis
Oliguria Hematuria
Dx:
CT, Xray
Tx:
Manage the pain, fluids, lithotripsy, surgery
dml revised/2012
22
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
5.
Hernia
Esophageal= Hiatal
Abdominal
Weakness in abdominal wall
Inguinal-can descend into scrotum
Umbilical- congenital or acquired
Incisional=ventral
Sx:
Pain, visual and palpable bulge
Dx:
Exam and history
Tx:
Non surgical
Surgical
Complications:
Strangulation- vascular supply is interrupted due to pressure
6. Testicular Torsion
Twisting of the spermatic cord, usually after strenuous exercise or trauma
Surgical emergency due to lack of blood flow
Sx:
Dx:
Tx:
pain, N & V, Lump in testicle
Doppler
Surgery
7.
Ovarian torsion- will cover on OB- GYN
8.
Urinary Retention
Prostate
Other causes
Abdominal assessment:
Look-(Inspect):
Position of comfort
Distension-ascites
DCAP-BTLS
Location: RUQ, RLQ, LUQ, LLQ
Regions of the Abdomen:
Epigastric
Periumbilical
Hypogastric
dml revised/2012
23
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
Listen-(Auscultate):
To your patient – remember open ended questions only!!!
For bowel sounds
Feel-(Palpate):
Soft
Rigid
Associated Symptoms:
Age
Chills/Fever
Anorexia
History of Abdominal Surgeries
Vaginal / Penile Discharge
General Terms
hemataemesis
hematachezia
melena
Peritoneal
Retroperitoneal
Terms to Describe Pain
Peritoneal
Visceral
Referred
Specific Signs of Injury
Kehr's
Cullens's
Gray Turner's
F. The Abdominal History:
O.
P:
Q:
R:
S:
T:
dml revised/2012
24
UW Health Emergency Education Center
Paramedic Training
Abdominal A & P
Abdominal Pathophysiology
Deb Martin Lightfoot RN MSN NREMT-P
_______________________________
S
A
M
P
L
Last intake
How much
How often
Last out put
Urine:
How much
How often
Color
Emesis:
How much
How often
Color
Consistency
Stool:
How much
How often
Color
Consistency
Diarrhea
Constipation
**Last Menstrual Period**
How much
How often
Color
E
dml revised/2012
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