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Abdominal Emergencies

Abdominal Emergencies. Paramedic Program Chemeketa Community College. Abdominal Emergencies. Abdominal pain is a frequent complaint. Most difficult to dx Relies greatly on History Physical Exam may be helpful, always necessary. Abdominal Emergencies, cont.

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Abdominal Emergencies

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  1. Abdominal Emergencies Paramedic Program Chemeketa Community College

  2. Abdominal Emergencies • Abdominal pain is a frequent complaint. • Most difficult to dx • Relies greatly on History • Physical Exam may be helpful, always necessary

  3. Abdominal Emergencies, cont. • Pathophysiology of abdominal pain • Bacterial/viral Infection • Chemical Irritation • Circulatory compromise • Trauma • Tumor • Obstruction

  4. Types of Pain • Somatic and Visceral • Merge in nerve pathway to brainDifficult to differentiate but • Visceral are more cramping and diffuse • e.g. Gas pains • Somatic is more constant and localized • e.g. Peritonitis

  5. Anatomy 101… • Abdomen - largest body cavity • Separated by diaphragm and artificial plane at pelvis • Bordered by spine and abdominal wall • Quadrants

  6. Anatomy • LUQ; • Spleen • Pancreas (retroperitoneal) • Stomach • Left kidney (retroperitoneal) • Splenic flexure of colon

  7. Anatomy • RUQ • Liver • Gall bladder • Head of pancreas • Duodenum • Right kidney (retroperitoneal) • Hepatic flexure of colon

  8. Anatomy • RLQ • Appendix (supposed to be here) • Ascending colon, • Small intestine • Right ovary, Fallopian tube • LLQ • Small intestine • Descending colon, • Left ovary, Fallopian tube

  9. Flank; lateral abdomen • Peritoneal; membrane lining the abdomen • Most organs within peritoneum • Retroperitoneal; kidneys, part of duodenum, part of pancreas.

  10. Solid organs • Liver • Spleen • Pancreas • Kidneys • Adrenals • Ovaries

  11. Hollow organs • Stomach • Intestines • Gall bladder • Urinary bladder • Uterus

  12. Mouth Esophagus Stomach Intestines Salivary glands Teeth Liver Gall bladder Pancreas Appendix GI System

  13. Circulatory system (abdominal cavity) • Descending aorta • Superior mesenteric and inferior mesenteric arteries • Aorta divides • Iliac arteries • Inferior vena cava • Portal system

  14. Genitourinary System • Kidneys • Ureters • Urinary bladder • Urethra

  15. Male reproductive system Testes Epididymis Prostate Vas deferens Urethra Penis • Female reproductive system • Ovaries • Fallopian tubes • Uterus • Vagina • Vulva

  16. Pain Referral • Pain isn’t always where it seems! • Visceral nerve fibers are shared • Pain shows up away from the source • e.g. Shoulder pain from diaphragm

  17. Upper Gastrointestinal Bleeding • Peptic ulcer disease • Erosive gastritis • Esophageal Varices • Mallory-Weiss Tear • Esophagitis • Duodenitis • Drug Ingestion

  18. Peptic Ulcer Disease • Ulcers in lining of esophagus, stomach, or duodenum – Loss of protective effects • 5 x more common after age 50

  19. Ulcers • If pain, usually ceases after onset of severe bleeding • 70-90% caused by Helicobacter pylori • Antibiotic therapy • Pain usually located in epigastrium or LUQ. • May improve after antacids • Can cause an acute abdomen-rigid, board-like • Mortality from 3 – 8%

  20. Gastritis • Inflammatory response - Gastric erosions secondary to increased gastric acid secretion • Associated with alcohol ingestion, drugs, stress • Pt. c/o epigastric pain, belching, indigestion, N/V

  21. Gastritis • Caused by: ASA, Steroids, Alcohol, NSAIDS, Burns, Sepsis, Trauma • Pain improves after eating • Gastric ulcer may develop • Most common presentation • Restless • Pale, cool, moist skin • Hypotension

  22. Varices • Swollen veins in lower 1/3 of esophagus • Secondary to portal hypertension • Most common cause: alcoholic cirrhosis • Accounts for 10% of all hematemesis, melena • Mortality 40-70% • Guess what drug they use to treat this acutely……… Beta Blockers

  23. Esophagitis • Common disorder, but uncommon cause of significant GIB • Esophageal reflux common • Melena more common presentation

  24. Mallory-Weiss Tear • Distal esophagus or proximal stomach • Laceration • Most common causes • Alcoholism and hiatal hernia • Belching, vomiting, blunt trauma, seizures, coughing • Multiple bouts of non-bloody emesis followed by sudden hematemesis • Bleeding usually mild to moderate, stops spontaneously

  25. Duodenitis • Mean age of presentation 49 years • Melena or hematemesis common • Hemorrhage often self-limited

  26. Drug ingestion • Aspirin (even moderate use) increases risk • Alcohol and Aspirin have a synergistic effect. • NSAID’s can also cause gastric erosions

