Acute Abdomen Acute Abdomen General name for presence

Acute Abdomen

Acute Abdomen General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

Acute Abdomen • Determining exact cause irrelevant in prehospital care • Important factor is recognizing acute abdomen is present

History • Where do you hurt? – Know locations of major organs – But realize abdominal pain locations do not correlate well with source

History • What does pain feel like? – Steady pain - inflammatory process – Crampy pain - obstructive process

History • Was onset of pain gradual or sudden? – Sudden = perforation, hemorrhage, infarct – Gradual = peritoneal irrigation, hollow organ distension

History • Does pain radiate (travel) anywhere? – Right shoulder, angle of right scapula = gall bladder – Around flank to groin = kidney, ureter

History • Duration? – > 6 hour duration = ? surgical significance • Nausea, vomiting? Bloody? “Coffee Grounds”? Any blood in GI tract = Emergency until proven otherwise

History • Change in urinary habits? Urine appearance? • Change in bowel habits? Appearance of bowel movements? Melena?

History • Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss

History • Females – Last menstrual period? – Abnormal bleeding? In females, abdominal pain = Gyn problem until proven otherwise

Physical Exam • General Appearance – Lies perfectly still inflammation, peritonitis – Restless, writhing obstruction • Abdominal distension? • Ecchymosis around umbilicus, flanks?

Physical Exam • Vital signs – Tachycardia ? Early shock (more important than BP) – Rapid shallow breathing peritonitis Tilt test should be done with nontraumatic abdominal pain

Physical Exam • Palpate each quadrant – Work toward area of pain – Warm hands – Patient on back, knee bent (if possible) – Note tenderness, rigidity, involuntary guarding, masses

Physical Exam • Bowel Sounds – Listen 1 minute in each quadrant – Listen before feeling – Absent bowel sounds ileus, peritonitis, shock Auscultating bowel sounds has no pre-hospital value in trauma patients

Management • • • Airway High concentration O 2 Anticipate vomiting Anticipate hypovolemia Nothing by mouth No analgesics, sedatives

Management • In adults > 30, consider possibility of referred cardiac pain. • In females, consider possible gyn problem, especially tubal ectopic pregnancy

Appendicitis • Usually due to obstruction with fecalith • Appendix becomes swollen, inflamed gangrene, possible perforation

Appendicitis • • Pain begins periumbilical; moves to RLQ Nausea, vomiting, anorexia Patient lies on side; right hip, knee flexed Pain may not localize to RLQ if appendix in odd location • Sudden relief of pain = possible perforation

Duodenal Ulcer Disease • Steady, well-localized epigastric pain • “Burning”, “gnawing”, “aching” • Increased by coffee, stress, spicy food, smoking • Decreased by alkaline food, antacids

Duodenal Ulcer Disease • May cause massive GI bleed • Perforation = intense, steady pain, pt lies still, rigid abdomen

Kidney Stone • • • Mineral deposits form in kidney, move to ureter Often associated with history of recent UTI Severe flank pain radiates to groin, scrotum Nausea, vomiting, hematuria Extreme restlessness

Abdominal Aortic Aneurysm • Localized weakness of blood vessel wall with dilation (like bubble on tire) • Pulsating mass in abdomen • Can cause lower back pain • Rupture shock, exsanguination

Pancreatitis • Inflammation of pancreas • Triggered by ingestion of Et. OH; large amounts of fatty foods • Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back • Signs, symptoms of hypovolemic shock

Cholecystitis • • Inflammation of gall bladder Commonly associated with gall stones More common in 30 to 50 year old females Nausea, vomiting; RUQ pain, tenderness; fever • Attacks triggered by ingestion of fatty foods

Bowel Obstruction • Blockage of inside of intestine • Interrupts normal flow of contents • Causes include adhesions, hernias, fecal impactions, tumors • Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

Esophageal Varices • Dilated veins in lower part of esophagus • Common in Et. OH abusers, patients with liver disease • Produce massive upper GI bleeds