NREMTP Review-Lara 🚑🚒 Abdominal Emergencies
Quadrants
LUQ
Spleen
Stomach
Pancreas
Small/large Intestine
RUQ
Liver
Gallbladder
Intestines
RLQ
Appendix
Ovary
Intestines
LLQ
Diverticulum (Inner lining of the large intestine)
Ovary
Intestines
Kidneys
Retroperitoneal
Abdominal A&P
Hollow Organs-Biggest concern is infection & septic shock
Solid Organs-Biggest concern is bleeding
Macronutrients
Protein
Carbs
Fats
Blood
WBCs
RBCs
Platelets
Plasma (Clotting factors, proteins-Albumin)
Water
Liver-RUQ-Solid
Filters out toxins (Bilirubin, Ammonia, ETOH-alcohol, medications)
Stores glycogen (storage form of glucose)
Produces Bile (Digestive enzyme to breakdown FATS!!!!!)
Produces Vitamin K (blood clotting)
Metabolizes albumin (plasma protein-supports BP/Fluid balance)
Gallbladder-RUQ-Hollow
Stores the bile
Appendix-RLQ
They still don't exactly know what it does
Stomach-LUQ-Hollow
Further breakdown food, w/ stomach acid (hydrochloric acid)
Spleen-LUQ-Solid........"Most commonly injured abdominal organ in trauma
Immune system
Filters out viruses & bacteria from the blood
Regulates blood cells (WBCs & RBCs)
Pancreas-LUQ-Solid.... Popular Topic
Remember 3 & 3 (3 Hormones & 3 Digestive enzymes)
Endocrine system
Secretes Insulin, from the BETA Cells
Secretes Glucagon, from the ALPHA Cells (Allows the liver to release glycogen into the bloodstream)
Secretes Somatostatin from the DELTA Cells (regulates other hormones, & glucose)
Secretes digestive enzymes (Lipase, Amylase, and Trypsin) *****
Insulin
Regulates BGL down-lowers glucose levels
Lock & Key-opens up the cells, to allow them to use glucose for energy
Bowels (small and large intestine)
Small Intestine
Absorption of macronutrients (Carbs, Fats, Protein)
Large Intestine (Colon)
Absorption of water
Radiating or Referred Pain
If the disease or injury is to an organ in the LUQ/RUQ, the pain will radiate to the same side of the shoulder or the back
They will also have epigastric pain
Example-Liver-RUQ-pain to right shoulder/back, epigastric
Chole=Gallbladder (Cholecystitis, Cholelithiasis)
Hepa=Liver (hepatic failure, hepatitis, Hepatic encephalopathy)
Col=Colon (Large Intestine)-Colitis, Ulcerative colitis
Nephro or Renal=Kidney
Renal=Kidney
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Peritoneum
a thin membrane which covers the entire abdominal cavity
Nothing should be free floating in the peritoneal space
Peritonitis "The Acute Abdomen"
Caused by a ruptured hollow organ, where the bacteria and toxins leak out into the peritoneal space
Ruptured appendix
Perforated bowel
Ovarian Rupture
The "big 4" warning signs for peritonitis (AKA, "the acute abdomen"):
Abdominal distention
Abdominal rigidity ("involuntary guarding"),
Vomiting
Pain (Diffuse abdominal pain)-not specific to a single quadrant
pain to any specific area/quadrant with or without palpation,
Diffuse (Everywhere) abdominal
signs of shock (septic shock/hypovolemic shock)
fever
Rebound tenderness (pain when releasing the hand from palpation)
Hypotension
Tachycardia
pale/hot skins
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Appendicitis (warm temps can cause the appendix and surrounding tissues to swell and become inflamed
Pain will always start in the umbilicus (Belly button)
McBurney's sign
RLQ pain
Fever
Anorexia (Loss of appetite)
Tachycardia
N/V
Rebound tenderness
McBurney's point/sign
+ Rovsing's Sign-Pain felt in the RLQ when palpating the LLQ
+ Psoas Sign-Severe RLQ pain when lifting the right leg
If the pt. states their pain is suddenly gone, and they feel better=Ruptured Appendix=peritonitis.
