2Lesson Objectives List the abdominal organs by quadrants. Know how to assess and manage abdominal injuries, including open and closed injuries and hernias.Know how to assess and manage abdominal illnesses, including pain, appendicitis, nausea and vomiting, diarrhea, constipation, bloody stools, and hemorrhoids.List the evacuation guidelines for abdominal problems.
4Abdominal Injuries (1 of 12) Closed: No break in skinOpen: Penetration of the peritoneal cavityBoth open and closed injuries can cause internal bleeding or leakage of intestinal contents that cause irritation and infection.
5Abdominal Injuries (2 of 12) Closed injuriesOrgans can be injured by a direct blow.Solid organ injuries usually result in significant bleeding.Hollow organ injuries are more likely to cause peritonitis.
6Abdominal Injuries (3 of 12) Closed injuriesWhat to look for:Mechanism of injuryBruising or abrasions of the abdominal wall or lower chestAbdominal pain and tenderness
7Abdominal Injuries (4 of 12) Closed injuriesWhat to look for:Possible spleen injury: Signs of shock, pain in right upper abdomenPossible kidney injury: Pain in the flank; blood in urine; signs of shock; enlarged, tight abdomen; increasing pain; fever; nausea and vomiting
8Abdominal Injuries (5 of 12) Closed injuriesWhat to do:Have victim rest completely, allow only sips of water.Record observations frequently.Evacuate if signs of shock or peritonitis appear.
9Abdominal Injuries (6 of 12) Open injuriesWhat to look for:Protruding bowel or fatExternal bleeding from a laceration of the abdominal wallSigns similar to closed injury
10Abdominal Injuries (7 of 12) Open injuriesWhat to do:For penetrating injury with medical help close by, leave object in place.Might be necessary to remove object for evacuation.Consider shortening a long object.Treat as for closed injuries.
11Abdominal Injuries (8 of 12) Open injuriesWhat to do:Protruding bowel that is not torn can be returned to the abdominal cavity if help is far away.If help is close, cover with a moist cloth.If bowel has torn, do not return to abdominal cavity.
12Abdominal Injuries (9 of 12) HerniaLoops of intestine protrude through a weak spot in the abdominal wall.More common in men than in women.Most common site is the groin.Rarely require surgery.Occasionally blood supply to the protruding loop of intestine is cut off requiring emergency medical care.
13Abdominal Injuries (10 of 12) HerniaWhat to look for: Unstrangulated herniaBulging in the groin that is easier to see when the victim is straining and coughingSwelling, usually soft and painlessSorenessBurningFeeling of pressure
14Abdominal Injuries (11 of 12) HerniaWhat to look for: Strangulated herniaHernia that will not reduceFirm bulge with rapidly increasing pain and tendernessPain spreading to the abdomenPossibly vomiting
15Abdominal Injuries (12 of 12) HerniaWhat to do:Attempt to reduce a possible strangulated hernia.Evacuate if there is increasing pain and you are unable to reduce the hernia.
16Abdominal Illnesses (1 of 17) PainOften difficult to determine exact cause.Decision to evacuate hinges on determining course of illness, difficulty in obtaining help, and the number of people in the group.
17Abdominal Illnesses (2 of 17) PainWhat to look for:Signs of shockSAMPLE historyLocation of the painDiarrhea and vomiting
18Abdominal Illnesses (3 of 17) PainWhat to look for:Signs of dehydrationWhether others in the party have the same problemIngestion of potentially poisonous plants or unpurified waterDiabetes or pregnancyPainful, rigid, swollen abdomen
19Abdominal Illnesses (4 of 17) PainWhat to do:Perform initial check and assess vital signsAllow sipping of clear, non-caffeinated fluids.Provide an antacid.Apply heat.Be prepared for vomiting.Allow victim to assume most comfortable position.
20Abdominal Illnesses (5 of 17) AppendicitisWhat to look for:Intermittent pain in midabdomen that moves to the lower right abdomen. Pain increases over 6 to 24 hours, becomes constant.Tenderness over right lower abdomen.
21Abdominal Illnesses (6 of 17) AppendicitisWhat to look for (continued):Intermittent vomiting.Loss of appetite.Low-grade fever.Pain and tenderness throughout abdomen, indicating ruptured appendix.
22Abdominal Illnesses (7 of 17) AppendicitisWhat to do:Place victim in most comfortable reclining position.Let victim sip fluids.Evacuate.
23Abdominal Illnesses (8 of 17) Nausea and vomiting: What to look forAbdominal painBlood or brown, grainy material in vomitDiarrheaChills and feverSigns of dehydrationOthers in group with similar symptomsRecent head injuryIngestion of wild plants/mushrooms or unpurified water
24Abdominal Illnesses (9 of 17) Nausea and vomiting: What to do:Provide clear fluids, clear soups, flat soda, juiceIf victim can keep fluids down, offer carbohydrates, but no milk products.Have victim rest.Evacuate if vomiting persists more than 48 hours.
25Abdominal Illnesses (10 of 17) Diarrhea: What to look forBloody mucus or pus in stoolDehydrationCramping abdominal painLack of bowel controlFeverOthers in group with similar symptoms
26Abdominal Illnesses (11 of 17) Diarrhea: What to doProvide clear fluids and monitor urine output to assess for dehydration.If victim can keep fluids down, gradually return to normal diet.Provide pink bismuth, if available.Provide loperamide HCL or diphenoxylate atropine if diarrhea persists, but not if there is fever or blood and pus in stools.
27Abdominal Illnesses (12 of 17) ConstipationWhat to look for:Painful, hard bowel movementsInfrequent bowel movements
28Abdominal Illnesses (13 of 17) ConstipationWhat to do:Eat high-fiber foods.Maintain adequate fluid intake.Try to have a bowel movement.Use stool softeners.Avoid laxatives, alcohol, and constipation-causing foods.
29Abdominal Illnesses (14 of 17) Bloody stools and hemorrhoidsWhat to look for:External hemorrhoid: Lump next to anus, bleeding with passage of stool, red blood and clots extruding from the lump or swellingInternal hemorrhoid: Soft swelling that may protrude from rectum during or after bowel movement; bleeding with passage of stool.
30Abdominal Illnesses (15 of 17) Bloody stools and hemorrhoidsWhat to look for (continued):Fissure: Painful crack at margin of anus.Signs of serious bowel bleeding: Painless bowel movements with large quantities of blood; signs of shock.
31Abdominal Illnesses (16 of 17) Bloody stools and hemorrhoidsWhat to do: For minor hemorrhoids and fissuresAdjust diet to soften stoolWarm baths to soothe and cleanse.Wear cotton underwear or loose clothing.Apply cold compresses, zinc oxide, or petroleum jelly
32Abdominal Illnesses (17 of 17) Bloody stools and hemorrhoidsWhat to do: For minor hemorrhoids and fissures (cont’d)Apply hemorrhoid suppositoriesIf cluster or swelling protrudes from rectum, have victim try to slip the tissue back inside by applying manual pressure.What to do: For major bleedingHave victim walk, if possible.Evacuate.
33Evacuation Guidelines for Abdominal Problems (1 of 2) Serious injuryPersistent abdominal pain or pain with high feverUnable to drink or retain fluids for more than 24 hoursPregnant with abdominal painPainful, rigid, swollen abdomen
34Evacuation Guidelines for Abdominal Problems (2 of 2) Pain that increases with cough or movementSigns and symptoms of appendicitisVomiting and diarrhea with severe pain, vomiting with severe headache, or diarrhea with fever and stools containing bloody mucusSigns of internal bleedingSigns of severe dehydration or shock