the inner most layer of the abdomen and is in contact with the abdominal organs.
visceral peritoneum
the outer most layer of the abdominal cavity
parietal peritoneum
abdominal quadrant : most of stomach spleen pancreas part of large intestine kidney
LUQ
abdominal quadrant : most of liver gallbladder part of large intestine kidney
RUQ
abdominal quadrant : appendix part of large intestine fallopian tube ureter ovary
RLQ
abdominal quadrant : part of large intestine ureter fallopian tube ovary
LLQ
contains/encloses the abdominal organs such as the stomach, spleen, liver, gallbladder, pancreas, small intestine, and part of the large intestine
Intraperitoneal
contains/encloses the abdominal organs such as the kidneys, ureters, pancreas, and abdominal aorta
retroperitoneal
the abdominal cavity contains three types of structures:
hollow organs
solid
vascular
contains some type of substance that may leak into the abdominal cavity if the organ is perforated or injured. any substance that leaks may lead to chemical or bacterial peritonitis.
hollow organs - typically do not have the same blood volume therefore they do not bleed as much.
organs that are very vascular (contain a large amount of vessels and blood). some are covered by a thick fibrous capsule (liver and spleen). when ruptured or injured, tends to bleed, potentially leading to severe shock.
solid organs
large blood vessels found in the abdominal cavity. rupture or injury to either vessel with result in major bleeding, rapid blood loss, and death.
vascular structures
hollow organs
appendix bladder common bile duct fallopian tubes gallbladder intestines stomach uterus ureters
solid organs
kidneys liver ovaries pancreas spleen
major vascular structures
abdominal aorta
inferior vena cava
abdominal pain usually results from one of the following three mechanisms:
mechanical forces (stretching)
inflammation
ischemia (organ and tissue hypoxia)
a saclike, stretchable pouch located below the diaphragm that receives food from the esophagus (tubelike structure from the throat). the stomach enables digestion by secreting a specialized fluid to air in the breakdown and absorption of food.
stomach
the first part of the small intestine that connects to the stomach
duodenum
a tubelike structure beginning at the distal end of the stomach and ending at the beginning of the large intestine. its digestive function is to absorb nutrients from intestinal contents
small intestine
a tubelike structure beginning at the distal end of the small intestine and ending at the anus. it reabsorbs fluid from intestinal contents, enabling the excretion of solid waste from the body
large intestine
a large, solid organ located in the RUQ just beneath the diaphragm with a slight portion extending to the LUQ. it filters the nutrients from blood as it returns from the intestines, stores glucose (sugar) and certain vitamins, plays a part in blood clotting, filters dead red blood cells, and aids in the production of bile. proportionally larger in the pediatric Pt.
liver
a pear-shaped sac that lies on the underneath right side of the liver. holds bile, which aids in the digestion of fats.
gallbladder
an elongated, oval, solid organ located in the LUQ behind and to the side of the stomach. it aids in the production of blood cells as well as the filtering and storage of blood. proportionally larger in the pediatric Pt.
spleen
a gland composed of many lobes and ducts located in both the RUQ and LUQ, just behind the stomach. it aids in the digestion and regulates carbohydrate metabolism.
pancreas
paired organs located behind the abdominal wall lining (retroperitoneal), one on each side of the spine. excrete urine and regulate water, electrolytes, and acid-base balance.
kidneys
a saclike structure that acts as a reservoir for the urine received from the kidneys
urinary bladder
pain from the organ itself
poorly localized, intermittent, crampy, dull of aching pain associated with ischemia, tearing, or distention of an organ.
visceral pain - also associated with nausea and vomiting
localized, intense, sharp, usually found on one side or the other - typically constant pain associated with irritation of the peritoneum.
parietal pain - also called somatic pain
abdominal regions:
right 3
right hypochondriac region
right lumbar region
right illiac region
abdominal regions:
middle 3
epigastric region
umbilical region
hypogastric region
abdominal regions:
left 3
left hypochondriac region
left lumbar region
left illiac region
pain that is felt elsewhere in the body. it is usually poorly localized but is felt consistently in the part of the body it is referred to. occurs when organs share a nerve pathway with a skin sensory nerve.
referred pain - the brain becomes confused in the interpretation of the impulse and causes the Pt to feel pain at a location that may be totally unrelated to the organ involved.
irritation and inflammation of the peritoneum. occurs when blood, pus, bacteria, or chemical substances leak into the peritoneal cavity.
