Transcript Chapter 23 64KB Jan 14 2015 08:21:49 AM

Chapter 23
Acute Abdominal Pain
(Generic Version)
Presented by:
Michael Farmer
Hollow, Solid, and Major
Vascular Structures
• Hollow –
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Appendix
Urinary bladder
Common bile duct
Fallopian tubes
Gallbladder
Intestines
Stomach
Uterus
Ureters
• Vessels
– Abdominal aorta
– Inferior vena cava
• Solid
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Kidneys
Ovaries
Liver
Pancreas
• Spleen
Do You Know
Where Your Guts Are?
• LUQ
– Stomach, spleen, pancreas, Part of large
intestine, kidney around back
• RUQ
– Liver, gall bladder, part of large intestine,
kidney around back
• LLQ
– Part of large intestine, female reproductive
organs
• RLQ
– Appendix, part of the large intestine, female
things
Organs of the Abdomen
And Their Function
• Great table 23-2 on page 481 of your
student text
Causes Of Abdominal Pain
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Mechanical forces – Stretching
Inflammation – disease, injury, leak
Ischemia – organ and tissue hypoxia
Parietal Pain
– Associated with irritation of the peritoneal
lining
• Visceral pain
– when the organ itself is involved
– Difficult to localize
Referred Pain
• Pain from the ailing organ itself felt
elsewhere in the body
– Shared nerve pathways
– Brain gets confused
– Example: Gallbladder pain is often felt
around the right scapula
– See table 23-3 on page 482
Scene Size-up and
Initial Assessment
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Threats
BSI
MOI or NOI
Clues to patient
condition
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LOC – AVPU/GCS
Guarded position
ABC’s
Vomiting and
positioning
• Shock?
• Severe pain
• Patient looks lousy
Hocus Focus(ed) History
and Physical Examination
• Guarding
• Restless vs. quiet
• Inspection for obvious
clues
• GENTLE palpation of
each quadrant
• Palpate area of
complaint last
• Pain elsewhere?
• Cardiac components?
Signs and Symptoms
• Pain and
tenderness
• Anxiety and fear
• Guarded position
• Rapid/shallow
breathing
• Paid pulse
• BP changes
(orthostatic)
• Nausea/vomiting/diarr
hea
• Rigid abdomen
• Distended abdomen
• Shock related s/s
• Signs of internal
bleeding
Specific Conditions
• Pancreatitis
– N/V
– Tenderness/Diste
ntion
– Severe pain
w/radiation to
back and
shoulders
– Fever, rapid
pulse, and shock
if severe
• Cholecysitis
– Sudden onset of
pain middle of upper
quadrants
(epigastric to RUQ
– Pain at night or after
fish and chips
– Tenderness on
palpation to RUQ
– Low grade fever
– N/V nasty green stuff
(bile)
Specific Conditions
• Intestinal Blockage
– Moderate to severe
pain
– Constipation –
sometimes days in
length
– N/V
– Distention
• Hernia
(Inguinal/Umbilical)
– Abdominal pain
after lifting
– Fever
– Rapid pulse
– Uncomfortable,
non-specific pain
– Similar to
obstruction
Specific Conditions
• Ulcer
– Pain
LUQ/Epigastric
area
(burning/gnawing)
empty
stomach/stress
– N/V - maybe blood
– Shock
– Peritonitis
• Esophageal
Varcies
– Vomiting bright red
blood
– History of alcohol
abuse common
– Absence of pain or
tenderness
– SOB
– Shock
– Jaundice
Worst Case Scenario……
• Abdominal Aortic Aneurysm (AAA)
– History – known, Hypertension, progression
– Gradual onset of lower lumbar and abdominal
pain
– Sudden onset of severe, constant pain
described as tearing.
– May radiate to lower back. Flank, or pelvis
– N/V
– Shock
– Weak/Absent femoral/pedal pulses
Bi/unilaterally
– Pulsating mass if abdomen is soft
– Rigid, board like abdomen if rupture/leak