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Accute Abdomen

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  • 1. Acute Abdomen Temple College EMS Professions
  • 2. Acute Abdomen General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
  • 3. Acute Abdomen
    • Determining exact cause irrelevant in pre-hospital care
    • Important factor is recognizing acute abdomen is present
  • 4. History
    • Where do you hurt?
      • Know locations of major organs
      • But realize abdominal pain locations do not correlate well with source
  • 5. History
    • What does pain feel like?
      • Steady pain - inflammatory process
      • Crampy pain - obstructive process
  • 6. History
    • Was onset of pain gradual or sudden?
      • Sudden = perforation, hemorrhage, infarct
      • Gradual = peritoneal irrigation, hollow organ distension
  • 7. History
    • Does pain radiate (travel) anywhere?
      • Right shoulder, angle of right scapula = gall bladder
      • Around flank to groin = kidney, ureter
  • 8. History
    • Duration?
      • > 6 hour duration = ? surgical significance
    • Nausea, vomiting? Bloody? “Coffee Grounds”?
    Any blood in GI tract = Emergency until proven otherwise
  • 9. History
    • Change in urinary habits? Urine appearance?
    • Change in bowel habits? Appearance of bowel movements? Melena?
  • 10. History
    • Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss
  • 11. History
    • Females
      • Last menstrual period?
      • Abnormal bleeding?
    In females, abdominal pain = Gyn problem until proven otherwise
  • 12. Physical Exam
    • General Appearance
      • Lies perfectly still  inflammation, peritonitis
      • Restless, writhing  obstruction
    • Abdominal distension?
    • Ecchymosis around umbilicus, flanks?
  • 13. Physical Exam
    • Vital signs
      • Tachycardia  ? Early shock (more important than BP)
      • Rapid shallow breathing  peritonitis
    Tilt test should be done with non-traumatic abdominal pain
  • 14. Physical Exam
    • Palpate each quadrant
      • Work toward area of pain
      • Warm hands
      • Patient on back, knee bent (if possible)
      • Note tenderness, rigidity, involuntary guarding,voluntary guarding, masses
  • 15. Physical Exam
    • Bowel Sounds
      • Listen 1 minute in each quadrant
      • Listen before feeling
      • Absent bowel sounds  ileus, peritonitis, shock
    Auscultating bowel sounds has no pre-hospital value in trauma patients
  • 16. Management
    • Airway
    • High concentration O 2
    • Anticipate vomiting
    • Anticipate hypovolemia
    • Nothing by mouth
    • No analgesics, sedatives
  • 17. Management
    • In adults > 30 , consider possibility of referred cardiac pain .
    • In females , consider possible gyn problem, especially tubal ectopic pregnancy
  • 18. Appendicitis
    • Usually due to obstruction with fecalith
    • Appendix becomes swollen, inflamed gangrene, possible perforation
  • 19. Appendicitis
    • Pain begins periumbilical; moves to RLQ
    • Nausea, vomiting, anorexia
    • Patient lies on side; right hip, knee flexed
    • Pain may not localize to RLQ if appendix in odd location
    • Sudden relief of pain = possible perforation
  • 20. Duodenal Ulcer Disease
    • Steady, well-localized epigastric pain
    • “Burning”, “gnawing”, “aching”
    • Increased by coffee, stress, spicy food, smoking
    • Decreased by alkaline food, antacids
  • 21. Duodenal Ulcer Disease
    • May cause massive GI bleed
    • Perforation = intense, steady pain, pt lies still, rigid abdomen
  • 22. Kidney Stone
    • Mineral deposits form in kidney, move to ureter
    • Often associated with history of recent UTI
    • Severe flank pain radiates to groin, scrotum
    • Nausea, vomiting, hematuria
    • Extreme restlessness
  • 23. Abdominal Aortic Aneurysm
    • Localized weakness of blood vessel wall with dilation (like bubble on tire)
    • Pulsating mass in abdomen
    • Can cause lower back pain
    • Rupture shock, exsanguination
  • 24. Pancreatitis
    • Inflammation of pancreas
    • Triggered by ingestion of EtOH; large amounts of fatty foods
    • Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back
    • Signs, symptoms of hypovolemic shock
  • 25. Cholecystitis
    • Inflammation of gall bladder
    • Commonly associated with gall stones
    • More common in 30 to 50 year old females
    • Nausea, vomiting; RUQ pain, tenderness; fever
    • Attacks triggered by ingestion of fatty foods
  • 26. Bowel Obstruction
    • Blockage of inside of intestine
    • Interrupts normal flow of contents
    • Causes include adhesions, hernias, fecal impactions, tumors
    • Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension
  • 27. Esophageal Varices
    • Dilated veins in lower part of esophagus
    • Common in EtOH abusers, patients with liver disease
    • Produce massive upper GI bleeds