(3) Abdominal Pain

Lab notes

Right Upper Quadrant

• Liver

• Stomach

• Gallbladder

• Duodenum

• Right kidney

• Pancreas

• Transverse colon

• Right adrenal gland

Left Upper Quadrant

• Liver

• Left adrenal gland

• Stomach

• Left kidney

• Pancreas

• Spleen

• Transverse colon

• Small intestine

Right Lower Quadrant

• Large intestine

• Cecum

• Appendix

• Right ureter

• Right reproductive organs:

  • ovary, fallopian tube, spermatic cord

Left Lower Quadrant

• Small intestine

• Large intestine

• Left ureter]

• Left reproductive organs:

  • fallopian tube, ovary, spermatic cord

• Sigmoid colon

solid organs

organs that bleed when rupture

• liver, spleen, pancreas, kidneys

hollow organs

organs that get infections when ruptured

• stomach, esophagus, small intestine, large intestine

15s

To listen to bowel sounds, place stethoscope in one quadrant for ____s.

Frequent bowel sounds

Frequent or infrequent bowel sounds?

overactive GI (possible diarrhea)

Infrequent bowel sounds

Frequent or infrequent bowel sounds?

inactive GI (possible constipation)

T

T or F?

Do not start in the quadrant where pt complains of pain.

Hernia

occurs when an organ or fatty tissue squeezes through a weak spot in the surrounding muscle or connective tissue

• most commonly appear in the abdomen or groin and often look like a visible bulge that may ache or disappear when lying down.

• They may be incarcerated (with feces)

T

T or F?
Hernias are when our intestines slip through the abdominal muscle wall.

Grey Turner’s and Cullen’s sign

• Most commonly associated with pancreatitis.

• Digestive enzymes get released into the surrounding tissues and can damage blood vessels causing hemorrhaging.

• The umbilicus and flanks are areas where blood can pool.

Abdominal aortic aneurysm (AAA)

• Pts have a complaint of abdominal pain

• tearing sensation to the back and groin might indicate a rupture

• Assume if you palpate a pulsating mass

AAA

If you palpate a pulsating mass, assume _____ until proven otherwise.

Aortic dissection

a false lumen develops as the inner lining is peeling off of the middle lining.

• affects pulse strengths on both sides and has the potential to rupture

true lumen; Intima; Media; Adventitia

Dissected aorta linings begining from false lumen:

1. false lumen

2. ____________

3. ____________

4. ____________

5. ____________

Diverticulosis

Small pockets that form within the intestines can make it difficult for bowel movements to pass through

Diverticulitis

Small pockets that form within the intestines that can trap feces and form infections

3

The artery has how many layers?

T

T or F?
A dissection is not the same thing as a rupture.

rebound tenderness

Diverticulosis produces which type of tenderness?

digested; stomach

Coffee ground emesis is (digested/undigested) blood as it makes its way through the _______.

Hematochezia

the passage of fresh, bright red or maroon blood through the rectum

• whole red blood

Portal hypertension; Esophageal varices (hematemesis); Hemorrhoids (hematochezia); Ulcers (melena or coffee-ground emesis)

What are the major complications of liver cirrhosis?

Liver cirrhosis

leads to:

• Portal hypertension

• Esophageal varices → hematemesis

• Hemorrhoids → hematochezia

• Ulcers → melena or coffee-ground emesis

hematemesis; airway

Why are bleeding esophageal varices dangerous for EMS?

• Can cause massive ________

• Blood may obstruct the ________

• Airway management can be difficult because of profuse bleeding

GI bleeding in liver cirrhosis

• Esophageal varices → Hematemesis (vomiting blood)

• Hemorrhoids → Hematochezia (bright red blood per rectum)

• Ulcers → Melena (black, tarry stool) or coffee-ground emesis

hypertension

occurs from liver failure

ascites

fluid in the peritoneal cavity

tympanic

hollow area in abdominal percussion:

dull

fluid beneath area in abdominal percussion:

Liver

produces bile

gallbladder

stores bile

gallstones (cholelithiasis)

hardened deposits of the digestive fluid bile

Cholecystitis

inflammation of the gallbladder

• When bile gets trapped in the gallbladder or when gallstones back up fluid

Pancreatitis

Inflammation of the pancreas typically caused by high fat content in blood (triglycerides).

