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Flashcards in Abdominal Emergencies Deck (81)
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1

Abdomen

Region between the diaphragm and pelvis

2

Which organ systems are found in the abdomen

– Digestive
– Reproductive
– Endocrine
– Regulatory

3

What are the solid organs of the abdomen

Spleen
Liver
Pancreas
Kidneys

4

What are the Hollow organs of the stomach

Stomach
Gallbladder
Duodenum
Large Intestine
Small Intestine

5

Peritoneum

thin membrane lining the abdominal cavity and covering each organ.
These organs include the stomach, liver, spleen, appendix, sm & lg intestine and in women the uterus, fallopian tubes & ovaries.

6

Parietal peritoneum

lines abdominal cavity

7

Visceral peritoneum

covers each organ

8

Which organs are found in the extra-peritoneal space, behind the peritoneum

Kidneys
Pancreas
Portion of the Aorta

9

Which organs lie inferior the the peritoneum

bladder
part of the rectum

10

Which organs are found in within the peritoneal cavity

Spleen (behind the liver)
Liver
Gallbladder
Stomach
Transverse Colon (and ascending & descending colon)
Small Bowel (intestine)

11

Which organs are within the retroperitoneal cavity

Kidney ( and ureters)
Pancreas
Duodenum
Abdominal Aorta

Inferior vena cava
Fallopian tube (and ovaries)
Sigmoid colon
Uterus
Rectum
Urinary Bladder

12

Abdomen divided into what regions

RUQ, LUQ, RLQ, LLQ Epigastric region

13

Visceral Pain

• Originates from the visceral peritoneum
• Fewer nerve endings allow for only diffuse sensations of pain
• Frequently described as “dull” or “achy”
• Colic (intermittent pain) may result from distention and/or contraction of hollow organs
• Persistent or constant pain often originates from solid organs

14

Parietal Pain

• Originates from the parietal peritoneum - parietal tenderness
• Many nerve endings allow for specific, efficient sensations of pain
• Frequently described as “sharp”
• Pain is often severe, constant, and localized to a specific area
• The pt will describe this kind of pain as worsening upon movement or getting better when still or lies with knees drawn up

15

Referred Pain

• Perception of pain in skin or muscles at distant locations
– Abdomen has many nerves from different parts of the nervous system
– Nerve pathways overlap as they return to the spinal cord
– Pain sensation is transmitted from one system to another

16

Tearing Pain

• Originates in the aorta
• Separation of layers of this large blood vessel caused by aneurysm
• Retroperitoneal location of aorta causes pain to be referred to back as that it is located

17

Appendicitis: What is it Signs & Symptoms

• Infection of appendix
• Appendectomy is usually indicated
• Signs and symptoms
– Persistent RLQ pain
– Pain often initially referred to umbilical region
– Rupture of appendix
• Sudden, severe increase in pain
• Contents released into abdomen causes severe peritonitis

18

Peritonitis: What is it Signs & Symptoms

• Irritation of peritoneum, usually caused by foreign material in peritoneal space
• Parietal peritoneum is sensitive, especially to acidic substances
• Irritation causes involuntary contraction of abdominal muscles
• Signs and symptoms
– Abdominal pain and rigidity

19

Cholecystitis: What is it Signs & Symptoms

• Inflammation of the gallbladder
• Often caused by blockage of its outlet by gall stones (cholecystolithiasis)
• Symptoms often worsened by ingestion of fatty foods
• Signs and symptoms
– Sharp RUQ or epigastric pain
– Pain often referred to shoulder

20

Pancreatitis: What is it Signs & Symptoms

• Inflammation of the pancreas
• Common with chronic alcohol abuse
• Signs and symptoms
– Epigastric pain
– Often referred to back or shoulder
– pain is referred as the organ is retroperitoneal

21

Gastrointestinal (GI) Bleeding: What is it Signs & Symptoms

• Hemorrhage within the lumen of the GI tract
• May be minor to severe
• Blood eventually exits (mouth or rectum)
• Often painless
• Gastric ulcers (holes in GI system from highly acidic gastric juices) can cause severe pain and peritonitis

• Signs and symptoms
– Dark-colored stool (maroon to black), often “tarry” (Melena)
– Frank blood from rectum (hemorrhoid)
– Vomiting “coffee ground” appearing blood
– Vomiting frank blood
– Pain: absent to severe

22

Abdominal Aortic Aneurysm (AAA): What is it Signs & Symptoms

• Weakening of inner wall of the aorta
• Tears and separates from outer layers (dissection)
• Weakened vessel bulges, may continue to grow
• May eventually rupture

• Signs and symptoms
– Progressive (often “tearing”) abdominal pain
– Frequently radiates to back (lumbar)
– Palpable abdominal mass, possibly pulsating
– Possible inequality in pedal pulses

• Signs and symptoms
– Sudden, severe increase in pain may indicate
rupture
• High aortic pressure causes rapid internal bleeding
• Sudden progression of shock
• Likely exsanguination (fatal hemorrhage)

23

Hernia: What is it Signs & Symptoms

• Hole in the abdominal wall, allowing tissue or parts of organs (commonly intestines) to protrude under skin
• May be precipitated by heavy lifting
• May cause strangulation of tissue or bowel obstruction
• May require surgical repair

• Signs and symptoms
– Sudden onset of abdominal pain, often following exertion
– Palpable mass or lump on abdominal wall or crease of groin (inguinal hernia)

24

Renal Colic: What is it signs & symptoms

• Severe pain caused by kidney stones traveling down the ureter
• Signs and symptoms
– Severe, cramping, intermittent pain in flank or back
– Frequently referred to groin
– Nausea, vomiting

25

Cardiac Involvement: What is it signs & symptoms

• Pain of myocardial infarction can produce
– Nausea or vomiting
– Epigastric pain
– Indigestion
• Always consider the possibility of a cardiac emergency as a cause of abdominal symptoms

26

Assessment and Care of Abdominal Pain or Discomfort

• Many potential causes of abdominal pain
• Role of EMT is not to diagnose
• Focus efforts
– Perform thorough history and physical exam
– Identify serious or life-threatening conditions

27

Scene Size-Up: What should you think of

• Protect self from blood-borne pathogens
• Be aware of odors
• Determine if patient’s condition is medical, trauma, or both

28

Primary Assessment: Steps and what are yo thinking of for the abdominal patient

• General impression
• ABC’s
• Level of consciousness

All pt's with abdominal pain should be given O2 immediately.

29

History of Present Illness: what kind of questions

• O: “When did it begin? What were you doing?”
• P: “What makes it better or worse? Movement? Position?”
• Q: “Describe your discomfort.”
• R: “Point to its location. Does it radiate or move?”
• S: “How bad is the pain on a scale of 1–10?”
• T: “Do you have pain all the time? Is it intermittent? Has it changed?”

30

History of the Present Illness: Other that OPQRST what kinds of questions would you ask a Female patient.

• Female patients
– “Where in your cycle are you?”
– “Is your period late?”
– “Are you experiencing vaginal bleeding?”
– “Is your flow normal?”
– “Have you experienced this pain before?”
– “Is it possible you are pregnant?”
– “Are you using birth control?”