Chapter 23 Acute Abdominal Pain (Generic Version)

1. Chapter 23Acute Abdominal Pain(Generic Version) Presented by: Michael Farmer

2. Hollow – Appendix Urinary bladder Common bile duct Fallopian tubes Gallbladder Intestines Stomach Uterus Ureters Vessels Abdominal aorta Inferior vena cava Solid Kidneys Ovaries Liver Pancreas Spleen Hollow, Solid, and Major Vascular Structures

3. Do You Know Where Your Guts Are? • LUQ • Stomach, spleen, pancreas, Part of large intestine, kidney around back • RUQ • Liver, gall bladder, part of large intestine, kidney around back • LLQ • Part of large intestine, female reproductive organs • RLQ • Appendix, part of the large intestine, female things

4. Organs of the AbdomenAnd Their Function • Great table 23-2 on page 481 of your student text Picture of organs

5. Causes Of Abdominal Pain • Mechanical forces – Stretching • Inflammation – disease, injury, leak • Ischemia – organ and tissue hypoxia • Parietal Pain • Associated with irritation of the peritoneal lining • Visceral pain • when the organ itself is involved • Difficult to localize

6. Referred Pain • Pain from the ailing organ itself felt elsewhere in the body • Shared nerve pathways • Brain gets confused • Example: Gallbladder pain is often felt around the right scapula • See table 23-3 on page 482

7. Threats BSI MOI or NOI Clues to patient condition LOC – AVPU/GCS Guarded position ABC’s Vomiting and positioning Shock? Severe pain Patient looks lousy Scene Size-up and Initial Assessment

8. Guarding Restless vs. quiet Inspection for obvious clues GENTLE palpation of each quadrant Palpate area of complaint last Pain elsewhere? Cardiac components? Hocus Focus(ed) Historyand Physical Examination

9. Pain and tenderness Anxiety and fear Guarded position Rapid/shallow breathing Paid pulse BP changes (orthostatic) Nausea/vomiting/diarrhea Rigid abdomen Distended abdomen Shock related s/s Signs of internal bleeding Signs and Symptoms

10. Pancreatitis N/V Tenderness/Distention Severe pain w/radiation to back and shoulders Fever, rapid pulse, and shock if severe Cholecysitis Sudden onset of pain middle of upper quadrants (epigastric to RUQ Pain at night or after fish and chips Tenderness on palpation to RUQ Low grade fever N/V nasty green stuff (bile) Specific Conditions

11. Intestinal Blockage Moderate to severe pain Constipation – sometimes days in length N/V Distention Hernia (Inguinal/Umbilical) Abdominal pain after lifting Fever Rapid pulse Uncomfortable, non-specific pain Similar to obstruction Specific Conditions

12. Ulcer Pain LUQ/Epigastric area (burning/gnawing) empty stomach/stress N/V - maybe blood Shock Peritonitis Esophageal Varcies Vomiting bright red blood History of alcohol abuse common Absence of pain or tenderness SOB Shock Jaundice Specific Conditions

13. Worst Case Scenario…… • Abdominal Aortic Aneurysm (AAA) • History – known, Hypertension, progression • Gradual onset of lower lumbar and abdominal pain • Sudden onset of severe, constant pain described as tearing. • May radiate to lower back. Flank, or pelvis • N/V • Shock • Weak/Absent femoral/pedal pulses Bi/unilaterally • Pulsating mass if abdomen is soft • Rigid, board like abdomen if rupture/leak

14. That's All Folks!