Abdominal structure and function by AmnaKhan

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									Chapter
    21
 Acute Abdominal Pain
CHAPTER
                         Topics
  21

    •   Abdominal structure and function
    •   Acute abdominal pain
    •   Assessment and care
    •   Conditions that cause abdominal
        pain
CHAPTER
                   Introduction
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     • Abdominal pain is experienced by
       most everybody, at some point in
       time

     • Acute abdominal pain that causes
       a person to summon EMS could
       signal a very serious medical
       condition
CHAPTER
           Abdominal Structure and Function
  21
    • Abdominal cavity
          – Located below the diaphragm, and
            extends to the pelvis
          – Lined by the visceral and parietal
            peritoneum
          – Contains many vital organs within the
            peritoneal sheath, or retroperitoneal
CHAPTER
          Abdominal Structure and Function
  21


Relation of the
abdominal
cavity to other
cavities
of the body
CHAPTER
          Abdominal Structure and Function
  21

Abdominal
quadrants
  – Upper right
    quadrant
  – Upper left
    quadrant
  – Lower right
    quadrant
  – Lower left
    quadrant
CHAPTER
          Abdominal Structure and Function
  21
CHAPTER
          Abdominal Structure and Function
  21




                Abdominal quadrants
CHAPTER
           Abdominal Structure and Function
  21


          • The abdomen contains three
            types of organs:
            – Hollow organs
            – Solid
            – Vascular
CHAPTER
          Abdominal Structure and Function
  21
CHAPTER
                  Acute Abdominal Pain
  21


          • Abdominal pain is also referred
            to as “acute abdomen,” or
            “acute abdominal distress”

          • All together, there are some
            100+ different diagnoses of
            abdominal pain
CHAPTER
                   Acute Abdominal Pain
  21


          • Abdominal pain may be from
            any one of numerous body
            systems
            – Cardiac or pulmonary
            – Gastrointestinal or urinary
            – Genital or reproductive
CHAPTER
                  Acute Abdominal Pain
  21


          • The actual cause, is usually
            from one of the following
            mechanisms
            – Mechanical forces
            – Inflammation
            – Ischemia
CHAPTER
                Acute Abdominal Pain
  21

      • Classification of abdominal pain
          – Visceral
          – Parietal
          – Referred
  CHAPTER
                   Acute Abdominal Pain
     21

The lines show
where pain may
be felt when
there is disease
or injury to the
organ named
CHAPTER         Assessment and Care:
  21            Acute Abdominal Pain


       • Scene size-up
          – Assess scene for hazards
          – BSI precautions
          – Look for MOI/NOI
          – Determine number of patients
          – Call for backup if additional
            resources needed
CHAPTER         Assessment and Care:
  21            Acute Abdominal Pain


       • Initial assessment
          – Form a general impression, and
            note if patient is in a “guarded
            position”
CHAPTER          Assessment and Care:
  21             Acute Abdominal Pain



          • Initial assessment
            – Ensure the patient has a patent
              airway and adequate breathing,
              and support any lost function
            – Look for signs of hypoperfusion
              during circulatory assessment
CHAPTER           Assessment and Care:
  21              Acute Abdominal Pain


     • Focused history and physical exam
          – If the patient is a high priority, complete
            the rapid medical assessment and
            vitals, then a SAMPLE history
          – If the patient is a low priority, complete
            first the SAMPLE history, then the
            focused history and physical exam, and
            obtain a set of vitals
CHAPTER           Assessment and Care:
  21              Acute Abdominal Pain


     • Focused history and physical
       exam
          – Pertinent questions of the SAMPLE
            history
          – What are examples of SAMPLE
            questions you would ask?
CHAPTER             Assessment and Care:
  21                Acute Abdominal Pain

       • Focused history and physical
         exam




       Inspection             Identify area of pain
CHAPTER         Assessment and Care:
  21            Acute Abdominal Pain

    • Focused history and physical exam
       – Palpate furthest away from location of
         pain first
CHAPTER          Assessment and Care:
  21             Acute Abdominal Pain