peritonitis
abdominal contents that are ______ that leak into the abdominal cavity and irritate the peritoneum will produce a sudden onset of severe, sharp, constant abdominal pain
acidic or alkaline
S/S: abd pain or tenderness N/V or diarrhea fever and chills lack of appetite positive markle (heel drop/jar) test
peritonitis
inflammation of the appendix
appendicitis
S/S: initial - umbilicus late - localized RLQ abd pain or cramping N/V fever lack of appetite abd guarding positive markle (heel drop)
appendicitis
inflammation of the pancreas
pancreatitis
S/S:
abd pain
N/V
abd tenderness and distention
mild jaundice (depending on cause)
severe abd pain - radiation from umbilicus to back and shoulders
fever, rapid pulse, and signs of shock (in some cases)
pancreatitis
inflammation of the gallbladder
cholecystitis (ko-luh-sis-TIE-tis)
S/S: sudden onset of abd pain located from the middle upper quadrants (epigastric area) to RUQ areas (pain is present more commonly at night and associated with ingestion of fatty foods. pain may also be referred to the right scapula.) tenderness upon palp of RUQ belching or heartburn N/V (contents may be greenish)
cholecystitis (ko-luh-sis-TIE-tis)
S/S: abd pain or tenderness hematemesis (vomit - bright red blood or coffee grounds) hematochezia (bright red blood in stool - rapid onset) melena (dark tarry stools) AMS tachycardia signs of shock
gastrointestinal bleeding
vomiting blood, which can be bright red or look like coffee grounds
hematemesis
bright red blood in the stool normally signifying a rapid onset
hematochezia
dark tarry stools containing decomposing blood normally from the upper gastrointestinal system
melena
bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus.
esophageal varices
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis.
cirrhosis
S/S: large amounts of bright red hematemesis (vomiting of blood) absence of pain or tenderness in the abd rapid pulse dyspnea pale, cool, clammy skin s/s of shock jaundice
esophageal varices
inflammation of stomach and small intestines, commonly associated with presence of abdominopelvic pain.
gastroenteritis
S/S: abd pain or cramping N/V and diarrhea abd tenderness fever and dehydration s/s of shock and hemorrhage may be present
gastroenteritis
open wounds or sores within the digestive tract, usually in the stomach or the beginning of the small intestine
ulcers
S/S:
sudden onset of abd pain normally in the LUQ and epigastric area, usually described as a burning or gnawing-type pain before meals or during stressful events
N/V
hematemesis, hematochezia, or melena or coffee ground emesis in some cases
s/s of shock in cases of massive bleeding
pertonitis with a rigid abd in cases of perforation
ulcers
a blockage that interrupts the normal flow of the intestinal contents
intestinal obstruction
S/S: abd pain N/V constipation abd distension and tenderness abnormally prominent, high-pitched bowel sounds w/ auscultation most at risk - age 50+
intestinal obstruction - can lead to sepsis, perforation, intestinal infarction, peritonitis
protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall.
hernia
S/S: sudden onset of abd pain (usually after heavy lifting or straining fever rapid pulse tender mass at point of hernia others similar to intestinal obstruction
hernia
a weakened, ballooned, and enlarged area of the wall of the abdominal aorta
AAA - abdominal aortic aneurysm
small tear of the inner vessel structure, which allows blood to leak between the walls of the aorta.
aortic dissection
S/S:
- gradual onset of lower lumbar, groin, and abd pain
- rupture associated with sudden onset of severe, constant abdominal pain. may radiate to lower back, flank, or pelvis. may be described as “tearing” pain.
- testicular pain in males
- possible N/V
- pale cool clammy possibly cyonotic in legs
- absent or decreased femoral or pedal pulses
- if abd is soft, a pulsating abdominal mass may be felt. if the aneurysm has burst, the abd will be rigid and tender
- if the aortic aneurysm is starting to rupture, the skin below the waistline may become cyanotic, cold, and mottled. from drop in blood flow to extremities
abdominal aortic aneurysm - AAA
a pt with an acute abd generally appears very ill and will assume a __________ with his knees drawn up and his hands clenched over his abdomen.
guarded position
abdominal wall contraction the Pt cannot control
involuntary guarding also referred to as rigidity
when Pt contracts the abdominal muscles, usually in anticipation of pain or an unpleasant sensation.
