1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 23-1 Chapter 23 Abdominal and Gastrointestinal Disorders

2. 23-2 Objectives

3. Anatomy Review Borders of the abdominal cavity –Diaphragm –Pelvis –Spine –Abdominal wall Major blood vessels –Aorta –Inferior vena cava 23-3

4. Anatomy Review Peritoneum Retroperitoneum (retroperitoneal space) 23-4

5. 23-5 Abdominal Quadrants

6. Solid Organs Abdomen –Liver –Spleen Retroperitoneal space –Kidneys 23-6

7. Hollow Organs Abdomen –Stomach –Intestines –Gallbladder Retroperitoneal space –Urinary bladder 23-7

8. Primary Digestive System Organs Mouth Pharynx Esophagus Stomach Small intestine Large intestine Rectum Anal canal 23-8

9. Accessory Digestive System Organs Teeth Tongue Salivary glands Liver Gallbladder Pancreas 23-9

10. Process of Digestion 23-10

11. The Acute Abdomen 23-11

12. Acute Abdomen Sudden onset of abdominal pain Possible associated assessment findings and symptoms –Nausea and vomiting –Abdominal tenderness and/or rigidity –Signs and symptoms of shock may also be present 23-12

13. Abdominal Pain Abdominal pain may or may not be the result of a problem involving an organ within the abdominal cavity. 23-13

14. Referred Pain Pain that is felt in a part of the body that is away from the tissues or organ that causes the pain. 23-14

15. Hemorrhagic Causes of Acute Abdominal Pain 23-15

16. Gastritis Inflammation of the stomach lining Possible causes –Increased gastric secretion associated with excessive consumption of alcohol –Infection caused by bacteria such as Helicobacter pylori (H. pylori) –Prolonged use of medications –Severe physical stress such as burns, severe infection, surgery, or trauma 23-16

17. Gastritis Assessment findings and symptoms –Belching –Nausea and vomiting –Indigestion –Burning sensation in the upper abdomen 23-17

18. Peptic Ulcer Disease A peptic ulcer is an open sore in the lining of the stomach (gastric ulcer), duodenum (duodenal ulcer), or esophagus (esophageal ulcer). Primary cause –H. pylori bacteria Contributing cause –Excess secretion of digestive juices, such as hydrochloric acid, by stomach cells 23-18

19. Peptic Ulcer Disease Gastric ulcer Duodenal ulcer Esophageal ulcer 23-19

20. Upper Gastrointestinal Bleeding Bleeding may occur from any part of the GI tract. GI bleeding is a medical emergency. Upper GI bleeding is bleeding from the esophagus, stomach, or duodenum. 23-20

21. Upper Gastrointestinal Bleeding Assessment findings and symptoms –Hematemesis May be bright red or resemble coffee grounds –Syncope –Fatigue –Shortness of breath 23-21

22. Lower Gastrointestinal Bleeding Can originate in the small intestine, colon, or rectum Common causes –Tumors, hemorrhoids, colitis Assessment findings and symptoms –Rectal bleeding, which may include melena –Increased frequency of stools –Cramping pain 23-22

23. Nonhemorrhagic Causes of Acute Abdominal Pain 23-23

24. Appendicitis Inflammation of the appendix Assessment findings and symptoms –Sudden onset of abdominal pain that shifts to the RLQ –Nausea –Vomiting –Fever –Loss of appetite 23-24

25. Intestinal Obstruction Blockage of the large or small intestine Assessment findings and symptoms –Cramping abdominal pain –Nausea –Vomiting or diarrhea –Gradual loss of appetite –Abdominal distention and tenderness –Decreased or no passage of stool –Inability to pass gas –Fever and chills 23-25

26. Pancreatitis Inflammation of the pancreas Assessment findings and symptoms –Abdominal pain that typically radiates to the back –Severe, deep, piercing, and steady pain –Nausea, vomiting –Abdominal tenderness –Fever –Hypotension, tachycardia 23-26

27. Cholecystitis Inflammation of the gallbladder Assessment findings and symptoms –Pain in the upper middle or right upper quadrant of the abdomen –Pain described as severe, steady, and worsens with movement –Nausea, vomiting –Constipation or diarrhea –Excessive belching 23-27

28. Gastroenteritis Inflammation of the intestinal lining –Most often caused by a virus Assessment findings and symptoms –Diarrhea –Abdominal pain and tenderness –Vomiting –Headache –Fever –Chills 23-28

29. Hepatitis Inflammation of the liver, most commonly caused by a viral infection Assessment findings and symptoms –Dull right upper quadrant pain and tenderness unrelated to food consumption –Nausea and vomiting –Loss of appetite –Extreme fatigue –Dark urine, clay colored stools –Jaundice 23-29

30. Patient Assessment 23-30

31. Patient Assessment Scene size-up Primary survey Establish patient priorities Determine the need for additional resources Make a transport decision 23-31

32. Patient History Signs/symptoms Allergies Medications Past medical history Last oral intake Events prior Onset Provocation/ Palliation / Position Quality Region/Radiation Severity Time 23-32

33. Physical Examination Observe the patient’s position Listen to breath sounds Assess vital signs and oxygen saturation Assess the abdomen for DCAP-BTLS 23-33

34. Emergency Care Prehospital care is supportive Allow the patient to assume a position of comfort Provide calm reassurance Administer oxygen Reassess as often as indicated 23-34

35. Questions? 23-35