Acute abdomen

Barry Kidd 2010Barry Kidd 2010 11

Acute AbdomenAcute Abdomen&&

Abdominal TraumaAbdominal Trauma


Abdominal PainAbdominal Pain

CommonCommon

What is causing it?What is causing it?

Life-threatening?Life-threatening?


Acute AbdomenAcute Abdomen

An acute abdomen is a sudden An acute abdomen is a sudden onset of abdominal pain.onset of abdominal pain.

It indicates peritoneal irritationIt indicates peritoneal irritation


AnatomyAnatomy

Gastrointestinal SystemGastrointestinal SystemRenal or Urinary SystemRenal or Urinary System

Reproductive SystemReproductive System MaleMaleFemaleFemale


The AbdomenThe Abdomen

The abdomen is The abdomen is the second major the second major body cavity.body cavity.

It contains the It contains the major organs of major organs of digestion and digestion and excretion.excretion.


The Abdomen

Barry Kidd 2010Barry Kidd 2010

Description of Abdominal Pain

Local Local General or diffuse General or diffuse ReferredReferredColicColic


GI Bleeding

PainPain ““heartburn”heartburn”Signs of shockSigns of shockAnd the following types of bleedingAnd the following types of bleeding


Bright red rectal bleeding

indicates bleed close to anus. indicates bleed close to anus.

obvious sign ( not subtle )obvious sign ( not subtle )minor bleeds usually hemorrhoidminor bleeds usually hemorrhoid


Melena

Dark, tar-like stoolsDark, tar-like stoolsLower GI bleedLower GI bleed

This may be the only indication of GI bleedThis may be the only indication of GI bleed

This can represent significant blood This can represent significant blood lossloss


Coffee ground emesis

Partially digested bloodPartially digested blood

It may be chronicIt may be chronicIt likely will emanate from the stomach It likely will emanate from the stomach

or duodenumor duodenum


Bright red emesis

Reflects an upper GI bleed or above Reflects an upper GI bleed or above stomachstomach

You may consider esophageal varices and You may consider esophageal varices and this can be severethis can be severe


GI complaints

Common signs & symptomsCommon signs & symptoms


Hemorrhoid

Enlarged blood vessels near the anus.Enlarged blood vessels near the anus.

Rectal painRectal pain bleedingbleeding


UlcerUlcer

Erosion of the stomach or intestinal lining.Erosion of the stomach or intestinal lining.

Epigastric or abdominal painEpigastric or abdominal pain Hematemesis – blood in emesisHematemesis – blood in emesis

• Bright red or coffee groundBright red or coffee ground


HerniaHernia

Protrusion of tissue through body wallProtrusion of tissue through body wall

pain pain red or blue skin discolorationred or blue skin discoloration incarceratedincarceratedcan be serious medical emergencycan be serious medical emergency


Esophageal VaricesEsophageal Varices

enlarged blood vessels in the esophagus enlarged blood vessels in the esophagus that can rupturethat can rupture

massive bright red bleeding (oral) massive bright red bleeding (oral) ShockShock Hx of liver disease or ETOH abuseHx of liver disease or ETOH abuse


Bowel ObstructionBowel Obstruction

A blockage of the bowel lumen prohibiting A blockage of the bowel lumen prohibiting the passage of materialthe passage of material

Hx of recent abdominal surgery Hx of recent abdominal surgery ConstipationConstipation colicky abdominal paincolicky abdominal pain abdominal distentionabdominal distention Nausea/VomitingNausea/Vomiting


AppendicitisAppendicitis

Inflammation of the appendixInflammation of the appendix

FeverFever AnorexiaAnorexia N/VN/V RLQ painRLQ pain Rebound tendernessRebound tenderness


CholecystitisCholecystitis

Inflammation of the gallbladderInflammation of the gallbladder

Gallstones?Gallstones? recent ingestion of fatty food?recent ingestion of fatty food? RUQ painRUQ pain gradual onsetgradual onset not colicky painnot colicky pain


Kidney StonesKidney Stones

Calculi in the kidneyCalculi in the kidney

severe flank painsevere flank pain maybe colickymaybe colicky RestlessnessRestlessness nausea & vomitingnausea & vomiting


Urinary Tract Infection (UTI)Urinary Tract Infection (UTI)

Bacterial infection in the urinary tractBacterial infection in the urinary tract

Lower abdominal painLower abdominal pain Pain and/or burning with urinationPain and/or burning with urination HematuriaHematuria Urgency and frequencyUrgency and frequency


PyelonephritisPyelonephritis

Inflammation of the kidneyInflammation of the kidney

Flank painFlank pain Pain and/or burning with urinationPain and/or burning with urination HematuriaHematuria FeverFever


