the area below the diaphragm and above the pelvis. It contains a variety of organs that perform digestive, reproductive, endocrine, and regularoy functions.
funtions of the organs in the abdomen
secreting insulin to regulate blood sugar (the islets of Langerhans of the pancreas), filtering blood and assisting with immune response (the spleen), and removing toxins from the body (the liver).
assisting with immune response
removing toxins them the body
secretes insuling to regulate blood sugar (islets of Langerhans)
four quadrants of the abdomen
RUQ-right upper quadrant
LUQ-left upper quadrant
RLQ-right lower quadrant
LLQ-left lower qadrant
are used to identify and describe areas of pain,
spleen, liver, pancreas, kidneys
stomack, gallbladder, duadenum, large intestine, small intestine, bladder.
hollow digestive organ, carries food from the mouth and pharynx to the stomach.
hollow digestive organ, an expandable organ located below the diaphragm and connected to the esophagus and small intestin. Begins breakdown of foods.
hollow digestive organ, consisting of the duadenum, jejunum and ilium, the small intestine take stomach contents, removing nutrients as it passes contents to the large intestine.
large intestine (colon)
hollow digestive organ, absorbs fluids from contents, creating fecal waste for excretion through the rectum and anus.
hollow lymphatic organ, a dead end sac of bowel rich in lymphatic tissue with no funtion in digestion, May become infected (appendicitis), causing pain and requiring surgery.
solid digestive, other functions, with regulation of the blood and detoxification, involved in regulationg levels of carbohydrate and othe stubstances in the blood. Involved in bile secretion for digestion of fats. Many ohter functions including detoxification of the blood.
hollow digestive organ, stores bile before release into the intestine.
solid lymphatic tissue, removes abnormal blood cells and is involved in the immune response.
solid digestive organ, releases enzymes that assist in breaking down food in the small intestine into absorbable molecules. Also secretes hormones into the blood that regulate blood sugar levels.
solid urinary organ, filter and excrete waste. Regulate water, blood, and electrolyte levels. Assist liver with dexification.
hollow urinary organ, collects urine from the kidneys prior to excretion (urination).
most of the organs of the abdomen are enclosed within the peritoneum. The membrane that lines the abdominal cavity and covers the organs within it.
Two layers-visceral peritoneum and the parietal peritoneum,
covers the organs
attached to the abdominal wall
are from the diaphram to the umbilicus
are from the umbilicus to the pelvis
the space between the visceral and parietal peritoneum
contains lubricant fluid
outside of the peritoneum, between the abdomen and the back.
The organs that are located in the retroperitoneal space are the kidneys and the pancreas and also the aorta.
organs in the pelvis and abdomen
ovaries, fallopian tubes, and uterus, which may be a source of abdominal pain.
originates from the organs within the abdomen, the organs themselves do not have a large number of nerve endings to detect pain, which is why viceral pain is often described as
DULL, ACHY, or INTERMITTENT or difficult to locate.
hollow organ pain
may be described intermittent, crampy or colicky
solid organ pain
may be described as dull and persistent
often refered to as peritoneal tenderness and is more easily located and described than visceral pain due to more efficient nerve endings. A localized, intense pain that arises from parietal peritoneum, the lining of the abdominal cavity. Irritations can result from internal bleeding, infection/inflamation. Can be described at shrp or constant and localized to a particular area. Can get worse with movement and better when remaining still with knees drawn up.
NOT common, as with (AAA) abdominal aoritic aneurysm.
is felt in a place other than, the organs share nerves with other parts of the body. Heart pain may be felt just below the xiphoid process.
assessment and care of abdominal pain patients
perform a scene size-up
perform and initial assessment and supply oxygen
take a patient history expose the site
palpate the abdominal quadrants
transport the patient.
Odors are important, blood, vomit, feces, shock, mechanism of injury, trauma vs medical
scene size up
as you approach the scene, level of consciousness, if talking=open airway. Unconscious patients need airway care and any history will be obtained from family or bystanders.
general impression, signs of shock, consciousness, position of patient, guarding or distress
signs of shock
low blood pressure, cyanosis, skin is pale, cool and clammy, Give Oxygen 15 lpm
abdominal pain is always considered an emergency
even if signs of shock are not present
signs and symptoms, OPQRST,
O- when did the pain begin?