voluntary guarding
S/S: pain or tenderness anxiety and fear position - feet drawn up/guarding rapid shallow breathing rapid pulse BP changes N/V and/or diarrhea rigid abdomen or guarding distended abdomen fever and chills belching or flatulence changes in bowl/urination other s/s of shock signs of internal bleeding - hematemesis, melena, hematochezia
acute abdominal pain
emergency care for abdominal pain
airway pos of comfort oxygen = 94% NEVER GIVE ANYTHING BY MOUTH calm and reassure treat for shock if need be ALS
reduction of number of red blood cells in the circulating blood volume
anemia
hereditary blood disorder - red blood cells have abnormal hemoglobin that does not carry adequate oxygen. as a result the cells take on a crescent shape and become fragile, stiff, and rigid.
sickle cell anemia
four common acute patterns for sickle cell crisis:
bone crisis
acute chest syndrome
abdominal crisis
joint crisis
sickle cell crisis that typically involves the large long bones in the arm and leg, causing sudden sever pain
bone crisis
sickle cell crisis that involves a sudden onset of chest pain, possibly with dyspnea, hypoxia, and cough, which may be nonproductive, or the pt may cough up blood. a low-grade fever may be present
acute chest syndrome
sickle cell crisis that causes sudden, constant abdominal pain that may be general or localized. there may or may not also be nausea, vomiting, and diarrhea.
abdominal crisis
sickle cell crisis that presents with an acute onset of one or more painful, stiff joints
joint crisis
S/S: bone pain joint pain fever chest pain SOB fatigue pale tachycardia jaundice ulcers on lower legs excessive thirst priapism frequent urination sudden blindness in one eye (retinal detachment)
sickle cell crisis
blood disorder that affects clotting. when a person with hemophilia is injured, it takes longer for the bleeding to stop because clots are unable to form properly.
hemophilia
the branch of medicine that studies health of the female Pt and her reproductive system
gynecology
the uterus is lined by the endometrium, which is sloughed off during ______, or the menstrual period
menses
S/S: lower abdominal or pelvic pain abd tenderness vaginal bleeding rapid pulse s/s of shock
spontaneous abortion
severe pain or cramps during menstruation
dysmenorrhea
abdominopelvic pain during the middle of a menstrual cycle that is associated with ovulation
mittelschmerz
fluid-filled sac that forms inside or on an ovary. formed during ovulation when a follicle containing the egg fails to open as it is supposed to.
ovarian cyst
S/S: unilateral abdominopelvic pain that may radiate to the back
abdominal tenderness
vaginal bleeding - irregular or abdnormal
pain during sex or bowel movements
most are asymptomatic (have no symptoms)
ovarian cyst
an inflammation of the endometrium.
endometritis
S/S: abdominopelvic pain or tenderness fever abdominal distention vaginal bleeding or discharge discomfort during a bowel movement
endometritis
inflammation of the female reproductive tract.
cause by the same bacteria that lead to STDs
pelvic inflammatory disease - PID
S/S: abdominopelvic pain or tenderness vaginal discharge with an abdnormal color, consistency, or odor fever and chills anorexia N/V irregular vaginal bleeding or cramping pain during sex
pelvic inflammatory disease - PID
most stds are cuased by 1 2 3 4
bacteria
viruses
parasites
fungi
S/S: abdominopelvic pain or tenderness vaginal discharge with abnormal color, consistency or odor fever and chills N/V irregular vaginal bleeding or cramping pain during sexual intercourse or urination genital itching, redness, swelling lesions or ulcers
STD
the branch of medicine that studies the urinary system in females and the genitourinary system in males
urology/urologist
the urinary system is composed of: 1 2 3 4
kidneys
ureter
urinary bladder
urethra
S/S: abdominopelvic pain or tenderness blood in urine urine with cloudiness or a foul or strong odor pain or burning with urination or sex frequent or urgent need to urinate genital or flank pain fever or chills N/V AMS
UTI
crystals of substances such as calcium, uric acid, struvite, and crystine that are formed from metabolic abnormalities.
most frequently occur in men between the ages of 20 and 50
kidney stones or renal calculi
S/S: abdominopelvic pain or tenderness flank or back pain that is colicky and severe groin pain abnormal urine color pain with urination frequent or urgent need to urinate fever or chills N/V
kidney stones
during this condition, the kidneys are not able to filter the wastes and maintain homeostasis as they normally would.
kidney failure
S/S blood in urine or stool AMS edema of feet, ankles, legs decreased urine or no urine hypertension swelling or easy bruising anorexia tachycardia
kidney failure
an artificial process used to remove water and waste substances from the blood when kidneys fail to function properly
dialysis
special fluid for dialysis
dialysate
dialysis machine containing dialystate is connected to an access site on the Pt.
hemodialysis
dialystate ran through a tube in the Pt’s abdomen.
peritoneal dialysis