Pelvic Inflammatory DiseasePelvic Inflammatory Disease

The inflammation of the female pelvic The inflammation of the female pelvic organs (STD)organs (STD)

Dull RLQ or LLQ painDull RLQ or LLQ pain abnormal vaginal dischargeabnormal vaginal discharge nausea & vomiting nausea & vomiting feverfever


Ectopic PregnancyEctopic Pregnancy

Embryo gestation outside uterus (usually Embryo gestation outside uterus (usually fallopian tube)fallopian tube)

RLQ or LLQ painRLQ or LLQ pain late LMP (menstrual period)late LMP (menstrual period) may have vaginal bleedingmay have vaginal bleeding shockshock


PeritonitisPeritonitis

Inflammation of the peritoneumInflammation of the peritoneum

Generalized abdominal painGeneralized abdominal pain FeverFever Rigid abdomenRigid abdomen Nausea and/or vomitingNausea and/or vomiting DistentionDistention


Dissecting Abdominal Aortic Dissecting Abdominal Aortic AneurysmAneurysm

Aneurysm develops between arterial Aneurysm develops between arterial layerslayers

shearing/tearing abdominal painshearing/tearing abdominal pain sudden onsetsudden onset ShockShock unequal femoral pulsesunequal femoral pulses


Assessment on all abdominal pain requires the following:

OPQRST - all pain is OPQRST - all pain is not not the samethe same SAMPLESAMPLE Always be on the lookout for the following:Always be on the lookout for the following:

nausea, vomiting, diarrheanausea, vomiting, diarrhea AnorexiaAnorexia FeverFever weakness or syncopeweakness or syncope


The physical examThe physical exam

observe for distentionobserve for distention PalpatePalpate check all 4 quadrantscheck all 4 quadrants start away from painstart away from pain


Females Always consider a gynecological problem with Always consider a gynecological problem with

women having abdominal painwomen having abdominal pain Could you be or are you pregnant?Could you be or are you pregnant? Did you have your LMP (last menstrual period) Did you have your LMP (last menstrual period)

as usual?as usual? Was it normal?Was it normal? Have you had any prior gynecological problemsHave you had any prior gynecological problems


Treatment

OxygenOxygen position of comfortposition of comfort no oral fluidsno oral fluids monitor vitals carefullymonitor vitals carefully treat for shock PRN (as required)treat for shock PRN (as required) transport to advanced caretransport to advanced care


Abdominal Trauma

Penetrating & Blunt Abdominal Penetrating & Blunt Abdominal InjuriesInjuries


Abdominal Anatomy

Hollow organsHollow organs

Solid organsSolid organs


Solid organs

Liver Liver SpleenSpleen KidneysKidneys PancreasPancreas


Hollow Organs

StomachStomach IntestinesIntestines BladderBladder


Which quadrant is it in?

StomachStomachLiverLiverSpleenSpleen intestineintestine


Which quadrant is it in?

KidneyKidneyBladderBladderappendixappendix


Injuries of the Abdomen

Closed injury (blunt)Closed injury (blunt)

Open injury (penetrating)Open injury (penetrating)


Signs & Symptoms

MechanismMechanism Pain - pain upon palpationPain - pain upon palpation TachycardiaTachycardia ShockShock BruisingBruising Distended or rigid abdomenDistended or rigid abdomen Nausea & vomitingNausea & vomiting


The Physical Exam

Determine type of injuryDetermine type of injury Observe for distentionObserve for distention Palpate Palpate Check all 4 quadrantsCheck all 4 quadrants Start away from painStart away from pain


Treatment of all abdominal injuries

High flow OHigh flow O22

Keep airway clearKeep airway clear Treat for shock prnTreat for shock prn No oral fluids No oral fluids Rapid transport to advanced care facilityRapid transport to advanced care facility Position the patient supine and treat for Position the patient supine and treat for

shock shock


Care for Penetrating Injuries

Check for exit wounds.Check for exit wounds.

Use dry sterile dressing to cover the Use dry sterile dressing to cover the woundwound

Stabilize the impaled object with bulky Stabilize the impaled object with bulky dressingdressing


Impalement Injuries


Abdominal Evisceration Internal organs or fat protrude through the Internal organs or fat protrude through the

open wound.open wound.

Never try to replace organs.Never try to replace organs.

Cover with moist gauze, then sterile dressing.Cover with moist gauze, then sterile dressing.

Keep organs warm and moist.Keep organs warm and moist.

Transport to advanced care facilityTransport to advanced care facility



QuestionsQuestions

Acute abdomen

Healthcare

distention

upper gi bleed

sterile dressing

bleed close

recent ingestion

open injury

abdominal

open wound