Chapter 23
Abdominal and
Gastrointestinal
Disorders
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23-1
Objectives
23-2
Anatomy Review
• Borders of the abdominal cavity
– Diaphragm
– Pelvis
– Spine
– Abdominal wall
• Major blood vessels
– Aorta
– Inferior vena cava
23-3
Anatomy Review
• Peritoneum
• Retroperitoneum (retroperitoneal space)
23-4
Abdominal Quadrants
23-5
Solid Organs
• Abdomen
– Liver
– Spleen
• Retroperitoneal space
– Kidneys
23-6
Hollow Organs
• Abdomen
– Stomach
– Intestines
– Gallbladder
• Retroperitoneal space
– Urinary bladder
23-7
Primary Digestive System Organs
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Mouth
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anal canal
23-8
Accessory Digestive System Organs
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Teeth
Tongue
Salivary glands
Liver
Gallbladder
Pancreas
23-9
Process of Digestion
23-10
The Acute Abdomen
23-11
Acute Abdomen
• Sudden onset of abdominal pain
• Possible associated assessment findings
and symptoms
– Nausea and vomiting
– Abdominal tenderness and/or rigidity
– Signs and symptoms of shock may also be
present
23-12
Abdominal Pain
• Abdominal pain may or may not be the result
of a problem involving an organ within the
abdominal cavity.
23-13
Referred Pain
• Pain that is felt in a part of the body that is
away from the tissues or organ that causes
the pain.
23-14
Hemorrhagic Causes of
Acute Abdominal Pain
23-15
Gastritis
• Inflammation of the stomach lining
• Possible causes
– Increased gastric secretion associated
with excessive consumption of alcohol
– Infection caused by bacteria such as
Helicobacter pylori (H. pylori)
– Prolonged use of medications
– Severe physical stress such as burns,
severe infection, surgery, or trauma
23-16
Gastritis
• Assessment findings and symptoms
– Belching
– Nausea and vomiting
– Indigestion
– Burning sensation in the upper abdomen
23-17
Peptic Ulcer Disease
• A peptic ulcer is an open sore in the lining of
the stomach (gastric ulcer), duodenum
(duodenal ulcer), or esophagus (esophageal
ulcer).
• Primary cause
– H. pylori bacteria
• Contributing cause
– Excess secretion of digestive juices, such
as hydrochloric acid, by stomach cells
23-18
Peptic Ulcer Disease
• Gastric ulcer
• Duodenal ulcer
• Esophageal ulcer
23-19
Upper Gastrointestinal Bleeding
• Bleeding may occur from any part of the GI
tract.
• GI bleeding is a medical emergency.
• Upper GI bleeding is bleeding from the
esophagus, stomach, or duodenum.
23-20
Upper Gastrointestinal Bleeding
• Assessment findings and symptoms
– Hematemesis
• May be bright red or resemble coffee grounds
– Syncope
– Fatigue
– Shortness of breath
23-21
Lower Gastrointestinal Bleeding
• Can originate in the small intestine, colon, or
rectum
• Common causes
– Tumors, hemorrhoids, colitis
• Assessment findings and symptoms
– Rectal bleeding, which may include melena
– Increased frequency of stools
– Cramping pain
23-22
Nonhemorrhagic Causes of
Acute Abdominal Pain
23-23
Appendicitis
• Inflammation of the appendix
• Assessment findings and symptoms
– Sudden onset of abdominal pain that shifts
to the RLQ
– Nausea
– Vomiting
– Fever
– Loss of appetite
23-24
Intestinal Obstruction
• Blockage of the large or small intestine
• Assessment findings and symptoms
– Cramping abdominal pain
– Nausea
– Vomiting or diarrhea
– Gradual loss of appetite
– Abdominal distention and tenderness
– Decreased or no passage of stool
– Inability to pass gas
– Fever and chills
23-25
Pancreatitis
• Inflammation of the pancreas
• Assessment findings and symptoms
– Abdominal pain that typically radiates to
the back
– Severe, deep, piercing, and steady pain
– Nausea, vomiting
– Abdominal tenderness
– Fever
– Hypotension, tachycardia
23-26
Cholecystitis
• Inflammation of the gallbladder
• Assessment findings and symptoms
– Pain in the upper middle or right upper
quadrant of the abdomen
– Pain described as severe, steady, and
worsens with movement
– Nausea, vomiting
– Constipation or diarrhea
– Excessive belching
23-27
Gastroenteritis
• Inflammation of the intestinal lining
– Most often caused by a virus
• Assessment findings and symptoms
– Diarrhea
– Abdominal pain and tenderness
– Vomiting
– Headache
– Fever
– Chills
23-28
Hepatitis
• Inflammation of the liver, most commonly
caused by a viral infection
• Assessment findings and symptoms
– Dull right upper quadrant pain and
tenderness unrelated to food consumption
– Nausea and vomiting
– Loss of appetite
– Extreme fatigue
– Dark urine, clay colored stools
23-29
– Jaundice
Patient Assessment
23-30
Patient Assessment
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Scene size-up
Primary survey
Establish patient priorities
Determine the need for additional resources
Make a transport decision
23-31
Patient History
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Signs/symptoms
Allergies
Medications
Past medical history
Last oral intake
Events prior
• Onset
• Provocation/
Palliation / Position
• Quality
• Region/Radiation
• Severity
• Time
23-32
Physical Examination
• Observe the patient’s position
• Listen to breath sounds
• Assess vital signs and oxygen saturation
• Assess the abdomen for DCAP-BTLS
23-33
Emergency Care
• Prehospital care is supportive
• Allow the patient to assume a position of
comfort
• Provide calm reassurance
• Administer oxygen
• Reassess as often as indicated
23-34
Questions?
23-35