          • Markle test:
            – Also known as “heel jar” or
              “heel drop” test
            – Technique used to assess for
              peritonitis
CHAPTER          Assessment and Care:
  21             Acute Abdominal Pain

          • Heel drop test
CHAPTER       Assessment and Care:
  21          Acute Abdominal Pain

 • Heel jar test – do not use on suspected
   trauma patients
CHAPTER           Assessment and Care:
  21              Acute Abdominal Pain


          • Common signs and symptoms:
              • Pain or tenderness
              • Anxiety and fear
              • Guarded positioning
              • Rapid and shallow breathing
              • Rapid pulse, or changes in blood
                pressure
              • Nausea, vomiting, or diarrhea
              • Rigid or distended abdomen
CHAPTER        Assessment and Care:
  21           Acute Abdominal Pain


• Emergency medical care
   – Keep airway patent (be alert for
     vomiting)
   – Place patient in position of comfort
   – Administer oxygen at 15 lpm
   – Calm and reassure the patient
   – Treat for hypoperfusion if present
   – Initiate quick transport
   – NEVER GIVE ANYTHING BY MOUTH
CHAPTER        Assessment and Care:
  21           Acute Abdominal Pain

  • Ongoing assessment
    – Perform an ongoing
      assessment during transport
    – Document and
      record all vital
      signs
CHAPTER       Conditions That May Cause
  21            Acute Abdominal Pain



          • Appendicitis
            – Inflammation of appendix
            – If left untreated, can lead to
              swelling and rupture
            – Rebound tenderness in RLQ
              upon exam
CHAPTER       Conditions That May Cause
  21            Acute Abdominal Pain


     • Pancreatitis
          – Inflammation of the pancreas
          – May be triggered by ingestion of
            ETOH or large amount of food
          – May be associated with trauma
          – Patient usually experiences severe
            pain
          – Chronic pancreatitis can lead to
            diabetes and drug addition
CHAPTER      Conditions That May Cause
  21           Acute Abdominal Pain


    • Cholecystitis
       – Inflammation of the gallbladder
       – Gallbladder may also become
         obstructed by gall stones
       – Worse pain after eating high fat meal
       – The 4 “F’s”
CHAPTER        Conditions That May Cause
  21             Acute Abdominal Pain


     • Intestinal obstruction
          – Blockage inside the intestines that
            stops the normal movement of
            intestinal contents
          – Commonly from adhesions,
            hernias, and tumors
CHAPTER   Conditions That May Cause
  21        Acute Abdominal Pain


                 • Hernia
                    – Caused by a small
                      hole forming in the
                      peritoneum.
                    – The “strangulated”
                      tissue may then
                      become necrotic
CHAPTER      Conditions That May Cause
  21           Acute Abdominal Pain


       • Ulcer
          – Open wounds or sores to the
            digestive tract
          – Common to stomach and small
            intestines
          – Caused by gastric juices
            deteriorating walls
CHAPTER        Conditions That May Cause
  21             Acute Abdominal Pain

     • Esophageal varices
          – Bulging or weakness to veins of
            esophagus
          – Commonly from various liver diseases
          – Can result in profuse, painless
            bleeding
          – Most commonly associated with long
            term alcoholism
CHAPTER        Conditions That May Cause
  21             Acute Abdominal Pain

     • Abdominal aortic aneurysm
          – Weakening of descending aortic wall
          – Most lethal cause of abdominal pain
          – Pulsating abdominal mass on exam
          – History of HTN
          – Obesity
          – Absence or poor femoral and tibial
            pulses in one leg
CHAPTER   Conditions That May Cause
            Acute Abdominal Pain
 21
CHAPTER      Conditions That May Cause
  21           Acute Abdominal Pain

  • Vomiting and
    diarrhea
     – Not an emergency
       in and of itself;
       rather an
       indication of some
       other abdominal
       problem
     – Assess for
       dehydration

								
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