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Acute Abdomen

Acute Abdomen. Temple College EMS Professions. Acute Abdomen. General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining). Acute Abdomen. Determining exact cause irrelevant in pre-hospital care Important factor is recognizing acute abdomen is present.

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Acute Abdomen

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  1. Acute Abdomen Temple College EMS Professions

  2. Acute Abdomen General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

  3. Acute Abdomen • Determining exact cause irrelevant in pre-hospital care • Important factor is recognizing acute abdomen is present

  4. History • Where do you hurt? • Know locations of major organs • But realize abdominal pain locations do not correlate well with source

  5. History • What does pain feel like? • Steady pain - inflammatory process • Crampy pain - obstructive process

  6. History • Was onset of pain gradual or sudden? • Sudden = perforation, hemorrhage, infarct • Gradual = peritoneal irrigation, hollow organ distension

  7. History • Does pain radiate (travel) anywhere? • Right shoulder, angle of right scapula = gall bladder • Around flank to groin = kidney, ureter

  8. History • Duration? • > 6 hour duration = ? surgical significance • Nausea, vomiting? Bloody? “Coffee Grounds”? Any blood in GI tract = Emergency until proven otherwise

  9. History • Change in urinary habits? Urine appearance? • Change in bowel habits? Appearance of bowel movements? Melena?

  10. History • Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss

  11. History • Females • Last menstrual period? • Abnormal bleeding? In females, abdominal pain = Gyn problem until proven otherwise

  12. Physical Exam • General Appearance • Lies perfectly still  inflammation, peritonitis • Restless, writhing  obstruction • Abdominal distension? • Ecchymosis around umbilicus, flanks?

  13. Physical Exam • Vital signs • Tachycardia ? Early shock (more important than BP) • Rapid shallow breathing peritonitis Tilt test should be done with non-traumatic abdominal pain

  14. Physical Exam • Palpate each quadrant • Work toward area of pain • Warmhands • Patient on back, knee bent (if possible) • Note tenderness, rigidity, involuntary guarding,voluntary guarding, masses

  15. Physical Exam • Bowel Sounds • Listen 1 minute in each quadrant • Listen before feeling • Absent bowel sounds  ileus, peritonitis, shock Auscultating bowel sounds has no pre-hospital value in trauma patients

  16. Management • Airway • High concentration O2 • Anticipate vomiting • Anticipate hypovolemia • Nothing by mouth • No analgesics, sedatives

  17. Management • In adults > 30, consider possibility of referred cardiac pain. • In females, consider possible gyn problem, especially tubal ectopic pregnancy

  18. Appendicitis • Usually due to obstruction with fecalith • Appendix becomes swollen, inflamed gangrene, possible perforation 

  19. Appendicitis • Pain begins periumbilical; moves to RLQ • Nausea, vomiting, anorexia • Patient lies on side; right hip, knee flexed • Pain may not localize to RLQ if appendix in odd location • Sudden relief of pain = possible perforation

  20. Duodenal Ulcer Disease • Steady, well-localized epigastric pain • “Burning”, “gnawing”, “aching” • Increased by coffee, stress, spicy food, smoking • Decreased by alkaline food, antacids

  21. Duodenal Ulcer Disease • May cause massive GI bleed • Perforation = intense, steady pain, pt lies still, rigid abdomen

  22. Kidney Stone • Mineral deposits form in kidney, move to ureter • Often associated with history of recent UTI • Severe flank pain radiates to groin, scrotum • Nausea, vomiting, hematuria • Extreme restlessness 

  23. Abdominal Aortic Aneurysm • Localized weakness of blood vessel wall with dilation (like bubble on tire) • Pulsating mass in abdomen • Can cause lower back pain • Rupture shock, exsanguination 

  24. Pancreatitis • Inflammation of pancreas • Triggered by ingestion of EtOH; large amounts of fatty foods • Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back • Signs, symptoms of hypovolemic shock

  25. Cholecystitis • Inflammation of gall bladder • Commonly associated with gall stones • More common in 30 to 50 year old females • Nausea, vomiting; RUQ pain, tenderness; fever • Attacks triggered by ingestion of fatty foods

  26. Bowel Obstruction • Blockage of inside of intestine • Interrupts normal flow of contents • Causes include adhesions, hernias, fecal impactions, tumors • Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

  27. Esophageal Varices • Dilated veins in lower part of esophagus • Common in EtOH abusers, patients with liver disease • Produce massive upper GI bleeds

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