Acute Abdomen Temple College EMS Professions
Acute Abdomen General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
Acute Abdomen <ul><li>Determining exact cause irrelevant in pre-hospital care </li></ul><ul><li>Important factor is recogn...
History <ul><li>Where do you hurt? </li></ul><ul><ul><li>Know locations of major organs </li></ul></ul><ul><ul><li>But rea...
History <ul><li>What does pain feel like? </li></ul><ul><ul><li>Steady pain - inflammatory process </li></ul></ul><ul><ul>...
History <ul><li>Was onset of pain gradual or sudden? </li></ul><ul><ul><li>Sudden = perforation, hemorrhage, infarct </li>...
History <ul><li>Does pain radiate (travel) anywhere? </li></ul><ul><ul><li>Right shoulder, angle of right scapula = gall b...
History <ul><li>Duration? </li></ul><ul><ul><li>> 6 hour duration = ? surgical significance </li></ul></ul><ul><li>Nausea,...
History <ul><li>Change in urinary habits?  Urine appearance? </li></ul><ul><li>Change in bowel habits?  Appearance of bowe...
History <ul><li>Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss </l...
History <ul><li>Females </li></ul><ul><ul><li>Last menstrual period?  </li></ul></ul><ul><ul><li>Abnormal bleeding?  </li>...
Physical Exam <ul><li>General Appearance </li></ul><ul><ul><li>Lies perfectly still    inflammation, peritonitis </li></u...
Physical Exam <ul><li>Vital signs </li></ul><ul><ul><li>Tachycardia   ? Early shock (more important than BP) </li></ul></...
Physical Exam <ul><li>Palpate each quadrant </li></ul><ul><ul><li>Work toward area of pain </li></ul></ul><ul><ul><li>Warm...
Physical Exam <ul><li>Bowel Sounds </li></ul><ul><ul><li>Listen 1 minute in each quadrant </li></ul></ul><ul><ul><li>Liste...
Management <ul><li>Airway </li></ul><ul><li>High concentration O 2 </li></ul><ul><li>Anticipate vomiting </li></ul><ul><li...
Management <ul><li>In  adults > 30 , consider possibility of referred  cardiac pain . </li></ul><ul><li>In  females , cons...
Appendicitis <ul><li>Usually due to obstruction with fecalith </li></ul><ul><li>Appendix becomes swollen, inflamed  gangre...
Appendicitis <ul><li>Pain begins periumbilical; moves to RLQ </li></ul><ul><li>Nausea, vomiting, anorexia </li></ul><ul><l...
Duodenal Ulcer Disease <ul><li>Steady, well-localized epigastric pain </li></ul><ul><li>“Burning”, “gnawing”, “aching” </l...
Duodenal Ulcer Disease <ul><li>May cause massive GI bleed </li></ul><ul><li>Perforation = intense, steady pain, pt lies st...
Kidney Stone <ul><li>Mineral deposits form in kidney, move to ureter </li></ul><ul><li>Often associated with history of re...
Abdominal Aortic Aneurysm <ul><li>Localized weakness of blood vessel wall with dilation (like bubble on tire) </li></ul><u...
Pancreatitis <ul><li>Inflammation of pancreas </li></ul><ul><li>Triggered by ingestion of EtOH; large amounts of fatty foo...
Cholecystitis <ul><li>Inflammation of gall bladder </li></ul><ul><li>Commonly associated with gall stones </li></ul><ul><l...
Bowel Obstruction <ul><li>Blockage of inside of intestine </li></ul><ul><li>Interrupts normal flow of contents </li></ul><...
Esophageal Varices <ul><li>Dilated veins in lower part of esophagus </li></ul><ul><li>Common in EtOH abusers, patients wit...
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Accute Abdomen

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

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