Abdominal Problems

The abdomen is the body region between the lower ribs and the pelvis that contains many vital organs. Abdominal pain can range from mild to severe, be dull or sharp; acute or chronic. Acute pain is sudden pain. The type of pain, its location, and other symptoms that come with it can help suggest the cause.

Due to the range of possible abdominal emergencies the hospital environment is the best place to be diagnosed as a number of tests may need to be carried out to indentify the cause. The main concern for ambulance personnel is to be able to assess the patient and to see if they are Time Critical and to appropriately manage the emergency until the patient reaches definitive care.

Digestive Organs

Systems Which Make Up The Abdominal Region

Gastro-intestinal - The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs which takes in food, digests it to extract energy and nutrients, and expels the remaining waste

Urinary - The urinary system is a system of organs, tubes, muscles, and nerves that work together to create, store, and carry, urine. The urinary system includes two kidneys, two ureters, the bladder, and the urethra.

Female Reproductive - is any of those parts of the body which are involved in sexual reproduction, namely the vagina, uterus, fallopian tubes and ovaries.

Male Reproductive - is any of those parts of the body which are involved in sexual reproduction, namely the penis, testicles, prostate glands and seminal ducts

Vascular - major blood vessels such as the aorta and inferior vena cava are also considered part of the abdomen, but are located in the part of the abdomen known as the retroperitoneum

Causes of Abdominal Pain

Below are the more serious causes of abdominal pain that you as ambulance personnel may have to deal with:

Abdominal Aortic Aneurysm - Aortic aneurysms commonly occur in the abdominal aorta, as abdominal aortic aneurysms (AAA), where the walls are thinner. These can grow to a large diameter. Some may grow to over 6 inches before rupturing. An abdominal aortic aneurysm can often be palpated by firm pressure above and around the navel as a large, pulsating mass.

Peptic Ulcer - An ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). These ulcers can also be caused or worsened by drugs such as Aspirin and other Non-steroidal anti-inflammatory drugs (NSAIDs), also by having periods of an empty stomach. Relief is often sought after intake of food or the use of antacids. Ulcers are a common cause of internal bleeding.

Kidney Stone - are solid crystals of dissolved minerals in urine found inside the kidneys or ureters, they typically leave the body in the urine stream. As long as they stay within the kidney problems are relatively rare it is when they leave the kidney and start to move down the ureter stretching their wall. This pain will often be collicky in nature and associated with haematuria, nausea and vomiting. Pain is said to be very severe and paramedic assistance may be required to administer strong opiate pain relief.

Diverticulitis - Small pouches in the colon that bulge outwards through weak spots. Each pouch is called a diverticulum. Faecal matter leaks through the thin walls and causes inflammation, on a few occasions this can causes abcesses to develop in the colonic structure. It is when these pouches become infected or inflamed, the condition is called diverticulitis.

Internal Bleeding - Signs and symptoms will include, haematemesis, rectal bleeding, unexpected vaginal bleeding. The fresher the blood the brighter red it will look. e.g. an upper oesophageal bleed will be bright red where old blood will show as coffee grounds.

Abdominal Assessment

Firstly just look at the abdomen and note anything unusual. Mentally note how the abdomen looks is it, concave, flat, rounded, or obese in size. Are there any noticeable scars or new wounds present, which may indicate past, or recent surgery or trauma. Abnormal observations of the exposed abdomen would include an asymmetric contour, prominent veins or pulsation, oedema, rashes, or a steadily increasing size of girth. 

Palpate the abdomen with the pads of your fingers, not your finger tips as this can cause pain to the patient. Don't palpate the painful area straight away, palpate other areas of the abdomen first to assess the full extent of the pain.

Abdominal Regions

The diagram above shows the different regions of the abdomen so when you handover to hospital staff you'll be able to pinpoint the pain to a certain area.

Some Signs and Symptoms of Abdominal Problems
Named Clinical Signs

Management

GO DR SHAVPU ACBC 

If any time critical features such as; suspected ruptured or leaking aortic aneurysm, traumatic injury causing disruption to the liver and spleen, ectopic pregnancy or sepsis secondary to perforation are present then correct any A and B problems and transfer to appropriate hospital.

Pain often accompanies abdominal emergencies. To help indentify what may be going on it is important to ask the following questions:

or using the SOCRATES mnemonic

Always consider the administration of Entonox for adequate pain relief pending examination (ascertain what pain relief has been taken by patient), 12 lead ECG monitoring in the elderly or those with cardiac risk factors if presenting with upper abdominal pain, treat for shock if large quantities of blood are believed to have been lost, call for paramedic backup if required.

NOTE: The new JRCALC 2013 No Longer makes reference to Entonox being a caution in the use of abdominal pain where a patient may have abdominal distension/obstruction. Please bear this in mind whenever Entonox is given to you patient as there could be a potential increase of a gas pocket caused by the nitrous oxide.

Secondary survey

ASHICE (consider)

Transport to hospital 

Professional handover 

Updated March 2014

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