Emt: Brady Emergency Care 11Th Edition - Chapter 18 - Acute Abdominal Emergencies

Front 1

What are the solid organs of the abdomen?

Back 1

Spleen
Liver
Pancreas
Kidneys

Front 2

In what abdominal quadrants will you find the kidneys?

Back 2

left and right upper quadrants

Front 3

What are the hollow organs of the abdomen?

Back 3

Stomach
Gallbladder
Duodenum
Large intestine
Small intestine
Bladder

Front 4

Where are most abdominal organs contained?

Back 4

Peritoneum

Front 5

What does the visceral peritoneum do?

Back 5

Covers organs

Front 6

What is the parietal peritoneum attached to?

Back 6

The abdominal wall

Front 7

What feature is found at the center junction of the four abdominal quadrants?

Back 7

Umbilicus

Front 8

What organs are found in the right lower quadrant?

Back 8

Colon

Small intestines

Major artery and vein to right leg

Ureter

Appendix

Front 9

What organs are found in the left lower quadrant?

Back 9

Colon

Small intestines

Major artery and vein to the left leg

Ureter

Front 10

What organs are found in the right upper quadrant?

Back 10

Liver

Right kidney

Colon

Pancreas

Gallbladder

Front 11

What organs are found in the left upper quadrant?

Back 11

Liver

Spleen

Left kidney

Stomach

Colon

Pancreas

Front 12

What organ is found in all four abdominal quadrants?

Back 12

Colon

Front 13

In what abdominal quadrants will you find the liver?

Back 13

Left and right upper quadrant

Front 14

In what abdominal quadrants will you find the small intestines?

Back 14

Left and right lower quadrant

Front 15

What do we describe using the abdominal quadrants?

Back 15

Pain

Tenderness

Injury

Abnormalities

Front 16

What does a pulsating mass indicate?

Back 16

An aneurysm ready to rupture (Abdominal Aortic Aneurysm, or AAA)

Front 17

What are the four types of abdominal pain?

Back 17

Visceral pain

Parietal pain

Tearing pain

Referred pain

Front 18

Define visceral pain

Back 18

Pain that originates from organs. No one specific area of pain. Could be intermittent, achy, crampy (often from hollow organs) or dull, persistent (often from solid organs)

Front 19

Define parietal pain

Back 19

Pain that originates from abdominal cavity lining. May be caused by irritation from internal bleeding or infection. Sharp, constant, and worse with movement.

Front 20

Define tearing pain.

Back 20

An uncommon type of pain usually associated with abdominal aortic aneurysm (AAA) -- this is VERY serious

Front 21

Define referred pain

Back 21

Pain felt in area different from where it originates due to shared nervous pathways.

Front 22

What might pain described as "indigestion" also be an indicator of?

Back 22

Cardiac involvement. Consider treating the patient for a heart attack.

Front 23

What can you do during scene size-up to help you get a grip on a call for an abdominal emergency?

Back 23

Note odors present

Be aware of vomiting

Use scene clues for any indication of trauma

Front 24

What can you do during initial assessment to help you get a grip on a call for an abdominal emergency?

Back 24

Determine level of consciousness

Ensure patent airway

Assess for signs of shock (always treat for shock during state medical trauma assessments)

Note patient's body positioning (doubling over, guarding, etc)

Administer high-concentration oxygen

Front 25

What questions must you ask specifically to female patients in case of an abdominal emergency call?

Back 25

Any possibility of being pregnant?

Where are you in your menstrual cycle? Are you late?

Any vaginal bleeding?

Any history of similar problems?

Front 26

What should you be on the lookout for when visually inspecting the abdomen?

Back 26

Discoloration

Distension

Bloating

Protrusions

Any other abnormalities

Question past surgical scars

Front 27

What guidelines should you keep in mind when palpating the abdomen?

Back 27

Palpate the area of pain last

Use fingertips to palpate

Loosen clothing to palpate lower quadrants

Only palpate each area once

Front 28

What is guarding?

Back 28

A protective defense to prevent pain -- arms drawn across the abdomen or abdominal muscle clenching are common

Front 29

What are some common signs and symptoms of abdominal emergencies?

Back 29

Pain and tenderness

Anxiety and fear

Guarded positioning

Rapid, shallow breathing

Rapid pulse, changes in BP

Nausea, vomiting, diarrhea

Rigid or distended abdomen

Front 30

How often do you assess vital signs when you're transporting a patient with a suspected abdominal emergency?

