Chapter 22: Abdominal Emergencies

Parietal Pain

A localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity

Peritoneum

the membrane that lines the abdominal cavity (the parietal peritoneum) and covers the organs within it (the visceral peritoneum)

Referred pain

Pain that is felt in a location other than where the pain originates

Retroperitoneal space

The area posterior to the peritoneum, between the peritoneum and the back

Tearing pain

Sharp pain that feels as if body tissues are being torn apart

Visceral pain

A poorly localized, dull, or diffused pain that arises from the abdominal organs

Retroperitoneum

where are the kidneys

No

Do you give aspirin to someone with ulcers?

Upper GI bleed

Throwing up coffee grounds is indication of what

Lower GI bleed

Throwing up dark red blood is indication of what

AAA

Tearing pain is felt during

Parietal peritoneum

layer attached to the abdominal wall

Visceral peritoneum

layer that covers each organ

Kidneys, pancreas, part of aorta

Organs in the retroperitoneal space

Bladder and part of rectum

Organs that lie inferior to peritoneum

Ovaries, Fallopian tubes, Uterus

Female reproductive organs

▪Aorta

▪Inferior vena cava

▪Hepatic artery

▪Splenic artery

▪Iliac artery and vein

Largest blood vessels in abdomen

Hollow

Intermittent, crampy, or colicky pain may result from which organs

Solid

Persistent or constant pain often originates from which organs

Visceral pain

– Originates from the organs within the abdomen

– Fewer nerve endings allow for only diffuse sensations of pain.

– Frequently described as “dull” or “achy”

Parietal pain

– Originates from the parietal peritoneum

– Many nerve endings allow for pain that is easier to locate and describe

– Frequently described as “sharp”

– Pain is often constant and localized to a specific area

Tearing pain

- Not the most common type of abdominal pain

– Originates in the aorta or stomach

Tearing pain

– Separation of layers of aorta caused by aneurysm

– Retroperitoneal location of aorta causes pain to be referred to back

– Ulcers in stomach can also cause this pain

Referred pain

Perception of pain in skin or muscles at distant locations

▪ Abdomen has many nerves from different parts of the nervous system.

▪Nerve pathways overlap as they return to the spinal cord.

▪ Pain sensation is transmitted from one system to another.

Appendicitis

Most common cause of someone needing surgery

- Nausea and sometimes vomiting

– Pain often initially referred to umbilical region, followed by persistent R L Q pain

Signs and symptoms of Appendicitis

▪Sudden, severe increase in pain

▪Contents releasing into abdomen causes severe peritonitis.

Signs and symptoms of Rupture of appendix

Appendicitis

Infection of appendix

Peritonitis

Irritation of peritoneum, usually caused by foreign material in peritoneal space

Peritonitis

- Parietal peritoneum is sensitive, especially to acidic substances.

- Irritation causes involuntary contraction of abdominal muscles.

Abdominal pain and rigidity

Signs and symptoms of Peritonitis

Cholecystitis/Gallstones

Symptoms often worsened by ingestion of fatty foods

Cholecystitis/Gallstones

Often caused by blockage of bile flow by gallstones

Cholecystitis/Gallstones

Inflammation of the gallbladder

– Severe R U Q or epigastric pain

– Pain often referred to shoulder

Signs and Symptoms of Cholecystitis/Gallstones

Pancreatitis

Inflammation of the pancreas

Pancreatitis

Common in patients with chronic alcohol abuse

– Epigastric pain

– Often referred to back and/or shoulder

Signs and symptoms of Pancreatitis

Gastrointestinal (G I) Bleeding

Bleeding within the G I tract, from esophagus to rectum

Gastrointestinal (G I) Bleeding

May be minor to severe; Blood eventually exits (mouth or rectum); Often painless

Gastric ulcers

(holes in G I system from highly acidic gastric juices) can cause severe pain and peritonitis.

– Dark-colored stool (maroon to black), often “tarry”

– Frank blood from rectum

– Vomiting “coffee-ground” appearing blood

– Vomiting of frank blood

– Pain can be absent to severe.

Signs and symptoms of Gastrointestinal (G I) Bleeding

Abdominal Aortic Aneurysm

Ballooning or weakening of inner wall of the aorta

Abdominal Aortic Aneurysm

Tears and separates from outer layers (dissection)

Abdominal Aortic Aneurysm

Weakened vessel bulges, may continue to grow; May eventually rupture

– Progressive (often sharp or tearing) abdominal pain

– Frequently radiates to back

– Rupture causes rapid onset of excruciating abdominal and back pain

– Signs of shock usually present

– Possible inequality in pedal pulses

Signs and symptoms of Abdominal Aortic Aneurysm

Hernia

Hole in the muscle layer of abdominal wall, allowing tissue or parts of organs (commonly intestines) to protrude up against skin

Hernia

May be precipitated by heavy lifting; May cause strangulation of tissue or bowel obstruction; Require transport to hospital for evaluation

– Sudden onset of abdominal pain, often following lifting

– Palpable mass or lump on abdominal wall or crease of groin

Signs and symptoms of a hernia

Renal Colic

Severe flank pain caused by kidney stones traveling down the ureter

– Severe pain in flank or back

– Frequently radiates to groin

– Nausea, vomiting

Signs and symptoms of Renal Colic

Cardiac involvement

• Pain from myocardial infarction may be felt as abdominal discomfort.

– Epigastric pain

– Indigestion or digestive discomfort

• Always consider the possibility of a cardiac emergency as a cause of abdominal symptoms.

ectopic pregnancy

Most serious cause of Abdominal Pain Associated with the Female Reproductive System

ectopic pregnancy

Occurs when fertilized embryo implants outside the uterus.

ectopic pregnancy

Rupture can cause life-threatening internal bleeding

Spleen, liver, pancreas, and kidneys

Solid organs

Stomach, Intestines, Gallbladder, Duodenum, Bladder

Hollow organs

Extraperioneal space

Area outside the peritoneum is called what

All quadrants

Location of large intestine

RLQ

Location of appendix

RUQ

Location of liver

RUQ

Location of gallbladder

LUQ

Location of spleen

RUQ

Location of pancreas