Solid organs in abdominal cavity.
liver, spleen, pancreas, kidneys, and ovaries
Which organs are retroperitoneal?
kidneys, ovaries, and pancreas
An injury to a _____ organ can cause shock and bleeding due to the amount of blood vessels contained in the organs.
solid
Main function of GI system is :
absorb and digest products to fuel cells.
Portal viein
Transports venous blood from GI tract to liver for processing of nutrients that have been absorbed.
What happens if blood flow through the liver slows?
The blood may back up throughout the GI system. Veins surrounding the stomach and esophagus dilate. Low pressure can cause leaking or rupture.
Two main functions of urinary system:
Keeps track of electrolytes, water content, and acids in blood.
Removes metabolic wastes, drug metabolites, and excess fluids.
Causes of peritonitis
Infection
Penetrating abd wound
Severe blunt injury
Many diseases
Major clinical signs of peritonitis
Abd tenderness and distention
Visceral peritoneum is only stimulated when :
distention or contraction of hollow abd organs active stretch receptors.
Parietal peritoneum can perceive the same sensations as skin because
its supply be the same nerves from the spinal cord that supply the skin overlying the abdomen.
What part of the nervous system supplies the visceral peritoneum?
Autonomic
Visceral pain
Occurs when receptors in hollow structures are stimulated.
Referred pain
Pain felt in an area of the body other than the area where the cause of pain is located.
Why is the source of visceral pain difficult to pinpoint?
Only a few nerve fibers may be involved in pain transmission.
Peritonitis typically causes ___.
Ileus - paralysis of muscular contractions.
Location of pain with appendicitis.
Direct: RLQ
Referred: navel
Palpation: rebound tenderness
Location of pain with cholecystitis.
Direct: RUQ
Referred: right shoulder
Location of pain with ulcer.
Upper mid-abd or upper back
Location of pain with diverticultitis.
LLQ
Location of pain with AAA.
Lower back
Lower quadrants
Location of pain with cystitis.
Retropubic
Location of pain with pylonephritis.
Costovertebral angle.
Location of pain with kidney stone.
Flank
Referred: radiating to genitalia
Location of pain with PID.
Lower quadrants
Location of pain with pancreatitis.
Upper abd
Back
Location of pain with pnuemonia.
Referred to upper abd
Conditions that may cause or lead to urinary retention.
Kidney stones BPH Urethral obstructions UTI Nerve damage
Causes of acute abdomen.
GI hemorrhage Esophagitis GERD Peptic ulcer disease Mallory-Weiss tear Esophageal varices Hemorrhoids
Acute abdomen
Sudden onset of abd pain that indicated irritation of peritoneum
Causes of upper GI bleed.
Esophagitis Esophageal varices Mallory-Weiss tear Esophageal cancer Cirrhosis, lover disease GERD Stomach ulcers Stomach cancer Gastritis Duodenal ulcer (can cause lower) Small intestine cancer (can cause lower) IBS (can cause lower)
Causes of lower GI bleed.
Duodenal ulcer (can cause upper) Small intestine cancer (can cause upper) IBS (can cause upper) Ulcerative colitis Colorectal polyps Colorectal cancer Diverticular disease Hemorrhoids
s/s of upper GI bleed.
Melena
Hematemesis
s/s of lower GI bleed.
Hematochezia
Complications and adverse reactions of dialysis
Hypotension Muscle cramps N/V Hemorrhage, access site Infection at access site AMS LOC Air embolism Electrolyte imbalance Myocardial ischemia
Why should you consider the possibility of cardiac dysrhythmias and ALS backup?
Dialysis changes the blood’s chemistry which can lead to an electrolyte imbalance.
What are some s/s if patient’s missed their dialysis treatment?
Weakness, pulmonary edema or excess of electrolytes.
How to manage a dialysis patient?
ABCDEs High-flow oxygen if indicated Manage bleeding from access site Position pt sitting upright in case of pulmonary edema. Supine if shock. Transport promptly.
How do you manage an air embolism in a dialysis patient?
Disconnect from dialysis machine
Supine
Transport immediately
s/s of air embolism
sudden dyspnea
hypotension
cyanosis
s/s disequilibrium syndrom
N/V
Headache
Confusion
What is the origin, description, and cause of visceral discomfort?
Origin : hollow organs
Description : difficult to localize; described as burning, cramping, gnawing, or aching; usually superficially
Cause : organ contracts too forcefully or is distended
What is the origin, description, and cause of parietal pain/rebound pain?
Origin : peritoneum
Description : steady, achy pain; easier to localize than visceral, increases with movement
Cause : inflammation of the peritoneum secondary to bleeding or infection
What is the origin, description, and cause of somatic pain?
Origin : peripheral nerve tracts
Description : deep localized pain
Cause : irritation of or injury to tissue causing activation of peripheral nerve tracts
What is the origin, description, and cause of referred abd pain?
Origin : peripheral nerve tracts
Description : pain originating in abd and causes perception of pain in distant locations; usually occurs after initial visceral, parietal, or somatic pain.
Cause : similar paths for the peripheral nerves of the abd and the distant location
What are pertinent negative you should obtain in your SAMPLE for GI or GU?
N/V Changes in bowel habits Urination Weight loss Belching or flatulence Pain Concurrent chest pain LNMP if female childbearing age Recent surgery or hospitalizations Ingested any substance that could cause the sxs
Where should you start when palpating the abd?
Opposite from the site of pain rotating clockwise.
Medical care prior to transport for GI/GU
- Do not dx
- Clear and maintain airway
- Anticipate vomiting - recovery position or comfort
- Administer 100% oxygen and anticipate ventilation
- NPO
- Document all pertinent info.
- Establish IV
- Keep patient comfortable. Conserve body heat. Provide gentle transport and constant psychological support.
- Monitor vital signs.
What fluids should be given for GI/GU emergencies?
Keep-vein-open rate
Signs of hypovolemia: 20-mL/kg bolus of isotonic crystalloid
UTI, kidney stone : bolus of fluid
What GI/GU emergencies should be transported promptly?
PID Ectopic pregnancy Aneurysm Hernia AKI CKD
