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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Accute Abdomen

  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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