L3 Abdominal Conditions 2020 PDF

Abdominal Conditions Component 5 © Department of Clinical Education & Standards 1  Abdominal Conditions – Component 5 Objective Describe relevant abdominal conditions and the underlying pathophysiology, sign & symptoms and...

Abdominal Conditions Component 5 © Department of Clinical Education & Standards 1  Abdominal Conditions – Component 5 Objective Describe relevant abdominal conditions and the underlying pathophysiology, sign & symptoms and management  Abdominal Conditions – Component 5 Abdominal pain is a common presenting symptom to ambulance the service. The specific cause can be difficult to identify in the pre-hospital setting. The nature, location and pattern of the pain and associated symptoms may indicate a possible cause. Many of the causes are self limiting and minor in nature HOWEVER it is important to recognise the risks associated with those conditions that need further input, as well as those that need more urgent life-saving interventions.  Abdominal Conditions – Component 5 THINK Abdominal pain can be localised or referred, due to overlapping of the organs contained in the abdomen (eg small and large intestines). In patients over 65 years old there is a 6-8 times higher mortality rate due to atypical presentations and the presence of co-morbidities. 25% of patients contacting the ambulance service with abdominal pain have serious underlying conditions. The elderly, those with alcohol dependence and immunosuppressed patients may have atypical presentations. For indigestion type pain always consider “ is it cardiac in origin”. Obtain a 12 lead ECG for patients with cardiac risks presenting with upper abdominal pain. © Department of Clinical Education & Standards 4  Abdominal Conditions – Component 5 Myocardial Infarction Peptic Ulcer Constipation Food poisoning Aortic aneurism Dehydration Crohn's disease Ectopic Pregnancy IBS Stomach ulcer Bowel obstruction Morning sickness Diverticulitis Pelvic Inflammatory disease Liver problems Appendicitis Trauma Peritonitis Period Pain Diaphragmatic rupture Endometriosis Trapped wind Retention of urine Pancreatitis Lumbar pain Hypoglycaemia Internal bleeding Dehydration Lesions Kidney Stones Threatened Post operative pain Gall Stones Miscarriage Hernia Candida Reflux Kidney infection Bowel rupture Oesophageal varices Torsion of the testes Septicaemia Gonorrhoea Nephritis Ruptured spleen Syphilis Tumour Urinary tract infection Salpingitis And there’s more! It is not always possible to identify the exact cause © Department of Clinical Education & Standards 5  Abdominal Conditions – Component 5 Abdominal pain can arise from both acute and chronic abdominal conditions © Department of Clinical Education & Standards 6  Abdominal Conditions – Component 5 Acute conditions Appendicitis Gastroenteritis Cholecystitis Pancreatitis Intestinal Diverticular disease obstruction Leaking or ruptured aortic Ureteric colic aneurysms Gastritis Gynaecological disorders Perforated peptic ulcer © Department of Clinical Education & Standards 7  Abdominal Conditions – Component 5 Chronic Conditions Irritable Bowel Syndrome (IBS) Inflammatory bowel syndromes (Ulcerative Colitis and Crohn’s disease) Gastric and Duodenal ulcers Hernias © Department of Clinical Education & Standards 8  Abdominal Conditions – Component 5 To assist the clinician with an assessment the abdomen in separated into four quadrants  Abdominal Conditions – Component 5 Lets look more closely at some of the conditions that may cause abdominal pain  Abdominal Conditions – Component 5 Appendicitis Frequently misdiagnosed especially in women of child bearing age. Most common surgical emergency in the UK, accounts for more than 40,000 hospital admissions each year. More common in children aged 12-16 years. Pain often starts in the peri-umbilical area and settles in the right lower quadrant. Other symptoms can include : increased temperature, nausea, vomiting, pain can worsen when coughing or walking  Abdominal Conditions – Component 5 Hernia A hernia occurs when an internal part of the body pushes through a weakness in the muscle of surrounding tissue wall. A hernia usually develops between the chest and hips. Often they cause no, or very few symptoms. There may be a lump or swelling in the abdomen or groin. A patient should seek urgent medical advise if they have a known hernia and experience any of the following symptoms : Sudden severe pain, nausea and vomiting, constipation or unable to pass wind. © Department of Clinical Education & Standards 12  Abdominal Conditions – Component 5 Bowel Obstruction A bowel obstruction is the inability for digestive waste to pass through the bowel. Symptoms of a bowel obstruction can include : intermittent and occasionally severe abdominal pain which has been bought on by eating, unintentional weight loss, constant swelling of the abdomen, nausea, vomiting. Bowel obstruction is a medical emergency. © Department of Clinical Education & Standards 13  Abdominal Conditions – Component 5 Peptic Ulcer Peptic ulcer is the erosion of the lining of the stomach or small intestine forming an ulcer. The most common causes of peptic ulcers is infection with the bacterium Helicobacter pylori and long term use of NSAIDs such as ibuprofen. Peptic ulcers include : Gastric Ulcers which occur on the inside of the stomach and Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum) Symptoms may include central burning abdominal pain, back pain, nausea. If the peptic ulcer perforates symptoms may include; sudden onset of severe epigastric pain, abdominal swelling and bloating. A perforated peptic ulcer is a medical emergency. © Department of Clinical Education & Standards 14  Abdominal Conditions – Component 5 Diverticulitis Diverticula usually develop when naturally weak places in the colon give way under pressure, causing marble sized pouches to protrude through the colon wall. Diverticulitis occurs when the diverticula tear which can result in inflammation and sometimes infection Symptoms of diverticular disease can include : lower abdominal pain, abdominal distention or swelling. Symptoms of diverticulitis can include : a more severe abdominal pain, predominately on the left side, fever of above 38C, diarrhoea. Diverticulitis will require medical attention. © Department of Clinical Education & Standards 15  Abdominal Conditions – Component 5 Inflammatory Bowel Disease Inflammatory bowel disease is the umbrella term for conditions such as Crohns disease and Ulcerative Colitis Both Crohns and Ulcerative Colitis are a result of an abnormal response by the body's immune system. Symptoms for both may include : abdominal pain, fatigue, weight loss, blood in the stool, malnutrition. If complications occur within these two inflammatory bowel diseases medical attention is required. © Department of Clinical Education & Standards 16  Abdominal Conditions – Component 5 Gastroenteritis Gastroenteritis is a condition usually caused by a virus or bacteria, it is a very common condition that causes diarrhoea and vomiting. It affects people of all ages. Symptoms include : vomiting, diarrhoea, nausea, fever, abdominal cramps, aching limbs and headache. Gastroenteritis is very contagious. Patients should seek further medical attention if : symptoms do not improve within a few days, they become dehydrated or have dizziness, have a fever above 38C, they have underlying conditions such as inflammatory bowel disease and kidney disease. © Department of Clinical Education & Standards 17  Abdominal Conditions – Component 5 Abdominal Aortic Aneurysm An abdominal aortic aneurysm is often referred to as a triple A or AAA AAA is a swelling or bulge in the aorta, the main blood vessel that runs from the heart down through the chest and abdomen. Screening for AAA for men over 65 years and women over 70 years who have underlying risk factors such as high blood pressure is routinely offered by the NHS. AAA do not usually cause any obvious symptoms and are often picked up at the screening, the aneurysm will then be closely monitored. If the AAA bursts it becomes a severe medical emergency, symptoms of a ruptured aortic aneurysm include a pulsating mass in the abdomen, severe abdominal and back pain, sweating, dizziness, shortness of breath, collapse. © Department of Clinical Education & Standards 18  Abdominal Conditions – Component 5 Gastrointestinal Bleeding Gastrointestinal (GI) bleeding is a common medical emergency and is commonly divided into: Upper gastrointestinal bleeding Lower gastrointestinal bleeding © Department of Clinical Education & Standards 19  Abdominal Conditions – Component 5 Upper GI bleeding Upper GI Bleeding is more common than lower GI bleeding and is more prevalent in socioeconomically deprived areas. Upper GI bleeding accounts for 85% of gastrointestinal events. Upper GI bleeding tends to be more extreme and can rapidly lead to hypovolemic shock. The upper gastrointestinal tract comprises of the oesophagus, stomach, duodenum. Common causes of upper GI bleeds include : Peptic ulcers, Gastritis, Oesophageal varices, tumours. © Department of Clinical Education & Standards 20  Abdominal Conditions – Component 5 Lower GI Bleeding Lower GI bleeding is less likely than upper GI bleeding to present with signs of haemodynamic compromise. Lower Gi bleeding is more prevalent in men who also have a history of use of aspirin or NSAID ( Ibuprofen) use. The lower gastrointestinal tract comprises of the lower part of the small intestine, the colon, rectum and anus. Common causes of lower GI bleeding include : diverticular disease, inflammatory bowel disease, bowel disease, haemorrhoids and tumour. © Department of Clinical Education & Standards 21  Abdominal Conditions – Component 5 Management Assess C ABCD Are there any time critical features present Are further interventions required, request assistance ASAP Start to correct C ABC if any Oxygen as per JRCALC Guideline Pain score/Pain relief Abdominal assessment Undertake time critical transfer if required Continue patient management on route If no life threatening signs identified in primary survey then continue to secondary survey ECG ( elderly and cardiac patients and upper abdominal pain) Constant observations © Department of Clinical Education & Standards 22 Abdominal Conditions – Component 5 History Taking - Pain © Department of Clinical Education & Standards 23  Abdominal Conditions – Component 5 History Taking - Medical History © Department of Clinical Education & Standards 24  Abdominal Conditions – Component 5 Management Patients will often find a position that is comfortable for them Fowler position – if patient is conscious Stable side position if patient is unconscious Abdominal Conditions – Component 5