1. Acute Abdomen Temple College EMS Professions

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

3. Acute Abdomen Determining exact cause irrelevant in pre- hospital care Important factor is recognizing acute abdomen is present

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

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

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

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

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

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

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

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

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

13. Physical Exam Vital signs –Tachycardia  ? Early shock (more important than BP) –Rapid shallow breathing  peritonitis Tilt test should be done with non- traumatic abdominal pain

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

15. 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

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

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

18. Appendicitis Usually due to obstruction with fecalith Appendix becomes swollen, inflamed gangrene, possible perforation 

19. 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

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

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

22. 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 

23. 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 

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

25. 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

26. 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

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