acute abdominal emergencies n.
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ACUTE ABDOMINAL EMERGENCIES. Abdominal Anatomy and Physiology Abdominal pain and distress Abdominal conditions. Function of organs Digestion Stomach Small intestine Large intestine (colon) Liver Gallbladder Pancreas. Digestion Stomach: Hollow organ; expands as it fills with food

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slide2
Abdominal Anatomy and Physiology
  • Abdominal pain and distress
  • Abdominal conditions
slide4
Function of organs

Digestion

  • Stomach
  • Small intestine
  • Large intestine (colon)
  • Liver
  • Gallbladder
  • Pancreas
slide5
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
slide6
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

slide7
Reproductive
  • Endocrine

Produces hormones ie insulin

  • Regulatory
slide8
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.
slide9
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.
slide13
RUQ
  • Liver
  • Gall Bladder
  • Duodenum
  • Pancreas
  • Colon
slide14
Gall Stones
  • Hepatitis
  • Liver Disease
  • Pancreatitis
  • Appendicitis
  • Peforated Ulcer
  • AMI
  • Pneumonia
slide15
Left Upper Quadrant
  • Stomach
  • Spleen
  • Left lobe of Liver
  • Body of Pancreas
  • Left Kidney
  • Colon
  • Parts of Transverse and Descending Colon
slide16
Gastritis
  • Pancreatitis
  • AMI
  • Pneumonia
slide17
Gastritis: Inflamation of the lining of the stomach
  • Common causes

Excessive alcohol consumption

Prolonged use of NSAIDS such as Ibuprofen and ASA

slide18
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
slide19
Appendicitis
  • Ruptured ectopic pregnancy
  • Pregnancy
  • Enteritis
  • PID
  • Ovarian cyst
  • Kidney stones
  • Abdominal abscess
  • Strangulated hernia
slide20
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).

slide21
LLQ
  • Part of descending colon
  • Sigmoid colon
  • Left ovary and Fallopian tube
slide22
Ruptured ectopic pregnancy
  • Ovarian cyst
  • PID
  • Kidney stones
  • Diverticulitis
  • Enteritis
  • Abdominal abscess
slide23
Midline
  • Bladder infection
  • Aortic aneurysm
  • Uterine disease
  • Intestinal disease
  • Early appendicitis
slide24
Diffuse Pain

The word "diffuse" means "widespread" and refers to pain that is more or less all over, or at least in many areas.

slide25
Pancreatitis
  • Peritonitis
  • Appendicitis
  • Gastroenteristis
  • Disecting/rupturing aortic aneurysm
  • Diabetes
  • Ischemic bowel
  • Sickle cell crisis
slide26
Visceral Pain
  • Dull and persistent

Usually originating from solid organs

  • Intermittent, crampy, or colicky

Pain comes from hollow organs

slide27
Parietal pain
  • Also called peritoneal pain
  • May be caused by internally bleeding
  • May be sharp and localized
  • May worsen when patient moves
slide28
Tearing pain
  • AAA

tearing pain in the back

Referred pain

  • Felt somewhere other than where it originates
  • MI-indigestion
slide29
Assessment and Care
  • Scene Size-up

Protect yourself from vomit

Odors

Shock

MOI

slide30
Initial Assessment

LOC

ABCs

Signs of shock

AMS

Anxiety

Pale

Cool, moist skin

Rapid pulse and respirations

Position of patient

O2

slide31
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

slide32
Female patients
  • Where are you in your menstrual cycle?
  • Period late?
  • Vaginal bleeding?
  • If menstruating, is flow normal?
  • PMHx
slide33
Is pregnancy possible?

Ectopic pregnancy is a priority pt., rapid transport.

slide34
Geriatric
  • Decreased ability to perceive pain
  • Medications for HTN or heart conditions that would prevent increased pulse when in shock
slide35
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

slide36
Physical Exam of the Abdomen
  • Inspect

Distension

Bloating

Discoloration

Protrusions

slide37
Palpate
  • Localize pain prior to palpating

palpate that area last

  • Observe for guarding
  • Carefully palpate a mass ONCE

VS

Serial vs

slide38
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
slide39
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
slide40
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
slide41
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