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Flashcards in EAC Abdominal Conditions and Assessment Deck (20):
1

describe the importance of history when assessing a patient

helps to provide insight into the potential cause of the problem

2

technique for history taking of patients with acute abdominal pain

Site
Onset
Character
Radiates
Associated signs and symptoms
Time
Exacerbating/Alleviating
Score

3

main causes of:
Acute abdominal pain

Appendicitis
Cholecystitis
Intestinal Obstruction
Ureteric Colic (stones)
Gastritis
Perforated Peptic Ulcer
Gastroenteritis
Pancreatitis
Diverticular Disease
Leaking or ruptured AAA
Gynaecological Disorders

4

main causes of:
Chronic abdominal pain

IBS
Inflammatory bowel syndromes: Ulcerative Colitis, Crohns Disease)
Gastric and Duodenal Ulcers
Intra-Abdominal Malignancy

5

signs and symptoms of:
Renal Colic (Kidney Stones)/Ureteric Colic

Cramp like pain that varies in intensity
Stone moves down ureters and stretches the wall
Pain is usually in side, radiating to the groin
Often with nausea and vomiting

6

signs and symptoms of:
Acute Cholecystitis

is swelling (inflammation) of the gallbladder

Sharp right upper quadrant pain
Right shoulder tip pain
Pain worse on deep breaths and palpitation
Pyrexia >38c
Nausea and vomiting
History of fat intolerance

7

signs and symptoms of:
Appendicitis

is a painful swelling of the appendix

Constant pain increasing in intensity
Peri umbilical to right lower quadrant
Pain worse on movement
Nausea, vomiting, anorexia
Pyrexia >37.5
Atypical signs in the elderly and young

8

signs and symptoms of:
UTI

Infection of Kidneys, Ureters, Bladder, Urethra

Cramping pain in lower abdomen or back
Dysuria - burning sensation
Increased frequency
Haematuria - cloudy or frank blood
?kidney infection: temp >38C, rigors, vomiting

9

signs and symptoms of:
Abdominal Aortic Aneurysm

is a swelling (aneurysm) of the aorta

Consider AAA in patients >50 years
Sudden onset of severe constant pain that peaks soon after onset, often will radiate to sides, lower back and buttocks
Renal colic type pain
Pulsatile mass
Hypotension and severe shock
Collapse
Hypotension with bilateral lower limb ischemia or mottling (a late sign)
History of smoking, Hypertension and Hypercholesterolemia

10

causes of abdominal pain and/or PV bleeding in Pregnancy

early pregnancy 24weeks
-Placental Abruption
-Uterine Rupture
-Severe pre-eclampsia

11

signs and symptoms of:
Ectopic Pregnancy

is when the foetus develops outside the uterine cavity, most commonly in the fallopian tubes.

Pain in lower abdo, pelvic area or back
Nausea
GI symptoms especially: DandV

if pregnancy ruptures: severe pain, shoulder tip pain, feeling faint/collapse

History:
Missed last menstrual period (can occur before this)
History of pelvic inflammatory disease
Previous ectopic pregnancy
Intrauterine device fitted
Tubal surgery
Sterilisation or reversal or procedure
Endometriosis

!!suspect ectopic pregnancy in any women of child bearing age with the above signs!!

12

serious conditions that cause abdominal pain
(from IHCD manual)

Internal Bleeding - vomiting blood, BPV

Peptic Ulcer - common cause of internal bleeding

Diverticulitis - Faecal matter seeps through thin walled diverticula causing inflammation and abscesses

Abdominal Aortic Aneurysm - area of weakening and dilation in the wall of an artery

Kidney Stone - symptoms usually occur when stone starts moving down the ureter and stretches the wall

Ectopic Pregnancy - foetus develops outside uterine cavity

Pelvic Inflammatory Disease - hx of PID predisposes to ectopic pregnancy

Appendicitis - painful swelling of the appendix

Immunosuppressed Patients - e.g. HIV and alcoholic pt's

13

define:
Addison's Disease

Rare disorder of the adrenal glands. It affects the production of two essential hormones called cortisol and aldosterone.

The adrenal gland is damaged and so cannot respond to crisis situations where an increase in adrenaline or cortisol is required.

14

signs and symptoms of:
Addison's Disease

early signs:
Fatigue
Muscle weakness
Low mood
Loss of appetite and unintentional weight loss
Increased thirst

Progressive signs:
Low BP when standing which can cause dizziness or fainting
Nausea
Vomiting
Diarrhoea
Abdominal, joint or back pain
Muscle cramps
Chronic exhaustion
Reduced libido
Brownish discolouration of the skin, lips and gums particularly in the creases of the palms, scars, knuckles, keens

15

management of:
Addison's Disease

Hydrocortisone IM

16

RED FLAGS associated with abdominal pain

Weight loss
Females
Dehydration
Irregular pulse
Tachycardia
Changes in bowel habits
Rigidity/guarding
Pulsatile mass
Pain post trauma
Malaena
Urinary retention
Absolute constipation

17

TIME CRITICAL features of abdominal pain

Major ABCD problems
Suspected leaking or ruptured AAA
Ectopic pregnancy
Sepsis resulting from perforation
Traumatic disruption of abdominal organs e.g. Liver and Spleen

Start correcting A and B and undertake a TIME CRITICAL transfer with pre-alert

18

positional placement of pregnant patient

left lateral tilt

this takes pressure off of the blood vessels and allows nutrients and oxygen to reach baby.

19

management of:
Acute Abdominal Problem

DRABCDE
secondary survey
history taking (socrates)
O2 as per guidelines
ECG
Analgesia - Entonox
Full obs
Expose abdomen - scars, distension, obvious masses, pulsating mass
Palpate abdomen: soft or board like, pulsating mass
Reassurance
Be prepared to assist ventilations/CPR
Nil by mouth
Anticipate vomiting
Anticipate shock
Fowler position if conscious
stable side if unconscious
heavily pregnant - left lateral tilt

Trauma:
treat any abdo injury
Do not remove impaled objects
Do not replace eviscerated organs - cover with Olaes or blast dressing (plastic sheet to bowel then dressing to cover)

20

Acute Abdominal Patient - Physical Assessment

aimed at establishing pt condition and urgency of the problem

ABCD's
Patients position
Degree of distress
Skin for sweating and pallor
Vital signs e.g. tachycardia and hypotension suggest a volume depletion which is a serious sign
The abdomen

Expose the abdomen
Inspect for scars, distension and any obvious masses
Palpate: consistency, soft or boardlike. Pulsating mass

do not spend a lot of time poking abdomen, it will increase discomfort and delay transport.
Simply decide whether its soft or rigid and whether there is a pulsating mass and leave it at that.

Auscultate for bowel sounds