Acute Abdomen and Abdominal Trauma

Question 1

What does a sudden onset of abdominal pain indicate?

Answer 1

Indicates peritoneal irritation

Question 2

What is the anatomy of the abdomen? What are the quadrants?

Answer 2

• The abdomen is the second major body cavity
• It contains major organs of digestion and excretion

Question 3

What are the descriptions of abdominal pain?

Answer 3

• Local
• General or diffuse
• Referred
• Colic

Question 4

What is associated with Gastrointestinal (GI) bleeding?

Answer 4

• Pain
• “heartburn”
• Signs of shock
• Bright red rectal bleeding
  Melena
• Coffee ground emesis
• Bright red emesis

Question 5

What does bright red rectal bleeding indicate?

Answer 5

• Indicates bleed close to anus
• Minor bleeding usually hemorrhoid

Question 6

What is Melena? WHere is it occur? What can it indicate? What does melena signify?

Answer 6

1. Dark tar like stools
2. Occurs: lower GI bleed
3. Can be the only indication of GI bleed
4. Can represent significant blood loss

Question 7

What is coffee ground emesis? What is a characteristic of it? Where does it occur?

Answer 7

1. Partially digested blood
2. Usually chronic
3. Occurs in stomach or duodenum

Question 8

What casues bright red emesis? What can cause it? Is it serious?

Answer 8

1. Bleeding of upper GI above the stomach
2. Esophageal varices can cause it (enlarged veins)
3. Can be severe

Question 9

What are hemorrhoids? What is associated with it?

Answer 9

1. Enlarged blood vessels near the anus
2. a. **rectal pain **
   b. bleeding

Question 10

What is an ulcer? WHat is a symptom? What is a sign?

Answer 10

1. Erosion of the stomach or intestinal lining
2. Epigastric or abdominal pain
3. Hematemsis: blood in emesis
   * -bright red or coffee ground*

Question 11

What is a hernia? What are some S/S?

Answer 11

1. Protrusion of tissue through body wall
2. -pain
   - red or blue skin
   - incarcerated

*can be serious medical emergency*

Question 12

What are esophageal varices? What can it cause?

Answer 12

1. Enlarged blood vessels in the esophagus that can rupture
2. -Massive bright red bleeding
   - Shock
3. *May have history of liver disease or ETOH (ethanol) abuse*

Question 13

WHat is bowel obstruction? What are some causes? What are some S/S?

Answer 13

1. A blockage of the bowel lumen prohibiting the passage of material
2. a. history of recent abdominal surgery
   b. constipation
3. a. colicky abdominal pain
   b. abdominal distention
   c. nasuea/vomiting

Question 14

What is appendicitis? What are some S/S?

Answer 14

1. Inflammation of the appendix
2. -fever
   - anorexia
   - nausea/vomiting N/V
   - right lower quadrant RLQ pain
   - rebound tenderness

Question 15

What is cholecystitis? What are some causes? S/S?

Answer 15

1. Inflammation of the gallbladder
2. a. gallstones
   b. recent ingestion of fatty food
3. a. RUQ pain
   b. gradual onset
   c. not colicky pain

Question 16

What are Kidney stones? Whata re some S/S?

Answer 16

1. Calculi (mineral deposit) in the kidney
2. -severe flank pain
   - maybe colicky
   - resltessness
   - N/V

Question 17

What is a urinary tract infection? S/S?

Answer 17

1. Bacterial infection in the urinary tract
2. -Lower abdominal pain
   - pain and/or burning during urination
   - hematuria (blood in urine)
   - urgency and frequency

Question 18

What is pyelonephritis? S/S?

Answer 18

1. Inflammartion of the kidney
2. -flank pain
   - pain and/or burning during urination
   - hematuria
   - fever

Question 19

What is pelvic inflammatory disease? S/S?

Answer 19

1. The inflammation of the female pelvic organs (STD)
2. -dull RLQ or LLQ pain
   - abnormal vaginal discharge
   - N/V
   - fever

Question 20

What is an ectopic pregnancy? S/S?

Answer 20

1. Embryo ghestation outisde uterus
   - usually fallopian tubes
2. -RLQ or LLQ pain
   - late last menstrual period LMP
   - may have vaginal bleeding
   - shock

Question 21

What is Peritonitis? S/S?

Answer 21

1. Inflammation of the peritoneum
2. -generalize abdominal pain
   - fever
   - rigid abdomen
   - N/V
   - Distention

Question 22

What is a dissecting abdominal aortic aneurysm? S/S?

Answer 22

1. Aneurysm develops between arterial layers
2. -shearing/tearing abdominal pain
   - sudden onset
   - shock
   - unequal femoral pulses

Question 23

How do you assess acute abdomen and abdominal trauma? What are some S/S to look for?

Answer 23

1. a.**OPQRST **
   - all pain is not the same
   b. SAMPLE or HAM
2. a. N/V diarrhea
   b. anorexia
   c. fever
   d. weakness or syncope (fainting)

Question 24

What do you look for in the physical exam of acute abdomen?

