chapter 22: abdominal emergencies Flashcards
(30 cards)
spleen
filtering blood and assisting with immune response
liver
removing toxins from the body
peritoneum
the membrane that lines the abdominal cavity (the parietal peritoneum) and covers the organs within it (the visceral peritoneum)
organs enclosed in the peritoneum
Encloses stomach, liver, spleen, appendix, small and lar organ,
Women: uterus, fallopian tubes, and ovaries
visceral peritoneum
covers the organs
parietal peritoneum
attached to the abdominal wall
extraperitoneal space
the area outside the peritoneum & contains retroperitoneal space
retroperitoneal space
area between the abdomen and the back
Inside: organs kidney, pancreas, aorta
Inferior: bladder and most of the rectum
What are the two main blood vessels and where are they located?
Aorta (largest artery): travels down through the diaphragm and traverses the retroperitoneal space
Inferior vena cava: behind the peritoneum
visceral pain
- originates from the organs (the viscera) within the abdomen
- Organs don’t contain many nerves therefore often described as dull, achy, or intermittent and may diffuse or difficult to locate
- intermittent, crampy, or colicky often comes from hollow organs of the abdomen.
- dull and persistent often originates from solid organs.
parietal pain
-arises from the parietal peritoneum, the lining of the abdominal cavity—thus, it is often referred to as peritoneal tenderness
-more widespread and efficient nerve endings, pain originating from the parietal peritoneum can be more easily located and described than pain from the visceral organs.
- Such irritation may be caused by internal bleeding (as from blood leaking into the peritoneum from an injured spleen) or infection/inflammation (such as pain in the RLQ from an infected appendix)
- may be sharp or constant and localized to a particular area
pain as worsening when he moves and getting better when he remains still or lies with the knees drawn up.
tearing pain
-Not very common
-Aorta and stomach have the ability to detect tearing sensations
-expanding abdominal aortic aneurysm (AAA), the inner layer of the aorta is damaged and blood leaks from the inner portions of the vessel to the outer layers. This causes a tearing of the vessel lining and pockets of blood resting in a weak area of the vessel
-Often sensed as a ‘tearing’ pain in the back
Patients with this problem often report burning or tearing pain and frequently bleed heavily as a result.
referred pain
- pain felt in a place other than where the pain originates
- Gallbladder is diseased felt in the right shoulder blade
- Common complaint associated with ectopic pregnancies
appendicitis
-Infection of the appendix
-Most common cause of a person needing surgery
-Signs and symptoms: nausea and sometimes vomiting, pain in the area of the umbilicus (initially), followed by persistent pain in the right lower quadrant (RLQ)
§ If ruptured: the patient will typically experience a sudden severe increase in pain
result of the bowel contents being let loose into the peritoneal cavity, leading to peritonitis
peritonitis
-the lining of the abdomen (very sensitive to foreign substances i.e. gastric juices, bowel contents, and blood)
-may be the result of a medical condition (such as the inflammation of a ruptured appendix) or the result of trauma (such as bleeding from a ruptured spleen)
-abdomen typically becomes extremely painful and rigid
-Not a voluntary response as guarding
-can also be accompanied by fever and other signs of infection
-Potentially life-threatening emergency
needs prompt evaluation by a physician to determine the appropriate treatment, which is often surgery
cholecystitis/ gallstones
inflammation of the gallbladder, often caused by gallstones
- experience severe and sometimes sudden right upper quadrant (RUQ) and/or epigastric (upper central abdomen just below the xiphoid process) pain, which may radiate to the shoulder.
- Often confused for chest pain
- may be caused or worsened by ingestion of foods high in fat and can sometimes abruptly end as a stone frees itself and is passed
pancreatitis
- inflammation of the pancreas, is common in patients with chronic alcohol problems
-Pain found in epigastric area - Pain may radiate to the back and/or shoulders
in advanced cases can present with signs of shock
Gastrointestinal (GI) Bleeding
- Can occur anywhere from the esophagus to the rectum
- Can be gradual, sudden or massive
- Passes through the rectum or the mouth
- May report abnormal black stool, maroon in color, and tarry in appearance
- Vomiting of frank blood or coffee grounds
- can be associated with pain but often occurs without pain
- chronic gastrointestinal hemorrhage
- Bleed in small vessels
- Slow blood loss
- Pale and weak
-Eventually the patient develops signs and symptoms and shock
-bleeding from the rectum or vomiting of either bright red blood or material that resembles coffee grounds. This type of bleeding is associated with the sudden onset of signs and symptoms of hypoperfusion.
blood vessels of the esophagus can become vulnerable often due to chronic alcohol ingestion or from hypertension in the liver. If these blood vessels rupture, massive upper GI bleeding can occur. This bleeding, because of its proximity to the pharynx, can threaten the airway and pose a serious life threat.
Abdominal Aortic Aneurysm (AAA)
- ballooning or weakening in the wall of the aorta as it passes through the abdomen. The weakening results in tearing of the internal layer of the blood vessel, which allows blood to escape into the weaker, outer layers.
- Area grows and ruptures
- Ruptured aneurysms are associated with an extremely high rate of death if they are discovered after they rupture
- gradually developing abdominal pain, which can be described as sharp pain or tearing pain and may radiate to the back
A sudden rupture of the aorta typically causes rapid onset of excruciating abdominal and back pain. Signs of shock are usually present. Depending on the location of the AAA, there may be inequality between the femoral or pedal pulses.
Hernia
- hole in the muscle layers of the abdominal wall, allowing tissue—usually intestine—to protrude up against the skin
- Aggravated by heavy lifting or straining
- cause a sudden onset of pain, usually after lifting
- A hernia may be palpated as a mass or lump on the abdominal wall or in the creases of the groin
- Only life-threatening if the hernia causes an obstruction or twisting of the intestine
- all patients with a painful hernia should be transported for further evaluation at the hospital.
Renal Colic
§ Kidney stones
§ descend down the ureter on the way to the bladder, it can cause severe flank pain that often radiates anteriorly to the groin area
§ Visceral pain is often severe
§ May be associated with nausea and vomiting
§ “writhing” because they move around, trying unsuccessfully to find a position of comfort.
Cardiac Involvement
§ Pain from a heart attack may be felt as abdominal discomfort
§ indigestion or digestive discomfort, is commonly felt in the epigastric region (the area below the xiphoid, in the upper center of the abdomen). All epigastric abdominal pain should be considered cardiac in nature until proven otherwise
Primary Assessment of Abdominal Pain
§ general impression you obtain as you approach the patient will be valuable in determining the seriousness of the patient’s condition and the urgency of your care
§ Level of consciousness
§ you will be able to notice the early signs of shock. An altered mental status; anxiety; pale, cool, or moist skin; and rapid pulse and respirations will alert you to shock long before you would take a blood-pressure or see trends in the blood pressure
§ Position is important
§ Consider supplemental oxygen
History Specific to Female Patients with abdominal pain
□ ectopic pregnancy (a pregnancy developing outside of the uterus) can be life-threatening conditions and must be considered in the history. Other conditions, such as ruptured ovarian cysts, pelvic inflammatory disease, and menstrual irregularities, can also cause significant pain.
□ Important Questions
Where are you in your menstrual cycle?
Is your period late?
Do you have bleeding from the vagina now that is not menstrual bleeding? If you are menstruating, is the flow normal?
Have you had this pain before?
If so, when did it happen and what was it like?
Is it possible you are pregnant?
Are you sexually active?
