ACUTE ABDOMINAL EMERGENCIES

Abdominal Anatomy and PhysiologyAbdominal pain and distressAbdominal conditions

Function of organsDigestionStomachSmall intestineLarge intestine (colon)LiverGallbladderPancreas

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

LiverBile secretion for breakdown of fats

GallbladderStores bile before release into the intestine

PancreasReleases enzymes that breakdown food into absorbable molecules. Takes place in the small intestine

ReproductiveEndocrineProduces hormones ie insulinRegulatory

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.

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.

Retroperitoneal Space

Abdominal Pain and Distress

Abdominal Quadrants

RUQLiverGall BladderDuodenum Pancreas Colon

Gall StonesHepatitisLiver DiseasePancreatitisAppendicitisPeforated UlcerAMIPneumonia

Left Upper QuadrantStomach SpleenLeft lobe of Liver Body of Pancreas Left Kidney Colon Parts of Transverse and Descending Colon

GastritisPancreatitisAMIPneumonia

Gastritis: Inflamation of the lining of the stomachCommon causesExcessive alcohol consumptionProlonged use of NSAIDS such as Ibuprofen and ASA

Right Lower QuadrantCecuma pouch, connecting the ileum with the ascending colon of the large instestine. Appendix Right ovary and Fallopian tube Right ureter

AppendicitisRuptured ectopic pregnancyPregnancyEnteritisPIDOvarian cystKidney stonesAbdominal abscessStrangulated hernia

EnteritisEnteritis 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).

LLQPart of descending colonSigmoid colon Left ovary and Fallopian tube

Ruptured ectopic pregnancyOvarian cystPIDKidney stonesDiverticulitisEnteritisAbdominal abscess

MidlineBladder infectionAortic aneurysmUterine diseaseIntestinal diseaseEarly appendicitis

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

PancreatitisPeritonitisAppendicitisGastroenteristisDisecting/rupturing aortic aneurysmDiabetesIschemic bowelSickle cell crisis

Visceral PainDull and persistentUsually originating from solid organsIntermittent, crampy, or colickyPain comes from hollow organs

Parietal painAlso called peritoneal painMay be caused by internally bleedingMay be sharp and localizedMay worsen when patient moves

Tearing painAAAtearing pain in the backReferred painFelt somewhere other than where it originatesMI-indigestion

Assessment and CareScene Size-upProtect yourself from vomitOdorsShockMOI

Initial AssessmentLOCABCsSigns of shockAMSAnxietyPaleCool, moist skinRapid pulse and respirationsPosition of patientO2

S A M P L EO P Q R S TTime: How long have you had the pain Has it changed over time

Female patientsWhere are you in your menstrual cycle?Period late?Vaginal bleeding?If menstruating, is flow normal?PMHx

Is pregnancy possible?Ectopic pregnancy is a priority pt., rapid transport.

GeriatricDecreased ability to perceive painMedications for HTN or heart conditions that would prevent increased pulse when in shock

Beta BlockersStimulation of 1 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 BlockersAtenololMetoprolol

Physical Exam of the AbdomenInspectDistensionBloatingDiscolorationProtrusions

PalpateLocalize pain prior to palpatingpalpate that area lastObserve for guardingCarefully palpate a mass ONCEVSSerial vs

CareABCsO2Transport decisionPosition of comfortOngoing assessment q 5 min.Alert for vomiting; suctionCalmNothing by mouthAMS or unresponsive; left lateral recumbentElevate legs for shock

AppendicitisNausea and sometimes vomitingPersistent pain RLQGallstonesSudden epigastric/RUQ painMay rotate to shoulder or backMay worsen by eating food high in fat

PancreatitisPain may radiate to back and shouldersCan be present with signs of shockInternal bleedingDigestive tract; coffee ground emesisRectal; black, tarry stoolsParitoneal cavity; abd pain and tenderness

AAASharp, tearing pain radiating to the backShockDifference between femoral and pedal pulsesHerniaPainful protrusionKidney stonesSevere flank pain radiating to anterior groinNausea and vomiting

Stomach: Hollow organ; expands as it fills with foodSmall intestine: Hollow organ where food absorption takes place; Divided into 3 parts: Duodenum, jejunum, ileumLarge Intestine; hollow organ; removes water from waste products