Chapter 12

Abdominal Emergencies

Lesson Objectives

• List the abdominal organs by quadrants.• Know how to assess and manage abdominal

injuries, including open and closed injuries and hernias.

• Know how to assess and manage abdominal illnesses, including pain, appendicitis, nausea and vomiting, diarrhea, constipation, bloody stools, and hemorrhoids.

• List the evacuation guidelines for abdominal problems.

Anatomy of the Abdomen

Abdominal Injuries (1 of 12)

• Closed: No break in skin

• Open: Penetration of the peritoneal cavity

• Both open and closed injuries can cause internal bleeding or leakage of intestinal contents that cause irritation and infection.

Abdominal Injuries (2 of 12)

• Closed injuries– Organs can be injured by a direct blow.– Solid organ injuries usually result in

significant bleeding.– Hollow organ injuries are more likely to

cause peritonitis.

Abdominal Injuries (3 of 12)

• Closed injuries– What to look for:

• Mechanism of injury • Bruising or abrasions of the abdominal

wall or lower chest• Abdominal pain and tenderness

Abdominal Injuries (4 of 12)

• Closed injuries– What to look for:

• Possible spleen injury: Signs of shock, pain in right upper abdomen

• Possible kidney injury: Pain in the flank; blood in urine; signs of shock; enlarged, tight abdomen; increasing pain; fever; nausea and vomiting

Abdominal Injuries (5 of 12)

• Closed injuries– What to do:

• Have victim rest completely, allow only sips of water.

• Record observations frequently.• Evacuate if signs of shock or peritonitis

appear.

Abdominal Injuries (6 of 12)

• Open injuries– What to look for:

• Protruding bowel or fat• External bleeding from a laceration

of the abdominal wall• Signs similar to closed injury

Abdominal Injuries (7 of 12)

• Open injuries– What to do:

• For penetrating injury with medical help close by, leave object in place.

• Might be necessary to remove object for evacuation.

• Consider shortening a long object.• Treat as for closed injuries.

Abdominal Injuries (8 of 12)

• Open injuries– What to do:

• Protruding bowel that is not torn can be returned to the abdominal cavity if help is far away.

• If help is close, cover with a moist cloth.

• If bowel has torn, do not return to abdominal cavity.

Abdominal Injuries (9 of 12)

• Hernia– Loops of intestine protrude through a weak

spot in the abdominal wall.– More common in men than in women.– Most common site is the groin.– Rarely require surgery.– Occasionally blood supply to the protruding

loop of intestine is cut off requiring emergency medical care.

Abdominal Injuries (10 of 12)

• Hernia– What to look for: Unstrangulated hernia

• Bulging in the groin that is easier to see when the victim is straining and coughing

• Swelling, usually soft and painless• Soreness• Burning• Feeling of pressure

Abdominal Injuries (11 of 12)

• Hernia– What to look for: Strangulated hernia

• Hernia that will not reduce• Firm bulge with rapidly increasing

pain and tenderness • Pain spreading to the abdomen• Possibly vomiting

Abdominal Injuries (12 of 12)

• Hernia– What to do:

• Attempt to reduce a possible strangulated hernia.

• Evacuate if there is increasing pain and you are unable to reduce the hernia.

Abdominal Illnesses (1 of 17)

• Pain– Often difficult to determine exact cause.– Decision to evacuate hinges on determining

course of illness, difficulty in obtaining help, and the number of people in the group.

Abdominal Illnesses (2 of 17)

• Pain– What to look for:

• Signs of shock• SAMPLE history• Location of the pain• Diarrhea and vomiting

Abdominal Illnesses (3 of 17)

• Pain– What to look for:

• Signs of dehydration• Whether others in the party have

the same problem• Ingestion of potentially poisonous

plants or unpurified water• Diabetes or pregnancy• Painful, rigid, swollen abdomen

Abdominal Illnesses (4 of 17)

• Pain– What to do:

• Perform initial check and assess vital signs

• Allow sipping of clear, non-caffeinated fluids.

• Provide an antacid.

• Apply heat.

• Be prepared for vomiting.

• Allow victim to assume most comfortable position.

