acute abdomen
TRANSCRIPT
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Acute Abdomen
Temple College
EMS Professions
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Acute Abdomen
General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
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Acute Abdomen
• Determining exact cause irrelevant in pre-hospital care
• Important factor is recognizing acute abdomen is present
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History
• Where do you hurt?– Know locations of major organs– But realize abdominal pain locations do not
correlate well with source
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History
• What does pain feel like?– Steady pain - inflammatory process– Crampy pain - obstructive process
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History
• Was onset of pain gradual or sudden?– Sudden = perforation, hemorrhage, infarct– Gradual = peritoneal irrigation, hollow organ
distension
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History
• Does pain radiate (travel) anywhere?– Right shoulder, angle of right scapula = gall
bladder– Around flank to groin = kidney, ureter
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History
• Duration?– > 6 hour duration = ? surgical significance
• Nausea, vomiting? Bloody? “Coffee Grounds”?
Any blood in GI tract = Emergency until proven otherwise
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History
• Change in urinary habits? Urine appearance?
• Change in bowel habits? Appearance of bowel movements? Melena?
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History
• Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss
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History
• Females– Last menstrual period? – Abnormal bleeding?
In females, abdominal pain = Gyn problem until proven otherwise
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Physical Exam
• General Appearance– Lies perfectly still inflammation, peritonitis– Restless, writhing obstruction
• Abdominal distension?
• Ecchymosis around umbilicus, flanks?
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Physical Exam
• Vital signs– Tachycardia ? Early shock (more important
than BP)– Rapid shallow breathing peritonitis
Tilt test should be done with non-traumatic abdominal pain
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Physical Exam
• Palpate each quadrant– Work toward area of pain– Warm hands– Patient on back, knee bent (if possible)– Note tenderness, rigidity, involuntary
guarding,voluntary guarding, masses
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Physical Exam
• Bowel Sounds– Listen 1 minute in each quadrant– Listen before feeling– Absent bowel sounds ileus, peritonitis, shock
Auscultating bowel sounds has no pre-hospital value in trauma patients
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Management
• Airway
• High concentration O2
• Anticipate vomiting
• Anticipate hypovolemia
• Nothing by mouth
• No analgesics, sedatives
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Management
• In adults > 30, consider possibility of referred cardiac pain.
• In females, consider possible gyn problem, especially tubal ectopic pregnancy
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Appendicitis
• Usually due to obstruction with fecalith
• Appendix becomes swollen, inflamed gangrene, possible perforation
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Appendicitis
• Pain begins periumbilical; moves to RLQ
• Nausea, vomiting, anorexia
• Patient lies on side; right hip, knee flexed
• Pain may not localize to RLQ if appendix in odd location
• Sudden relief of pain = possible perforation
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Duodenal Ulcer Disease
• Steady, well-localized epigastric pain
• “Burning”, “gnawing”, “aching”
• Increased by coffee, stress, spicy food, smoking
• Decreased by alkaline food, antacids
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Duodenal Ulcer Disease
• May cause massive GI bleed
• Perforation = intense, steady pain, pt lies still, rigid abdomen
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Kidney Stone
• Mineral deposits form in kidney, move to ureter
• Often associated with history of recent UTI
• Severe flank pain radiates to groin, scrotum
• Nausea, vomiting, hematuria
• Extreme restlessness
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Abdominal Aortic Aneurysm
• Localized weakness of blood vessel wall with dilation (like bubble on tire)
• Pulsating mass in abdomen
• Can cause lower back pain
• Rupture shock, exsanguination
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Pancreatitis
• Inflammation of pancreas
• Triggered by ingestion of EtOH; large amounts of fatty foods
• Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back
• Signs, symptoms of hypovolemic shock
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Cholecystitis
• Inflammation of gall bladder
• Commonly associated with gall stones
• More common in 30 to 50 year old females
• Nausea, vomiting; RUQ pain, tenderness; fever
• Attacks triggered by ingestion of fatty foods
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Bowel Obstruction
• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias, fecal impactions, tumors
• Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension
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Esophageal Varices
• Dilated veins in lower part of esophagus
• Common in EtOH abusers, patients with liver disease
• Produce massive upper GI bleeds