  27. Upper GI Bleeding • Assessment findings • Acute/chronic • Vomiting/hematemesis • Stool/melena • Meal history • Chest pain/gas pain • Altered mentation • Skin pale, cool, moist

  28. Upper GI (cont.) • Most common presentation • Acute • Painless • N/V/hematemesis • Melena • Hypotension, tachycardia, pale, cool, moist skin

  29. Causes of Acute Upper GI Bleeding • Peptic ulcer disease (50%) • Varices (10%) • Hemorrhagic gastritis (25%) • Esophagitis • Mallory-Weiss tear

  30. Upper GI Bleeding (cont.) • Management • Oxygen • Positioning • IV, consider fluid challenge • Consider MAST • Gastric lavage • Transfusion • Psychological support →

  31. Lower Gastrointestinal Bleeding • Diverticulitis • Angiodysplasia • Carcinoma • Rectal Disease

  32. Diverticulitis • Presents in 50% of patients > 60 year old • Inflammation in or around diverticula - Retention of food residue and bacteria • Present like appendicitis • Pt c/o abdominal pain, fever, vomiting, anorexia, tenderness

  33. Diverticulitis • Tx: antibiotics, diet changes, possibly surgery • Bleeding Diverticulitis • Presents as painless rectal bleeding, commonly left-sided abdominal pain • Tx: prevention of shock

  34. Angiodysplasia • Acquired disorder of unknown cause • Most commonly found in cecum and ascending colon • AV malformations in 25% of patients > 65 years • Melena • Difficult to diagnose • 10-15% Mortality

  35. Carcinoma • Uncommon cause of major LGIB • Presentation diverse • Painless rectal bleeding • Weight loss • Abdominal pain • Treatment is prevention of shock

  36. Rectal Disease • Most common cause of rectal bleed • Bright red bleeding • Inflamed veins of anal canal

  37. Gastroenteritis Crohn’s Disease Appendicitis Perforated abdominal viscus Bowel Obstruction Pancreatitis Cholecystitis Hepatitis Aortic Aneurysm Renal Calculi UTI Pyleonephritis PID Renal Failure Ovarian cyst Ectopic pregnancy Mittelschmirz Testicular torsion Epididymitis Other Abdominal Emergencies

  38. Gastroenteritis • Causative organisms • Many viruses, parasites • Contracted via fecal-oral transmission, contaminated food, water • S/S • N/V, fever, abdominal pain, cramping, anorexia, lassitude, shock

  39. Crohn’s Disease/ Ulcerative Colitis • Idiopathic, chronic inflammatory disease of intestines • Crohn’s - involves rectum & small bowel • Ulcerative Colitis – rectum and small bowel spared

  40. Crohn’s Disease • Inflammatory disorder, small and large bowel • Increased t-cell activity • Lesions, fistulas • Risk factors - positive family history, stress • Pt. presents with irritable bowel, diarrhea, weight loss

  41. Appendicitis • Obstruction appendical lumen • Ulceration appendiceal mucosa (viral/bacterial) • Pt c/o RLQ abdominal pain onset acute, originates at umbilicus, migrates to RLQ • Presentation with N/V, fever, anorexia, rebound tenderness • Tx: fluid replacement, prevention of shock, surgery

  42. Perforated Abdominal Viscus • Causes include perforated ulcers or diverticulum • Presentation • sudden onset abdominal pain • generalized tenderness • rebound tenderness • rigid abdomen • shock • Tx: IV fluids, antibiotics, surgery

  43. Bowel Obstruction. • Causes include tumors, ingestion of FB, prior abdominal surgery, fecal impaction • Hx: progressive anorexia, fever, chills, skin pale, cool, moist, peritonitis • Acute/chronic, N/V/D/Unable • Hypotension, tachycardia • Tx: fluid replacement, prevention of shock

  44. Pancreatitis • Inflammation of pancreas due to digestion of gland by its own enzymes • Associated with chronic alcohol abuse, elevated lipids

  45. Pancreatitis • Patient complaints • Abrupt onset abdominal pain, mid-abdomen radiating to back and shoulders • N/V • Hypotension, tachycardia • Pale, cool, moist skin • Tx: IV fluids, pain meds, NG tube

  46. Cholecystitis • Inflammation of the gallbladder • Obstruction by a gallstone in gallbladder neck, cystic duct, or common bile duct Six F’s Female Fertile Fair Fat Forty Flatulent

  47. Cholecystitis • S/S • Pain in RUQ, worse after meals, esp. high-fat • Flank pain common; may radiate to genitals • Antacids don’t relieve pain • Skin pale, cool, moist • Fever • Tx; pain meds, surgery

  48. Hepatitis • Caused by viral infections, alcohol, substance abuse • S/S • Dull RUQ tenderness • Decreased appetite, N/V • Fatigue, H/A, malaise, photophobia, pharyngitis, cough • Clay-colored stool • Skin: Warm, rash, jaundice • Tx: symptomatically

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