P- does anything make it worse or better?
R-where is the pain and do you feel it anywhere else?
S-how severe is the pain on a scale of 1-10?
T-how long have you had this pain, has it changed over time?
Is it better or worse?
Use other words not just pain, use
discomfort, pressure, bloating, cramping,
second question of SAMPLE
prescribes, over the counter, herbs, asprin (can cause stomach bleeding)
Last oral intake
liquids, meals, snacks and is this normal for this patient?
Events leading to the emergency
can help determine progression, constipation, vomiting, nausea, diarrhea, bright red, or coffee ground like substance were noted indicating internal bleeding.
history specific to female patients
childbearing must ask additional questions, eptopic pregnancy / life threatening, ruptured overian cysts, pelvic inflammatory disease, and menstrual irregularities all can cause significant amounts of pain.
menstrual questions to ask
where are you in your menstrual cycle?
is your period late?
Do you have bleeding from tha vagina now that is not
If you are menstruating, is the flow normal?
Have you had this pain before?
If so, when did it happen and what was it like?
geriatric patients (old people)
may have a decreased ability to feel pain and their cause may be more serious and have a 9 time greater chance of death due the the same abdominal pain. Heart meds may keep the heart rate from increasing during shock.
physical examination of the abdomen involves two procedures
inspection and palpation
is not for the EMT, takes too long (3min per quadrant)
before physical assessment of the abdomen
ask the patient where the area is that is uncomfortable, palpate that area last.
feel for rigidity or hardening and ask the patient if this causes addition pain for the patient.
two possible presentations, drawing his arms across the abdomen or the patient tensing the muscles before you touch. Guarding is voluntary or involuntary attempt to protect the abdomen to prevent further pain.
abdominal aortic aneurysm
may be a pulsating mass, buldge or lump. Patient may have knowledge that was not serious and has worsened or it was inoperable. Usually felt easily in skinny patients. A larger patient will tend to discibe the pain as tearing pain.
signs of pain
anxiety, fear, guarding, rapid shallow breathing.
protruding abdominal wall,
abdominal bleeding, internal, warm and distended, hard
increased pulse rate and breathing (shallowor more rapid)
vital signs should be taken initially
and every 5 min. after for abdominal pain. Include pulse, respiration, blood pressure,m and skin color, temperature, and condition, mental status. Shock will have increased pulse and respirations, pale, moist skin and anxiety. Falling BP is a late sign. Increased pulse due to pain, also shallow breathing and more rapidly
scene size up, BSI, mechanism of injury, general impression, level of distress, mental status, airway, breathing and circulation, oxygen, tranport/priority decision
vomiting, suctioning, calm the patient, SAMPLE history, focused physical exam, vital signs, ongoing every 5 min.
initial assessment, airway, may vomit, suction, oxygen 15 lpm nonrebreather mask, position of comfort, shock or airway problems= lateral recumbent position, rains the legs of shock patient, transport
nausea, vomiting, diarrhea are examples of
digestive system but may also be due to cardiac, diabetic, food poisoning, or the flu.
nausea and vomiting, pain in the umbilicus initially followed by persistent pain in the RLQ.
tea and dairy
severe and sometimes sudden epigastric (upper and central abdomen just below the xiphoid process or RUQ which may radiate to the shoulder or back. May be caused or worsened by foods high in fat.
chronic alcohol problems, epigastric area, behind the stomach, radiate to the back and or shoulders, can present signs of shock.
pain below the sternum, blood can arrise in any location between the esophagus to the rectum, vomit, bright red or coffe ground appearance, from the rectum=red, maroon, or black tarry colored blood or stool.
peritoneum cavity- spleen due to trauma and results in irritation of the peritoneum and is associated with abdominal pain and tenderness.
abdominal aortic aneurysm (AAA)
ballooning or weakening in the wall of the aorta. Extremely high rate of death. SHARP PAIN or TEARING. Sudden onset has excruciating pain. Shock may be present. May have ine quality in the femoral or pedal pulses and
protrusion of the intestine. heavy lifting or straining , sudden onset of pain usually after lifting. palpated as a mass or lump on the abdominal wall or in the creases of the groin.
reassess vital of unknown illness every