Chapter 26: Abdominal Emergencies
Topics
● Abdominal Anatomy and Physiology
● Abdominal Pain and Discomfort
● Abdominal Conditions
● Assessment and Care of Abdominal Pain or Discomfort
Abdominal Anatomy and Physiology
● Abdomen contains many organs from several different body systems.
● Can cause confusion when determining the cause of abdominal emergencies.
● Thorough patient assessment is key.
● Specific diagnosis may not be necessary; treatment is the same for most conditions.
● Abdomen
○ Region between diaphragm and pelvis
○ Contains many organs that provide the following functions:
■ Digestive
■ Reproductive
■ Endocrine
■ Regulatory
● Abdomen divided into “quadrants”
○ RUQ, LUQ, RLQ, LLQ
○ Used to describe and identify areas of pain, tenderness, discomfort, injury, or
other abnormalities
● Organs of the abdomen
○ Peritoneum
■ Thin membrane lining the abdominal cavity and covering each organ
■ Parietal peritoneum attached to the abdominal wall
○ Visceral peritoneum covers each organ
○ Most enclosed within parietal peritoneum
○ A few lie in extraperitoneal space (outside the peritoneum)
■ Kidneys, pancreas, part of the aorta lie in retroperitoneal space, behind
peritoneum
■ Bladder and part of rectum lie inferior to peritoneum
○ Female reproductive organs and structures lie within abdomen and pelvis
■ Ovaries
■ Fallopian tubes
■ Uterus
○ Largest blood vessels
■ Aorta
■ Inferior vena cava
■ Hepatic artery
■ Splenic artery
■ Iliac artery and vein
, Abdominal Pain or Discomfort
● Visceral pain
○ Originates from the organs within the abdomen
○ Fewer nerve endings allow for only diffuse sensations of pain
○ Frequently described as “dull” or “achy”
○ Intermittent, crampy, or colicky pain may result from hollow organs
○ Persistent or constant pain often originates from solid organs
● Parietal pain
○ Originates from the parietal peritoneum
○ Many nerve endings allow for pain that is easier to locate and describe
○ Frequently described as “sharp”
○ Pain is often constant and localized to a specific area
● Tearing pain
○ Not the most common type of abdominal pain
○ Originates in the aorta or stomach
○ Separation of layers of aorta caused by aneurysm
○ Retroperitoneal location of aorta causes pain to be referred to back
○ Ulcers in stomach can also cause tearing pain
● Referred pain
○ Perception of pain in skin or muscles at distant locations
■ Abdomen has many nerves from different parts of the nervous system.
■ Nerve pathways overlap as they return to the spinal cord.
■ Pain sensation is transmitted from one system to another.
Abdominal Conditions
Appendicitis
● Infection of the appendix
● Signs and symptoms
○ Nausea and sometimes vomiting
○ Pain often initially referred to the umbilical region, followed by persistent RLQ
pain
○ Rupture of appendix
■ Sudden, severe increase in pain
■ Contents releasing into abdomen causes severe periotonitis.
Peritonitis
● Irritation of peritoneum, usually caused by foreign material in peritoneal space
● Parietal peritoneum is sensitive, especially to acidic substance.
● Irritation causes involuntary contraction of abdominal muscles.
● Signs and symptoms
○ Abdominal pain and rigidity
Cholecystitis/Gallstones
● Inflammation of the gallbladder
Topics
● Abdominal Anatomy and Physiology
● Abdominal Pain and Discomfort
● Abdominal Conditions
● Assessment and Care of Abdominal Pain or Discomfort
Abdominal Anatomy and Physiology
● Abdomen contains many organs from several different body systems.
● Can cause confusion when determining the cause of abdominal emergencies.
● Thorough patient assessment is key.
● Specific diagnosis may not be necessary; treatment is the same for most conditions.
● Abdomen
○ Region between diaphragm and pelvis
○ Contains many organs that provide the following functions:
■ Digestive
■ Reproductive
■ Endocrine
■ Regulatory
● Abdomen divided into “quadrants”
○ RUQ, LUQ, RLQ, LLQ
○ Used to describe and identify areas of pain, tenderness, discomfort, injury, or
other abnormalities
● Organs of the abdomen
○ Peritoneum
■ Thin membrane lining the abdominal cavity and covering each organ
■ Parietal peritoneum attached to the abdominal wall
○ Visceral peritoneum covers each organ
○ Most enclosed within parietal peritoneum
○ A few lie in extraperitoneal space (outside the peritoneum)
■ Kidneys, pancreas, part of the aorta lie in retroperitoneal space, behind
peritoneum
■ Bladder and part of rectum lie inferior to peritoneum
○ Female reproductive organs and structures lie within abdomen and pelvis
■ Ovaries
■ Fallopian tubes
■ Uterus
○ Largest blood vessels
■ Aorta
■ Inferior vena cava
■ Hepatic artery
■ Splenic artery
■ Iliac artery and vein
, Abdominal Pain or Discomfort
● Visceral pain
○ Originates from the organs within the abdomen
○ Fewer nerve endings allow for only diffuse sensations of pain
○ Frequently described as “dull” or “achy”
○ Intermittent, crampy, or colicky pain may result from hollow organs
○ Persistent or constant pain often originates from solid organs
● Parietal pain
○ Originates from the parietal peritoneum
○ Many nerve endings allow for pain that is easier to locate and describe
○ Frequently described as “sharp”
○ Pain is often constant and localized to a specific area
● Tearing pain
○ Not the most common type of abdominal pain
○ Originates in the aorta or stomach
○ Separation of layers of aorta caused by aneurysm
○ Retroperitoneal location of aorta causes pain to be referred to back
○ Ulcers in stomach can also cause tearing pain
● Referred pain
○ Perception of pain in skin or muscles at distant locations
■ Abdomen has many nerves from different parts of the nervous system.
■ Nerve pathways overlap as they return to the spinal cord.
■ Pain sensation is transmitted from one system to another.
Abdominal Conditions
Appendicitis
● Infection of the appendix
● Signs and symptoms
○ Nausea and sometimes vomiting
○ Pain often initially referred to the umbilical region, followed by persistent RLQ
pain
○ Rupture of appendix
■ Sudden, severe increase in pain
■ Contents releasing into abdomen causes severe periotonitis.
Peritonitis
● Irritation of peritoneum, usually caused by foreign material in peritoneal space
● Parietal peritoneum is sensitive, especially to acidic substance.
● Irritation causes involuntary contraction of abdominal muscles.
● Signs and symptoms
○ Abdominal pain and rigidity
Cholecystitis/Gallstones
● Inflammation of the gallbladder