Abdominal Illnesses (5 of 17)

• Appendicitis – What to look for:

• Intermittent pain in midabdomen that moves to the lower right abdomen. Pain increases over 6 to 24 hours, becomes constant.

• Tenderness over right lower abdomen.

Abdominal Illnesses (6 of 17)

• Appendicitis – What to look for (continued):

• Intermittent vomiting.• Loss of appetite.• Low-grade fever.• Pain and tenderness throughout abdomen,

indicating ruptured appendix.

Abdominal Illnesses (7 of 17)

• Appendicitis – What to do:

• Place victim in most comfortable reclining position.

• Let victim sip fluids.• Evacuate.

Abdominal Illnesses (8 of 17)

• Nausea and vomiting: What to look for– Abdominal pain

– Blood or brown, grainy material in vomit

– Diarrhea

– Chills and fever

– Signs of dehydration

– Others in group with similar symptoms

– Recent head injury

– Ingestion of wild plants/mushrooms or unpurified water

Abdominal Illnesses (9 of 17)

• Nausea and vomiting: What to do:– Provide clear fluids, clear soups, flat

soda, juice– If victim can keep fluids down, offer

carbohydrates, but no milk products.– Have victim rest.– Evacuate if vomiting persists more than

48 hours.

Abdominal Illnesses (10 of 17)

• Diarrhea: What to look for– Bloody mucus or pus in stool– Dehydration– Cramping abdominal pain– Lack of bowel control– Fever– Others in group with similar symptoms

Abdominal Illnesses (11 of 17)

• Diarrhea: What to do– Provide clear fluids and monitor urine output to

assess for dehydration.– If victim can keep fluids down, gradually return

to normal diet.– Provide pink bismuth, if available.– Provide loperamide HCL or diphenoxylate

atropine if diarrhea persists, but not if there is fever or blood and pus in stools.

Abdominal Illnesses (12 of 17)

• Constipation– What to look for:

• Painful, hard bowel movements• Infrequent bowel movements

Abdominal Illnesses (13 of 17)

• Constipation– What to do:

• Eat high-fiber foods.• Maintain adequate fluid intake.• Try to have a bowel movement.• Use stool softeners.• Avoid laxatives, alcohol, and constipation-

causing foods.

Abdominal Illnesses (14 of 17)

• Bloody stools and hemorrhoids – What to look for:

• External hemorrhoid: Lump next to anus, bleeding with passage of stool, red blood and clots extruding from the lump or swelling

• Internal hemorrhoid: Soft swelling that may protrude from rectum during or after bowel movement; bleeding with passage of stool.

Abdominal Illnesses (15 of 17)

• Bloody stools and hemorrhoids

– What to look for (continued):• Fissure: Painful crack at margin of anus.• Signs of serious bowel bleeding: Painless

bowel movements with large quantities of blood; signs of shock.

Abdominal Illnesses (16 of 17)

• Bloody stools and hemorrhoids – What to do: For minor hemorrhoids and

fissures• Adjust diet to soften stool• Warm baths to soothe and cleanse.• Wear cotton underwear or loose clothing.• Apply cold compresses, zinc oxide, or

petroleum jelly

Abdominal Illnesses (17 of 17)

• Bloody stools and hemorrhoids – What to do: For minor hemorrhoids and fissures (cont’d)

• Apply hemorrhoid suppositories

• If cluster or swelling protrudes from rectum, have victim try to slip the tissue back inside by applying manual pressure.

– What to do: For major bleeding

• Have victim walk, if possible.

• Evacuate.

Evacuation Guidelines for Abdominal Problems (1 of 2)

• Serious injury• Persistent abdominal pain or pain with

high fever• Unable to drink or retain fluids for more

than 24 hours• Pregnant with abdominal pain• Painful, rigid, swollen abdomen

Evacuation Guidelines for Abdominal Problems (2 of 2)

• Pain that increases with cough or movement• Signs and symptoms of appendicitis• Vomiting and diarrhea with severe pain, vomiting

with severe headache, or diarrhea with fever and stools containing bloody mucus

• Signs of internal bleeding• Signs of severe dehydration or shock