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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 • SAMPLE • 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 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. 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
