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Chapter 23
Abdominal and
Gastrointestinal
Disorders
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
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Objectives
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Anatomy Review
• Borders of the abdominal cavity
– Diaphragm
– Pelvis
– Spine
– Abdominal wall
• Major blood vessels
– Aorta
– Inferior vena cava
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Anatomy Review
• Peritoneum
• Retroperitoneum (retroperitoneal space)
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Abdominal Quadrants
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Solid Organs
• Abdomen
– Liver
– Spleen
• Retroperitoneal space
– Kidneys
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Hollow Organs
• Abdomen
– Stomach
– Intestines
– Gallbladder
• Retroperitoneal space
– Urinary bladder
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Primary Digestive System Organs
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Mouth
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anal canal
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Accessory Digestive System Organs
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Teeth
Tongue
Salivary glands
Liver
Gallbladder
Pancreas
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Process of Digestion
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The Acute Abdomen
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Acute Abdomen
• Sudden onset of abdominal pain
• Possible associated assessment findings
and symptoms
– Nausea and vomiting
– Abdominal tenderness and/or rigidity
– Signs and symptoms of shock may also be
present
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Abdominal Pain
• Abdominal pain may or may not be the result
of a problem involving an organ within the
abdominal cavity.
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Referred Pain
• Pain that is felt in a part of the body that is
away from the tissues or organ that causes
the pain.
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Hemorrhagic Causes of
Acute Abdominal Pain
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Gastritis
• Inflammation of the stomach lining
• Possible causes
– Increased gastric secretion associated
with excessive consumption of alcohol
– Infection caused by bacteria such as
Helicobacter pylori (H. pylori)
– Prolonged use of medications
– Severe physical stress such as burns,
severe infection, surgery, or trauma
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Gastritis
• Assessment findings and symptoms
– Belching
– Nausea and vomiting
– Indigestion
– Burning sensation in the upper abdomen
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Peptic Ulcer Disease
• A peptic ulcer is an open sore in the lining of
the stomach (gastric ulcer), duodenum
(duodenal ulcer), or esophagus (esophageal
ulcer).
• Primary cause
– H. pylori bacteria
• Contributing cause
– Excess secretion of digestive juices, such
as hydrochloric acid, by stomach cells
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Peptic Ulcer Disease
• Gastric ulcer
• Duodenal ulcer
• Esophageal ulcer
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Upper Gastrointestinal Bleeding
• Bleeding may occur from any part of the GI
tract.
• GI bleeding is a medical emergency.
• Upper GI bleeding is bleeding from the
esophagus, stomach, or duodenum.
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Upper Gastrointestinal Bleeding
• Assessment findings and symptoms
– Hematemesis
• May be bright red or resemble coffee grounds
– Syncope
– Fatigue
– Shortness of breath
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Lower Gastrointestinal Bleeding
• Can originate in the small intestine, colon, or
rectum
• Common causes
– Tumors, hemorrhoids, colitis
• Assessment findings and symptoms
– Rectal bleeding, which may include melena
– Increased frequency of stools
– Cramping pain
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Nonhemorrhagic Causes of
Acute Abdominal Pain
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Appendicitis
• Inflammation of the appendix
• Assessment findings and symptoms
– Sudden onset of abdominal pain that shifts
to the RLQ
– Nausea
– Vomiting
– Fever
– Loss of appetite
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Intestinal Obstruction
• Blockage of the large or small intestine
• Assessment findings and symptoms
– Cramping abdominal pain
– Nausea
– Vomiting or diarrhea
– Gradual loss of appetite
– Abdominal distention and tenderness
– Decreased or no passage of stool
– Inability to pass gas
– Fever and chills
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Pancreatitis
• Inflammation of the pancreas
• Assessment findings and symptoms
– Abdominal pain that typically radiates to
the back
– Severe, deep, piercing, and steady pain
– Nausea, vomiting
– Abdominal tenderness
– Fever
– Hypotension, tachycardia
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Cholecystitis
• Inflammation of the gallbladder
• Assessment findings and symptoms
– Pain in the upper middle or right upper
quadrant of the abdomen
– Pain described as severe, steady, and
worsens with movement
– Nausea, vomiting
– Constipation or diarrhea
– Excessive belching
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Gastroenteritis
• Inflammation of the intestinal lining
– Most often caused by a virus
• Assessment findings and symptoms
– Diarrhea
– Abdominal pain and tenderness
– Vomiting
– Headache
– Fever
– Chills
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Hepatitis
• Inflammation of the liver, most commonly
caused by a viral infection
• Assessment findings and symptoms
– Dull right upper quadrant pain and
tenderness unrelated to food consumption
– Nausea and vomiting
– Loss of appetite
– Extreme fatigue
– Dark urine, clay colored stools
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– Jaundice
Patient Assessment
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Patient Assessment
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Scene size-up
Primary survey
Establish patient priorities
Determine the need for additional resources
Make a transport decision
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Patient History
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Signs/symptoms
Allergies
Medications
Past medical history
Last oral intake
Events prior
• Onset
• Provocation/
Palliation / Position
• Quality
• Region/Radiation
• Severity
• Time
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Physical Examination
• Observe the patient’s position
• Listen to breath sounds
• Assess vital signs and oxygen saturation
• Assess the abdomen for DCAP-BTLS
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Emergency Care
• Prehospital care is supportive
• Allow the patient to assume a position of
comfort
• Provide calm reassurance
• Administer oxygen
• Reassess as often as indicated
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Questions?
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