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Acute AbdomenAcute Abdomen&&
Abdominal TraumaAbdominal Trauma
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Abdominal PainAbdominal Pain
CommonCommon
What is causing it?What is causing it?
Life-threatening?Life-threatening?
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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
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AnatomyAnatomy
Gastrointestinal SystemGastrointestinal SystemRenal or Urinary SystemRenal or Urinary System
Reproductive SystemReproductive System MaleMaleFemaleFemale
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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.
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The Abdomen
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Description of Abdominal Pain
Local Local General or diffuse General or diffuse ReferredReferredColicColic
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GI Bleeding
PainPain ““heartburn”heartburn”Signs of shockSigns of shockAnd the following types of bleedingAnd the following types of bleeding
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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
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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
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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
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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
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GI complaints
Common signs & symptomsCommon signs & symptoms
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Hemorrhoid
Enlarged blood vessels near the anus.Enlarged blood vessels near the anus.
Rectal painRectal pain bleedingbleeding
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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
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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
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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
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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
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AppendicitisAppendicitis
Inflammation of the appendixInflammation of the appendix
FeverFever AnorexiaAnorexia N/VN/V RLQ painRLQ pain Rebound tendernessRebound tenderness
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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
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Kidney StonesKidney Stones
Calculi in the kidneyCalculi in the kidney
severe flank painsevere flank pain maybe colickymaybe colicky RestlessnessRestlessness nausea & vomitingnausea & vomiting
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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
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PyelonephritisPyelonephritis
Inflammation of the kidneyInflammation of the kidney
Flank painFlank pain Pain and/or burning with urinationPain and/or burning with urination HematuriaHematuria FeverFever
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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
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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
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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
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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
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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
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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
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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
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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
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Abdominal Trauma
Penetrating & Blunt Abdominal Penetrating & Blunt Abdominal InjuriesInjuries
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Abdominal Anatomy
Hollow organsHollow organs
Solid organsSolid organs
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Solid organs
Liver Liver SpleenSpleen KidneysKidneys PancreasPancreas
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Hollow Organs
StomachStomach IntestinesIntestines BladderBladder
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Which quadrant is it in?
StomachStomachLiverLiverSpleenSpleen intestineintestine
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Which quadrant is it in?
KidneyKidneyBladderBladderappendixappendix
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Injuries of the Abdomen
Closed injury (blunt)Closed injury (blunt)
Open injury (penetrating)Open injury (penetrating)
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Signs & Symptoms
MechanismMechanism Pain - pain upon palpationPain - pain upon palpation TachycardiaTachycardia ShockShock BruisingBruising Distended or rigid abdomenDistended or rigid abdomen Nausea & vomitingNausea & vomiting
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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
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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
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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
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Impalement Injuries
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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
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QuestionsQuestions