Acute Abdomen & Abdominal Trauma

Acute Abdomen & Abdominal Trauma non traumatic abdomen

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Abdominal Pain x Common x What is causing it? x Life-threatening? non traumatic abdomen

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Acute Abdomen Sudden onset of abdominal pain Indicates peritoneal irritation non traumatic abdomen

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Anatomy x Gastrointestinal System Look it Up! x Renal or Urinary System x Reproductive System – Male– Female non traumatic abdomen

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The Abdomen (1 of 2) x The abdomen is the second major body cavity. x It contains the major organs of digestion and excretion. non traumatic abdomen

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The Abdomen (2 of 2) non traumatic abdomen

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Description of Abdominal Pain x Local x General or diffuse x Referredx Colic non traumatic abdomen

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GI Bleeding x Painx “heartburn”x Signs of shockx And the following types of bleeding non traumatic abdomen

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Bright red rectal bleeding x indicates bleed close to anus. –obvious sign ( not subtle )–minor bleeds usual y hemorrhoid non traumatic abdomen

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Melena x Dark, tar-like stoolsx Lower GI bleed Can be only indication of GI bleed can represent significant blood loss non traumatic abdomen

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Coffee ground emesis x Partial y digested blood – chronic– stomach or duodenum non traumatic abdomen

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Bright red emesis x upper Gi bleed x above stomach – Think Esophageal varices– Can be severe non traumatic abdomen

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GI complaints Common signs & symptoms non traumatic abdomen

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Hemorrhoid Enlarged blood vessels near the anus. Rectal painbleeding non traumatic abdomen

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Ulcer Erosion of the stomach or intestinal lining. Epigastric or abdominal painHematemesis – blood in emesis Bright red Coffe ground non traumatic abdomen

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Hernia x Protrusion of tissue through body wall – pain – red or blue skin discoloration– incarcerated– can be serious medical emergency non traumatic abdomen

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Esophageal Varices enlarged blood vessels in the esophagus that can rupture massive bright red bleeding (oral) Shock Hx of liver disease or ETOH abuse non traumatic abdomen

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Bowel Obstruction A blockage of the bowel lumen prohibiting the passage of material Hx of recent abdominal surgery constipationcolicky abdominal painabdominal distentionNausea/Vomiting non traumatic abdomen

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Appendicitis Inflammation of the appendix feveranorexiaN/VRLQ painRebound tenderness non traumatic abdomen

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Cholecystitis Inflammation of the gallbladder Gallstones?recent ingestion of fatty food?RUQ paingradual onsetnot colicky pain non traumatic abdomen

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Kidney Stones Calculi in the kidney severe flank painmaybe colickyrestlessnessnausea & vomiting non traumatic abdomen

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Urinary Tract Infection (UTI) Bacterial infection in the urinary tract Lower abdominal painPain and/or burning with urinationHematuriaUrgency and frequency non traumatic abdomen

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Pyelonephritis Inflammation of the kidney Flank painPain and/or burning with urinationHematuriaFever non traumatic abdomen

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Pelvic Inflammatory Disease The inflammation of the female pelvic organs (STD) Dul RLQ or LLQ painabnormal vaginal dischargenausea & vomiting fever non traumatic abdomen

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Ectopic Pregnancy Embryo gestation outside uterus (usually fallopian tube) RLQ or LLQ painlate LMPmay have vaginal bleedingshock non traumatic abdomen

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Peritonitis Inflammation of the peritoneum Generalized abdominal painFeverRigid abdomenNausea and/or vomitingDistention non traumatic abdomen

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Dissecting Abdominal Aortic Aneurysm Aneurysm develops between arterial layers shearing/tearing abdominal painsudden onsetshockunequal femoral pulses non traumatic abdomen

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Assessment x OPQRST – all pain is not the samex SAMPLE or HAM – nausea, vomiting, diarrhea– anorexia– fever– weakness or syncope non traumatic abdomen

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The physical exam x observe for distentionx palpate for TRPGRx check all 4 quadrantsx start away from pain non traumatic abdomen

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Females x Always consider a gynecological problem with women having abdominal pain – Pregnant?– LMP– Normal?– Prior gynecological problems non traumatic abdomen

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Treatment x oxygenx position of comfortx no oral fluidsx monitor vitals carefullyx transport x treat for shock PRN non traumatic abdomen

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Notes x Dialysisx shunts / fistulasx kidneys role in homeostasisx digestive “juices” = hydrochloric acid non traumatic abdomen

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Notes x nasogastric tubes (NG tubes)x gastrointestinal tube (GI tubes)x colostomy / illeostomy non traumatic abdomen

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Abdominal Trauma Penetrating & Blunt non traumatic abdomen

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Abdominal Anatomy x look it up in your text bookx Hol ow organsx Solid organs non traumatic abdomen

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Solid organs x Liver x Spleenx Kidneysx Pancreas non traumatic abdomen

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Hollow Organs x Stomachx Intestinesx Bladder non traumatic abdomen

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Which quadrant is it in? x stomachx liverx spleenx intestine non traumatic abdomen

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Which quadrant is it in? x kidneyx bladderx appendix non traumatic abdomen

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Injuries of the Abdomen x Closed injury (blunt) x Open injury (penetrating) non traumatic abdomen

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Signs & Symptoms x Mechanismx Pain – pain upon palpationx Tachycardiax Shockx Bruisingx Distended or rigid abdomenx Nausea & vomiting non traumatic abdomen

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The Physical Exam x Determine type of injuryx Observe for distentionx Palpate (TRPGR)x Check all 4 quadrantsx Start away from pain non traumatic abdomen

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Treatment of all abdominal injuries x High flow O2x Keep airway clearx Treat for shock prnx No oral fluids x Rapid transportx Supine / shock non traumatic abdomen

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Care for Penetrating Injuries x Check for exit wounds. x Dry sterile dressing x Bulky dressing for impaled object non traumatic abdomen

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Abdominal Evisceration x Internal organs or fat protrude through the open wound. x Never try to replace organs. x Cover with moist gauze, then sterile dressing. x Keep organs warm and moist. x Transport promptly. non traumatic abdomen

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the end non traumatic abdomen

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