Back 30

Every 5 minutes

Front 31

What are some common abdominal conditions?

Back 31

Appendicitis

Cholecystitis/gallstones

Pancreatitis

Ulcer/internal bleeding

Abdominal aortic aneurysm (AAA)

Hernia

Renal colic

Front 32

What is appendicitis?

Back 32

Inflammation of the appendix -- if left untreated can lead to swelling and rupture.

Pain originates in right lower quadrant. "Rebound pain" when palpating this quadrant is a good indicator of appendicitis.

Front 33

What are some common signs and symptoms of appendicitis?

Back 33

Onset of pain followed by vomiting and fever. Pain localized in right iliac fossa. Extreme sensitivity to palpation. Rebound tenderness is common (pain upon release of palpation). Remember that sometimes palpation will elicit no pain because a distended cecum can prevent the palpations from reaching the appendix and causing pain.

Front 34

What are some common findings with cholecystitis?

Back 34

Sudden onset of pain to epigastric region and RUQ

More common at night and after eating fatty foods

Tenderness to RUQ

Low-grade fever

Nausea, vomiting

Most common to females between 30-50 years of age

Front 35

What is pancreatitis?

Back 35

Inflammation of pancreas, may be triggered by ingestion of alcohol or large amount of food. Also can be caused by excessive triglyceride buildup in blood.

Front 36

What are some common findings with pancreatitis?

Back 36

Severe pain in middle of the upper quadrants

Nausea and vomiting

Abdominal pain with radiation from umbilicus to the back and shoulders

Severe cases may have fever, tachycardia, and hypoperfusion

Front 37

What are ulcers/internal bleeding?

Back 37

Open wounds or sores to the digestive tract.

Common to stomach and small intestines

Caused by gastric fluids deteriorating walls

Front 38

What are some common findings to ulcers and internal bleeding?

Back 38

Sudden burning pain to epigastric and LUQ before meals or during stress

Nausea and vomiting (possible hematemesis)

If bleeding severe, possible hypoperfusion

Indications of possible peritonitis

Front 39

What is an abdominal aortic aneurysm?

Back 39

Weakening of descending aortic wall

Most lethal cause of abdominal pain

Front 40

What are common findings with AAA (abdominal aortic aneurysm)?

Back 40

Onset of lower lumbar and abdominal pain

Possible tearing sensation

Nausea, vomiting

Mottled or spotty abdominal skin

Decreased or absent femoral or pedal pulses

Rigidity or tenderness if the aneurysm bursts

Front 41

Define hematemesis

Back 41

Vomiting of blood

Front 42

What's a hernia?

Back 42

Caused by a small hole forming in peritoneum -- the "strangulated" tissue may become necrotic.

Front 43

What are some common findings with a hernia?

Back 43

Sudden onset of abdominal pain (usually after heavy lifting or strain)

Fever

Rapid pulse

Front 44

What structures in the pancreas actually secrete insulin?

Back 44

Islets of Langerhans

Front 45

Which abdominal organ has a role in both filtering blood and assisting with immune response?

Back 45

The spleen

Front 46

Which abdominal organ removes toxins from the body?

Back 46

The liver

Front 47

What are the four quadrants of the abdomen?

Back 47

Left upper quadrant (LUQ)
Right upper quadrant (RUQ)
Left lower quadrant (LLQ)
Right lower quadrant (RLQ)

Front 48

Define "peritoneum"

Back 48

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

Front 49

Within what structure are most organs of the abdomen enclosed?

Back 49

The peritoneum

Front 50

What is contained between the parietal peritoneum and the visceral peritoneum?

Back 50

Lubricant fluid

Front 51

What type of organ is the esophagus, and what does it do?

Back 51

Hollow digestive organ. Carries food from the mouth and pharynx into the stomach.

Front 52

What type of organ is the stomach, and what does it do?

Back 52

Hollow digestive organ. Begins breakdown of foods.

Front 53

What type of organ is the small intestine, and what does it do?

Back 53

Hollow digestive organ. Takes stomach contents, removes nutrients, and passes them on to the large intestine.

Front 54

What type of organ is the large intestine, and what does it do?

Back 54

Hollow digestive organ. Absorbs fluid from contents, creating fecal waste for excretion.

Front 55

What type of organ is the appendix, and what does it do?

