Human

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Somatic Pain
• Patient:
➢ Generally hesitant to move
➢ Lies on back or side with legs flexed
➢ Involuntary guarding of abdomen
➢ Rebound tenderness
• Common causes
➢ Appendicitis
➢ Inflamed or perforated viscera

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Referred Pain
• Pain in area remote from tissue causing pain
➢ Visceral fiber branches synapse in spinal cord with
same neurons that receive pain fibers from skin
➢ Pain fibers stimulated, sensations spread
➢ Pain felt in areas distant from source
➢ Examples

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Referred Pain

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GIT Signs and Symptoms
• Nausea, vomiting, anorexia
➢ Gastritis
➢ Pancreatitis
➢ Biliary tract disease
➢ High intestinal obstruction
• Diarrhea
➢ Gastroenteritis, ulcerative colitis
• Constipation
➢ Dehydration, obstruction, medications
ttt…… Codeine, morphine

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GIT Signs and Symptoms
• Change in stool color
➢ Biliary tract obstruction (clay-colored stools)
➢ Lower intestinal bleeding (black, tarry stools)
• Chills and fever
➢ Bacterial infection
➢ Appendicitis
➢ Cholecystitis

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Palpation
• Gentle palpation
• Away from painful area
• Note:
➢ Rigidity or spasm
➢ Tenderness or masses
➢ Facial expressions
➢ If abdomen is soft or rigid

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Percussion
• Assess tympany and dullness to detect:
➢ Fluid
➢ Air
➢ Solid masses
• Side-to-side or clockwise, noting:
➢ Tenderness
➢ Abdominal skin temperature and color

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Specific Abdominal
Emergencies
• Upper GI bleeding
➢ Lesions
➢ Peptic ulceration
➢ Esophageal varices

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Specific Abdominal
Emergencies
• Lower GI bleeding
➢ Colonic lesions
➢ Diverticulosis
➢ Hemorrhoids

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GI Bleeding
• Chronic or acute
• Causes of upper GI bleeding:
➢ Peptic ulcer disease
➢ Esophageal varices
➢ Mallory-Weiss syndrome
➢ Tumors
• Worse if clotting is impaired

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Lower GI Bleeding
• Causes
➢ Diverticulosis most common
➢ Cancer, polyps, inflammatory bowel
• Signs and symptoms
➢ Cramping pain
➢ Diarrhea (may be bloody)
➢ Nausea, vomiting

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Severe GIT Bleeding
• Hematemesis
• Blood in stool
➢ Melena
➢ Hematochezia
• Management
➢ Oxygen
➢ IV fluids

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Gastroenteritis
• Inflammation of stomach and intestines
• Diarrhea and/or vomiting
• Infection, allergies, immune disorders
• Common in:
➢ Institutions
➢ Disasters
➢ Travelers

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Gastroenteritis
• Can lead to:
➢ Severe dehydration
➢ Electrolyte imbalances
• Management
➢ IV fluids
➢ Antiemetics
➢ Antibiotics sometimes needed

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Chronic Gastroenteritis
• Inflammation of stomach and intestines
• Causes
➢ Infection
➢ Medication
➢ Alcohol

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Gastritis
• Signs and symptoms
➢ Epigastric pain, tenderness
➢ Nausea, anorexia
➢ Vomiting
➢ Fever
➢ Bleeding
➢ Shock

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Gastritis
• Management
➢ Diet regulation
➢ Medications
➢ Fluid resuscitation
• Hypovolemia or dehydration

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Appendicitis
• Signs and symptoms
➢ Variable
➢ Anorexia, nausea, vomiting
➢ Chills, fever
➢ Pain
• Initially diffuse
• Right lower quadrant
• May diminish after rupture

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Peptic Ulcer Disease
• Pain
➢ Epigastric burning, gnawing
➢ Before meals
➢ Relief with vomiting, food, antacids
• Melena
• Initiate IV fluids
• Treat shock if present

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Bowel Obstruction
• Occlusion of intestinal lumen
• Blocks flow of intestinal contents
• Causes
➢ Ileus
➢ Mechanical obstruction
➢ Intussusception
➢ Volvulus

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Bowel Obstruction
• Signs and symptoms
➢ Constipation
➢ Nausea, vomiting
➢ Abdominal distention
➢ Abdominal pain
• Management
➢ IV fluids, NG tube
➢ Surgery may be needed

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Hemorrhoids
• Swollen, distended
veins
• Internal and/or external
➢ 50% of people by age
50
• Bleeding usually
resolves on own
• Anemia possible
• Management
➢ Dietary, fixation
techniques, and surgery

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Cholecystitis
• Inflammation of gallbladder
➢ Often with gallstones
• High-risk groups
• Signs and symptoms
➢ Pain at night
➢ Right upper abdomen
➢ Radiates to right scapula
➢ After ingestion of fatty food

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Cholecystitis
• Bile duct obstruction
➢ Chills, fever
➢ Jaundice
➢ Pancreatitis
• Treatment
➢ IV
➢ NG tube
➢ Transport for surgery

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Acute Hepatitis
***May be bacterial, fungal, parasitic, toxic, drug,
alcohol or Viral infection (A, B or C)
• Liver inflammation (HAV, HBV, HCV)
➢ Malaise, weakness, anorexia
➢ Intermittent nausea and vomiting
➢ Dull right upper quadrant pain
➢ Jaundice, dark urine within 1 wk