ACUTE ABDOMINAL EMERGENCIES. Abdominal Anatomy and Physiology Abdominal pain and distress Abdominal...
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Transcript of ACUTE ABDOMINAL EMERGENCIES. Abdominal Anatomy and Physiology Abdominal pain and distress Abdominal...
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ACUTE ABDOMINAL EMERGENCIES
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• Abdominal Anatomy and Physiology
• Abdominal pain and distress
• Abdominal conditions
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Function of organsDigestion• Stomach• Small intestine• Large intestine (colon)• Liver• Gallbladder• Pancreas
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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
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• 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
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• Reproductive
• Endocrine
Produces hormones ie insulin
• Regulatory
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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.
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• 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.
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Retroperitoneal Space
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Abdominal Pain and Distress
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Abdominal Quadrants
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RUQ
• Liver
• Gall Bladder
• Duodenum
• Pancreas
• Colon
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• Gall Stones• Hepatitis• Liver Disease• Pancreatitis• Appendicitis• Peforated Ulcer• AMI• Pneumonia
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Left Upper Quadrant• Stomach • Spleen• Left lobe of Liver • Body of Pancreas • Left Kidney • Colon • Parts of Transverse and Descending Colon
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• Gastritis
• Pancreatitis
• AMI
• Pneumonia
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• Gastritis: Inflamation of the lining of the stomach
• Common causes
Excessive alcohol consumption
Prolonged use of NSAIDS such as Ibuprofen and ASA
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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
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• Appendicitis• Ruptured ectopic pregnancy• Pregnancy• Enteritis• PID• Ovarian cyst• Kidney stones• Abdominal abscess• Strangulated hernia
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• 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).
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LLQ
• Part of descending colon
• Sigmoid colon
• Left ovary and Fallopian tube
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• Ruptured ectopic pregnancy
• Ovarian cyst
• PID
• Kidney stones
• Diverticulitis
• Enteritis
• Abdominal abscess
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Midline
• Bladder infection
• Aortic aneurysm
• Uterine disease
• Intestinal disease
• Early appendicitis
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• Diffuse Pain
The word "diffuse" means "widespread" and refers to pain that is more or less all over, or at least in many areas.
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• Pancreatitis• Peritonitis• Appendicitis• Gastroenteristis• Disecting/rupturing aortic aneurysm• Diabetes• Ischemic bowel• Sickle cell crisis
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Visceral Pain
• Dull and persistent
Usually originating from solid organs
• Intermittent, crampy, or colicky
Pain comes from hollow organs
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Parietal pain
• Also called peritoneal pain
• May be caused by internally bleeding
• May be sharp and localized
• May worsen when patient moves
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Tearing pain
• AAA
tearing pain in the back
Referred pain
• Felt somewhere other than where it originates
• MI-indigestion
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Assessment and Care
• Scene Size-up
Protect yourself from vomit
Odors
Shock
MOI
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• Initial AssessmentLOCABCsSigns of shock
AMSAnxietyPaleCool, moist skinRapid pulse and respirations
Position of patientO2
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• 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
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Female patients
• Where are you in your menstrual cycle?
• Period late?
• Vaginal bleeding?
• If menstruating, is flow normal?
• PMHx
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• Is pregnancy possible?
Ectopic pregnancy is a priority pt., rapid transport.
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Geriatric
• Decreased ability to perceive pain
• Medications for HTN or heart conditions that would prevent increased pulse when in shock
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• 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
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Physical Exam of the Abdomen
• Inspect
Distension
Bloating
Discoloration
Protrusions
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Palpate
• Localize pain prior to palpating
palpate that area last
• Observe for guarding
• Carefully palpate a mass ONCE
VS
Serial vs
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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
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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
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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
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AAA• Sharp, tearing pain radiating to the back• Shock• Difference between femoral and pedal pulsesHernia• Painful protrusionKidney stones• Severe flank pain radiating to anterior groin• Nausea and vomiting