This document discusses acute abdominal pain and abdominal trauma. It begins by defining an acute abdomen as the sudden onset of abdominal pain, indicating peritoneal irritation. It then describes various potential causes of abdominal pain from different organ systems. These include gastrointestinal, renal, reproductive and vascular issues. Common signs and symptoms of abdominal trauma are also outlined, including the importance of determining the mechanism of injury and type (blunt vs penetrating). The focus is on initial assessment, treatment including positioning, monitoring and rapid transport to advanced care.

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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 suddenAn 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 System
 Renal or Urinary SystemRenal or Urinary System
 Reproductive SystemReproductive System
MaleMale
FemaleFemale

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The AbdomenThe Abdomen
The abdomen isThe abdomen is
the second majorthe second major
body cavity.body cavity.
It contains theIt contains the
major organs ofmajor organs of
digestion anddigestion and
excretion.excretion.

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The Abdomen

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Description of Abdominal Pain
LocalLocal
General or diffuseGeneral or diffuse
ReferredReferred
ColicColic

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GI Bleeding
 PainPain
 ““heartburn”heartburn”
 Signs of shockSigns of shock
 And 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 stools
Lower 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 bloodThis can represent significant blood
lossloss

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Coffee ground emesis
Partially digested bloodPartially digested blood
It may be chronicIt may be chronic
It likely will emanate from the stomachIt likely will emanate from the stomach
or duodenumor duodenum

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Bright red emesis
 Reflects an upper GI bleed or aboveReflects an upper GI bleed or above
stomachstomach
You may consider esophageal varices andYou 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
painpain
red or blue skin discolorationred or blue skin discoloration
incarceratedincarcerated
can be serious medical emergencycan be serious medical emergency

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Esophageal VaricesEsophageal Varices
 enlarged blood vessels in the esophagusenlarged 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 prohibitingA blockage of the bowel lumen prohibiting
the passage of materialthe passage of material
 Hx of recent abdominal surgeryHx 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 pelvicThe inflammation of the female pelvic
organs (STD)organs (STD)
 Dull RLQ or LLQ painDull RLQ or LLQ pain
 abnormal vaginal dischargeabnormal vaginal discharge
 nausea & vomitingnausea & vomiting
 feverfever

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Ectopic PregnancyEctopic Pregnancy
 Embryo gestation outside uterus (usuallyEmbryo 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 AorticDissecting Abdominal Aortic
AneurysmAneurysm
 Aneurysm develops between arterialAneurysm 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 isOPQRST - all pain is notnot 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 withAlways 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 AbdominalPenetrating & Blunt Abdominal
InjuriesInjuries

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Abdominal Anatomy
Hollow organsHollow organs
Solid organsSolid organs

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Solid organs
 LiverLiver
 SpleenSpleen
 KidneysKidneys
 PancreasPancreas

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Hollow Organs
 StomachStomach
 IntestinesIntestines
 BladderBladder

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Which quadrant is it in?
 StomachStomach
 LiverLiver
 SpleenSpleen
 intestineintestine

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Which quadrant is it in?
 KidneyKidney
 BladderBladder
 appendixappendix

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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
 PalpatePalpate
 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 fluidsNo oral fluids
 Rapid transport to advanced care facilityRapid transport to advanced care facility
 Position the patient supine and treat forPosition the patient supine and treat for
shockshock

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Care for Penetrating Injuries
 Check for exit wounds.Check for exit wounds.
 Use dry sterile dressing to cover theUse dry sterile dressing to cover the
woundwound
 Stabilize the impaled object with bulkyStabilize the impaled object with bulky
dressingdressing

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Impalement Injuries

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Abdominal Evisceration
 Internal organs or fat protrude through theInternal 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