Paramedic Treatment
Any time a patient has an abdominal condition that will require immediate surgery (Peritonitis & Appendicitis) do NOT give pain medications
Advise and keep the patient NPO status (Do NOT eat or drink Anything)
Antiemetic=Zofran (N/V)
IV
Fluids if vomiting or signs of dehydration
Rapid transport
!!!!!!If a patient has an abdominal condition that will require immediate surgery, DO NOT EVER GIVE PAIN MEDICATIONS!!!!!!
Appendicitis
Peritonitis
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Gallbladder Disease
Cholelithiasis=Gallstones (causes cholecystitis)
Cholecystitis=Inflammation of the gallbladder
"The 6 Fs of gallbladder disease "Risk Factors
Female
Fat
Forty
Fertile
Fatty or Fried foods****
Fair Skinned
Signs/Symptoms
RUQ abdominal pain
radiating pain to the right shoulder/back
Epigastric pain
fever
Tachycardia
recent ingestion of a fatty meal
N/V-Emesis
"Murphy's Sign-RUQ pain on palpation, during inhalation**********
Treatment
Antiemetics
Pain management
IV
Fluids
IV fluid bolus/250-500 mL
When do we give fluids?
Hypotension
Burns
Dry Mucus membranes
Poor skin turgor
Vomiting
Sweating=heat emergency
Fever or infection
Hyperglycemia, or DKA or HHS
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Liver Failure/Cirrhosis
The liver cells become inflamed, swell, eventually die, and the liver becomes fibrotic (Hardens)
Causes=1. Alcoholism 2. Hepatitis B/C
RUQ pain
Referred to right shoulder/back
Epigastric pain
Jaundice-the liver is unable to filter bilirubin
Icterus=Jaundice
Bruising or ecchymosis
N/V
Edema=pedal edema
Ascites-fluid in the abdomen
Distended abdomen
JVD
Hepatomegaly
Portal HTN
Esophageal Varices
Varices-varicose vein-a swollen painful vein
Esophageal Varices
Seen in alcoholic Liver Failure
Due to portal HTN
Varicose (Varices) veins
swollen & painful veins
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Pancreatitis
The pancreas swells, and the digestive enzymes cannot be released. The enzymes now start to auto-digest the pancreas (eats away the pancreas from the inside out) leading to intraabdominal bleeding!!
Seen in alcoholism & Gallstones
LUQ abdominal pain
Pain may radiate to the left back/shoulder
Epigastric pain
fever
tachycardia
N/V
Cullen's sign-bruising around the umbilicus
Gray Turner's sign-bruising over the flanks
Lead to hypovolemic shock
Hypotension
pale/cool skins
"SIGNS"
Murphy's Sign- (indicates cholecystitis)-RUQ pain, on palpation, during inhalation
Cullen's Sign-bruising around the umbilicus (indicates intra-abdominal bleeding)
Gray Turner's Sign-bruising over the flanks (indicates retroperitoneal bleeding (kidneys)
McBurney's Sign-pain between the umbilicus and right iliac crest (pelvis)
Indicates Appendicitis!!!!!!!
Rovsing's Sign-pain in the RLQ when palpating the LLQ (Appendicitis)
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Diverticulum
Inner lining of the large intestine (Colon)
Diverticulosis
Develops pockets or outpouchings called diverticula
Diverticulitis
Inflammation/infection of the pouches
LLQ pain
Fever
tachycardia
Blood in the stool!!!!*****
Anorexia (loss of appetite)
Bloating/Gas
Next Session
Liver Failure/Cirrhosis
IBD-Inflammatory bowel disease (Crohn's Disease & Ulcerative colitis)
Upper vs Lower G.I Bleeds