• Mid abdominal pain

Appendicitis

• may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract.

• Or it may happen when the tube that joins your large intestine and appendix is blocked or trapped by stool.

peritonitis

If the appendix ruptures, the patient is at risk for:

Spleen

Stores and filters about 25% of our blood and produces white blood cells for infections

blunt trauma

The spleen is at risk for rupturing from:

left upper quadrant (LUQ)

Splenic injury would cause pain in which quadrant?

left shoulder

Splenic injury would cause referred pain to the:

kidney stones (renal calculi)

Brought on by history of dehydration and high salt diet

antibiotics

Urinary Tract Infections (UTI) require:

Dysuria; hematuria; unilateral pain

Signs and symptoms of Genitourinary (GU) conditions

Perforated diverticulum; Transport in a position of comfort

You are managing a 37 year old male patient complaining of abdominal pain. He is sitting with his knees flexed. Movement worsens the pain which is described as severe. There is tenderness to palpation in the left lower quadrant. Vital signs are P96, R18, BP 100/60, SpO2 96%

You should suspect

• Ruptured appendix

• Splenic infarction

• Perforated diverticulum

Your management

• Transport in a position of comfort

• Administer oxygen by non-rebreather mask

• Place the patient in a supine position

Endometritis

inflammation of the endometrium

Endometriosis

The lining that grows and sheds during menses is found outside of the uterus

Fibroids

abnormal growth in certain areas

Gravida

total # of pregnancies

Para

# of delivered births including stillbirth

Ectopic pregnancy

pregnancy outside the uterus

Preeclampsia

hypertensive, hypersensitivity to light

Eclampsia

seizures

Gestational Diabetes

uncontrolled blood sugar

Hyperemesis Gravidarum

intractable vomiting leading to volume depletion

Ruptured Uterus

onset of trauma, fetus is in abdominal space (life threatening emergency)

Placenta Previa

Placenta is blocking the cervix (infant will have to be delivered via c-section)

Abruptio Placentae

onset of blunt trauma, placenta has partially or completely torn off from uterus (70% fetal demise)

Miscarriage

possibility if pregnant patient has heavy clots in vaginal bleeding

every 2 min

Threshold for how often contractions occur is:

90 s or more

Threshold for how long contractions last is:

left lateral recumbent

If transporting pt in their third trimester, lay pt in which positon to displace infant off of venous system?

Nuchal cord

umbilical cord is wrapped around the infant’s head

• think ‘noose’

Prolapsed cord

Umbilical cord is presenting instead of crowning

present

In prolapsed cord:

• If pulse is (present/absent) in prolapsed cord, then cover with moist gauze and reassess in transport

absent

In prolapsed cord:

• If pulse is (present/absent), then insert your fingers and attempt to displace infant off of cord to restore pulse

Limb Presentation

One hand or one foot presenting. Unable to deliver vaginally. 

F

T or F?

A pt is able to deliver vaginally during limb presentation.

knees to chest

During limb presentation, transport the pt in what position?

Breech presentation

The complication comes when the infant’s head gets stuck upon delivery. We would insert our first two fingers

Shoulder dystocia

Perform McRobert’s Maneuver (knee to chest) and apply suprapubic pressure. Clavicular fracture may be needed as well

suprapubic area

In the McRoberts Maneuver, apply pressure to what area?

1 minute and 5 minutes after delivery

When should the APGAR assessment be performed after delivery?

dry, warm, stimulate

In order to induce the infants 1st breath:

T

T or F?
Providing a fundal massage and allowing the adult patient to nurse the infant will stimulate hemorrhage control

amniotic fluid embolism (AFE)

one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation

• causes cardiovascular collapse

anaphylactic reaction

Fetal blood introduced into maternal circulation may cause an:

Disseminated Intravascular Coagulopathy (DIC)

overactive clotting

Appearance

What does the 1st ‘A’ in APGAR score stand for?

Pulse (Heart rate)

What does the ‘P’ in APGAR score stand for?

Grimace (Reflex irritability)

What does the ‘G’ in APGAR score stand for?

Activity (Tone)

What does the 2nd ‘A’ in APGAR score stand for?

Respiration

What does the ‘R’ in APGAR score stand for?

placenta previa

3rd trimester, vaginal bleeding, NO pain

abruptio placentae

3rd trimester, vaginal bleeding, PAIN