Back 55

Hollow lymphatic organ. Rich in lymphatic tissue. Has a few suspected purposes, but in modern times is mostly just good for becoming infected and hurting and/or killing people.

Front 56

What type of organ is the liver, and what does it do?

Back 56

Solid digestive organ. Helps regulate carbohydrate levels, involved in bile secretion, detoxifies blood.

Front 57

What type of organ is the gallbladder, and what does it do?

Back 57

Hollow digestive organ. Stores bile before release into the intestine.

Front 58

What type of organ is the spleen, and what does it do?

Back 58

Solid lymphatic organ. Removes abnormal blood cells and helps in immune response.

Front 59

What type of organ is the pancreas, and what does it do?

Back 59

Solid digestive organ. Releases enzymes that assist in breaking down food, secretes hormones to regulate blood sugar.

Front 60

What type of organ is the kidney, and what does it do?

Back 60

Solid urinary organ. Filters and excretes waste. Regulates water, blood, and electrolyte levels. Helps liver w/ detoxification.

Front 61

What type of organ is the bladder, and what does it do?

Back 61

Hollow urinary organ. Collects urine from kidneys prior to excretion.

Front 62

Define "retroperitoneal."

Back 62

Outside of the peritoneum.

Front 63

What three abdominal organs are found in the retroperitoneal area?

Back 63

Kidneys
Pancreas
Aorta

Front 64

What abdominal organs are found only in females and can be a source of pain?

Back 64

Ovaries
Fallopian tubes
Uterus

Front 65

Should abdominal pain or discomfort always be considered an emergency if signs of shock are not present?

Back 65

Yes. Always treat abdominal pain or discomfort as an emergency.

Front 66

What are the six basic steps in assessing a patient with abdominal distress?

Back 66

1) Scene size-up

2) Initial assessment and interventions (provide oxygen)

3) Take a patient history

4) Expose the site

5) Palpate the abdominal quadrants

6) Transport the patient

Front 67

What additional determination can you make during the "last oral intake" section of the SAMPLE history that might be especially pertinent to a patient in abdominal distress?

Back 67

Determine whether the patient's recent oral intake has been at all out of the norm.

Front 68

When interviewing a patient about events leading up to their abdominal emergency, what five events are of specific importance?

Back 68

Vomiting

Nausea

Diarrhea

Constipation

Presence of bright red, dark red, or coffee-ground-like substances in feces.

Front 69

What important questions can you ask a woman of childbearing age when interviewing her about an abdominal emergency?

Back 69

1) Where are you in your menstrual cycle?

2) Is your period late?

3) Do you have bleeding from the vagina that isn't menstrual bleeding?

4) If you are menstruating, is the flow normal?

5) Have you had this pain before?

If so, what did it happen and what was it like?

Is it possible you are pregnant?

Front 70

If a woman reports abdominal pain, and any abnormalities in menstruation or possible pregnancy, what condition should you expect, and how should you react?

Back 70

Suspect ectopic pregnancy, transport immediately.

Front 71

What three factors make assessing a geriatric patient with abdominal pain unique?

Back 71

1) Older patients have decreased ability to sense pain

2) Elderly patients are more likely to have a life-threatening cause of abdominal pain than younger patients

3) Elderly patients are frequently on medications that affect their bodies

Front 72

What two techniques do you use to physically assess the abdomen?

Back 72

Inspection and palpation

Front 73

What should you be looking for when inspecting the abdomen?

Back 73

Distension

Bloating

Discoloration

Protrusions

Front 74

When do you palpate the abdominal quadrant in which pain is reported?

Back 74

Last.

Front 75

What may you do if the initial palpation doesn't cause pain in the patient?

Back 75

You may palpate a bit deeper.

Front 76

What do you do if you palpate a pulsating mass in the abdomen?

Back 76

Do not palpate again. Assign high priority for transport. Call medical control and let them know that you're transporting a patient with a suspected abdominal aortic aneurysm. Keep them informed.

Front 77

Under normal conditions, might you feel a faint pulsating sensation when deeply palpating a patient's abdomen?

Back 77

Yes. On very thin patients you may just be feeling the aorta pulsate. However, if you actually feel a pulsating MASS, this is an issue.

Front 78

How often do you reassess a patient with abdominal pain?

Back 78

Every five minutes.

Front 79

Can abdominal pain increase a patient's pulse?

Back 79

Yes, the pain alone can increase a patient's pulse.