ACUTE ABDOMINAL EMERGENCIES

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

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. Beta Blockers 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