Acute Abdominal Emergencies

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
• 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

• 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
• Reproductive
• Endocrine
Produces hormones ie insulin
• Regulatory
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
RUQ
• Liver
• Gall Bladder
• Duodenum
• Pancreas
• Colon
• Gall Stones
• Hepatitis
• Liver Disease
• Pancreatitis
• Appendicitis
• Peforated Ulcer
• AMI
• Pneumonia
Left Upper Quadrant
• Stomach
• Spleen
• Left lobe of Liver
• Body of Pancreas
• Left Kidney
• Colon
• Parts of Transverse and Descending Colon
• Gastritis
• Pancreatitis
• AMI
• Pneumonia
• Gastritis: Inflamation of the lining of
the stomach
• Common causes
Excessive alcohol consumption
Prolonged use of NSAIDS such as Ibuprofen
and ASA
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
• Appendicitis
• Ruptured ectopic pregnancy
• Pregnancy
• Enteritis
• PID
• Ovarian cyst
• Kidney stones
• Abdominal abscess
• Strangulated hernia
• 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).
LLQ
• Part of descending colon
• Sigmoid colon
• Left ovary and Fallopian tube
• Ruptured ectopic pregnancy
• Ovarian cyst
• PID
• Kidney stones
• Diverticulitis
• Enteritis
• Abdominal abscess
Midline
• Bladder infection
• Aortic aneurysm
• Uterine disease
• Intestinal disease
• Early appendicitis
• Diffuse Pain
The word "diffuse" means "widespread" and
refers to pain that is more or less all over,
or at least in many areas.
• Pancreatitis
• Peritonitis
• Appendicitis
• Gastroenteristis
• Disecting/rupturing aortic aneurysm
• Diabetes
• Ischemic bowel
• Sickle cell crisis
Visceral Pain
• Dull and persistent
Usually originating from solid organs
• Intermittent, crampy, or colicky
Pain comes from hollow organs
Parietal pain
• Also called peritoneal pain
• May be caused by internally bleeding
• May be sharp and localized
• May worsen when patient moves
Tearing pain
• AAA
tearing pain in the back
Referred pain
• Felt somewhere other than where it
originates
• MI-indigestion
Assessment and Care
• Scene Size-up
Protect yourself from vomit
Odors
Shock
MOI
• Initial Assessment
LOC
ABCs
Signs of shock
AMS
Anxiety
Pale
Cool, moist skin
Rapid pulse and respirations
Position of patient
O2
• SAMPLE
• OPQRST
Time: How long have you had the pain
Has it changed over time
Female patients
• Where 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.
Geriatric
• Decreased ability to perceive pain
• Medications for HTN or heart conditions
that would prevent increased pulse when
in shock
• 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
Physical Exam of the Abdomen
• Inspect
Distension
Bloating
Discoloration
Protrusions
Palpate
• Localize pain prior to palpating
palpate that area last
• Observe for guarding
• Carefully palpate a mass ONCE
VS
Serial vs
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
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
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
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

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ACUTE ABDOMINAL

• Large Intestine; hollow organ; removes water from waste products

• forms the lining of the abdominal cavity or the

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