Answer 24

• Observe for distention
• Palpate for TRPGR
• Check all four quadrants
• Start away from pain

Question 25

What does the acronym **TRPGR, OPGRST, SAMPLE**, and **HAM** stand for? ## Footnote

Answer 25

1. **TRPGR**: **T**enderness, **R**igidity, **P**ulsating masses, **G**uarding, **R**ebound tenderness 2. **OPQRST**: **O**nset, **P**rovoked, **Q**uality, **R**adiates, **S**everity (**S**cale), **T**ime 3. **SAMPLE**: **S**igns/**S**ymptoms, **A**llergies, **M**edication, **P**ast medical history, **L**ast know intake, **E**vent 4. **HAM**: **H**istory, **A**llergies, **M**edications

Question 26

What should one consider when _assessing_ **females**?

Answer 26

1. Always **consider gynecological problem** with women having **abdominal pain** 2. **Pregant** 3. Last menstrual period **LMP** 4. **Prior gynecological problems**

Question 27

What is the best _treatment_ for **acute abdomen**?

Answer 27

* **Oxygen** * **Position of comfort** * **No oral fluids** * **Monitor vitals carefully** * **Transport** * **Treat for shock** PRN

Question 28

What are definitions for **Dialysis, shunts/fistulas, kidneys role in homeostasis, and hydrocholirc acid**.

Answer 28

1. **Dialysis**: is a process for removing waste and excess water from theblood, and is used primarily as an artificial replacement for lost kidney function in people with renal failure 2. **Fistula**: is an abnormal connection between an organ, vessel, or intestine and another structure 3. **Shunt:** a hole or a small passage which moves, or allows movement of fluid from one part of the body to another 4. **Kindeys maintain homeostatis**: releasing hormones to regulate blood pressure and through altering sodium and electrolyte balances to maintain proper fluid amounts in the body 5. **Hydrocholoric acid**: or digestive juices

Question 29

What is _classified_ as **abdominal trauma**?

Answer 29

**Penetrating and blunt**

Question 30

Which are the **solid organs** of the _abdomen_? And **hollow**?

Answer 30

1. **a. liver b. spleen c. kidneys d. pancrease** 2. **2. a. stomach b. intestines c. bladder**

Question 31

What organs are in the **RUQ**?

Answer 31

**Largely liver, gallbladder,** _tail of the pancreas_**, _right_ kidney with adrenal gland**

Question 32

What organs are in the **LUQ**?

Answer 32

**Stomach, spleen,** _head of the pancreas_, **_left_ kidney with adrenal gland**

Question 33

What organs are in the **RLQ**?

Answer 33

**Large/small intestines & ovary**

Question 34

What organs are in the **LLQ**?

Answer 34

**Large/small intestines & ovary**

Question 35

What is a **blunt or penetrating injury**?

Answer 35

1. **Blunt: closed injury** 2. **Penetrating: open injury**

Question 36

What are the _S/S_ of **abdominal trauma**?

Answer 36

* **Mechanism of injury** * **Pain (pain upon palpatation)** * **Tachycardia** * **Shock** * **Bruising** * **Distended or rigid abdomen** * **N/V**

Question 37

How do you _physically exam_ an **abdominal trauma** patient?

Answer 37

* **Determine type of injury** * **Observe for distention** * **Palpate** (_TRPGR_) * **CHeck all four quadrants** * **Start away from pain**

Question 38

How do you _treat_ **all abdominal injuries**?

Answer 38

* **High flow O2** * **Keep airway clear** * **Treat for shock PRN** * **No oral fluids** * **Rapid transport** * **Supine/shock**

Question 39

How do you _care_ for patients with **penetrating injuries**?

Answer 39

* **Check for exit wounds** * **Dry sterile dressing** * **Bulky dressing for impaled wounds**

Question 40

What is **abdominal evisceration**? What should you **_not do_**? How do you _care_ for it?

Answer 40

1. **Internal organs or fat protrude through the open wound** 2. **Never try to replae organs** 3. **-cover with moist gauze, then sterile dressing -keep organs warm and moist transport promptly**

Question 41

What are the functions of the **Mouth, esophagus, stomach, small intestine, large intestine, anus, liver, pancreas, gallbladder**

Answer 41

**Mouth**: _mechanically breaks down food_; _begins chemical breakdown_ with saliva **Esophagus**: _moves from mouth to the stomach_; muscular and vascular system **Stomach**: performs _mechanical and chemical breakdown of food_; food in, _chyme out_ **Small intestine**: major site for _chemical breakdown of food_; _major __absorption_ of water, fats, proteins, carbohydrates and vitamins **Large intestine**: _water absorption_; _formation of feces_, _bacterial digestion of food_ **Anus**: last portion of large intestine ; _sphincter to control release of feces_ **Liver**: _prodcution of pile_, assissts with carbohydrate, and fat _metabolism of nutrients within bloodstream_; _vitamin storage and manufacture_; _detoxification of blood_; _elimination of waste_ **Pancreas**: **exocrine**; _enzymes_ for protein, carbohydrate, and fat breakdown; **endocrine**: _insulin and glucagon_ **Gallbladder**: storage and bile