Chapter 23

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Chapter 23
2014-03-15 22:04:40

Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies
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  1. Acute Abdomen
    • Acute abdominal pain; may be severe, and it can have any number of causes
    • May arise from the cardiac, pulmonary, gastrointestinal, hematologic, genital, urinary, reproductive, or other body systems
  2. Abdominal Cavity
    Located below the diaphragm and extends to the top of the pelvis
  3. Peritoneum
    • Lines the abdominal cavity
    • Two layers: visceral peritoneum and the parietal peritoneum
    • The visceral peritoneum is the innermost layer and is in contact with the abdominal organs, whereas the parietal peritoneum is the outermost layer
  4. Abdominal Aorta
    The portion of the descending aorta that extends from the thoracic portion of the aorta to the distal point where the aorta divides into the iliac arteries. Arteries branching from the abdominal aorta supply the abdominal organs
  5. Left Upper Quadrant (LUQ)
    Contains most of the stomach, the spleen, the pancreas, and part of the large intestine. The left kidney is behind the abdominal lining
  6. Right Upper Quadrant (RUQ)
    Contains most of the liver, the gallbladder, and part of the large intestine. The right kidney is behind the abdominal lining
  7. Right Lower Quadrant (RLQ)
    Contains the appendix, part of the large intestine, and the female reproductive organs
  8. Left Lower Quadrant (LLQ)
    Contains part of the large intestine and the female reproductive organs
  9. Solid Organs
    • Spleen
    • Liver
    • Pancreas
    • Kidneys
  10. Hollow Organs
    • Stomach
    • Gallbladder
    • Duodenum
    • Large intestine
    • Small intestine
    • Bladder
  11. Vascular Structures
    • The large blood vessels found in the abdominal cavity
    • Portions of the descending aorta and the inferior vena cava
  12. Visceral Pain
    • Occurs when the organ itself is involved
    • Also associated with nausea and vomitting
  13. Parietal Pain or Somatic Pain
    • Associated with irritation of the peritoneal lining
    • Pain more severe and more localized
  14. Referred Pain
    Visceral pain that is felt elsewhere in the body
  15. Peritonitis
    • Irritation and inflammation of the peritoneum
    • Occurs when blood pus, bacteria, or chemical substances leak into the peritoneal cavity

    Signs and symptoms: abdominal pain or tenderness, nausea, vomiting, diarrhea, fever and chills, lack of appetite (anorexia), positive Markle (heel drop or heel jar) test
  16. Appendicitis
    • An inflammation of the appendix that commonly causes an acute abdomen.
    • Usually caused by a blockage in the intestines and results in inflammation and irritation

    Signs and symptoms: abdominal pain or cramping, nausea, vomiting, low-grade fever and chills, lack of appetite, abdominal guarding, positive Markle test
  17. Pancreatitis
    • Inflammation of the pancreas may cause sever pain in the middle of the upper quadrants.
    • Sometimes radiates to the back
    • Ingestion of alcohol, gallstone, infection

    Signs and symptoms: abdominal pain, nausea, vomiting, abdominal tenderness and distension, mild jaundice, severe abdominal pain with radiation, fever, rapid pulse, and signs of shock
  18. Cholecystitis
    • Inflammation of the gallbladder, commonly associated with the presence of gallstones
    • Blockage of opening of gallbladder to small intestine

    Signs and symptoms: Sudden onset of abdominal pain located from middle of upper quadrants to RUQ, tenderness upon palpation of RUQ, belching or heartburn, nausea and vomiting
  19. Gastrointestinal Bleeding
    • Upper gastrointestinal bleeds frequently caused by peptic ulcers, gastric erosion, and varices. More prevalent in adult males
    • Lower gastrointestinal bleeds are frequently caused by diverticulosis and occur more in women

    Signs and symptoms: abdominal pain or tenderness, hematemesis (vomiting blood, which can be bright red or look like coffee grounds), hematochezia (bright red blood in the stool normally signifying a rapid onset), melena (dark tarry stools containing decomposing blood normally from the upper gastrointestinal system), altered mental status, weakness, syncope, tachycardia, signs of shock
  20. Esophageal Varices
    Bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus

    Signs and symptoms: large amounts of bright red hematemesis (vomiting blood), absence of pain or tenderness in the abdomen, rapid pulse, breathing difficulty, pale cool clammy skin, other signs and symptoms of shock, jaundice
  21. Gastroenteritis
    Inflammation of the stomach and small intestines, is commonly associated with the presence of abdominopelvic pain

    Signs and symptoms: abdominal pain or cramping, nausea, vomiting, diarrhea, abdominal tenderness, fever and dehydration
  22. Ulcers
    Open wounds or sores within the digestive tract, usually in the stomach or the beginning of the small intestines. Associated with a breakdown of the lining that usually protects the intestine from the digestive fluids

    Signs and symptoms: sudden onset of abdominal pain in the LUQ, nausea, vomiting, hematemesis, hematochezia, melena, signs or symptoms of shock, peritonitis with a rigid abdomen
  23. Intestinal Obstruction
    A blockage that interrupts the normal flow of the intestinal contents within the intestines

    Signs and symptoms: abdominal pain moderate to severe, nausea, vomiting, constipation, abdominal distension and tenderness, abnormally prominent high-pitched bowel sounds with auscultation
  24. Hernia
    A protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall. Most commonly associated with increased pressure in the abdominal cavity during heavy lifting or straining, causing the peritoneum to be pushed into the weakness or opening

    Signs and symptoms: sudden onset of abdominal pain, fever, rapid pulse, tender mass at point of hernia, others similar to intestinal obstruction
  25. Abdominal Aortic Aneurysm (AAA)
    A weakened, ballooned, and enlarged area of the wall of the abdominal aorta

    Signs and symptoms: gradual onset of lower lumbar, groin and abdominal pain, rupture associated with sudden onset of severe, constant abdominal pain may radiate to lower back, flank, or pelvis, testicular pain, nausea, vomiting, mottled skin, pale cool clammy, absent femoral or pedal pulse, soft pulsating mass
  26. Hematologic Emergencies
    Involve the blood and its components

    Anemia, sickle cell anemia, hemophilia
  27. Anemia
    A reduction of the number of red blood cells in the circulating blood volume
  28. Sickle Cell Anemia
    Hereditary blood disorder, some red blood cells have abnormal hemoglobin that does not carry adequate oxygen

    • Bone crisis
    • Acute chest syndrome
    • Abdominal crisis
    • Joint crisis
  29. Hemophilia
    Blood disorder that affects clotting
  30. Gynecology
    The branch of medicine that studies health of the female patient and her reproductive system
  31. Menarche
    Onset of menses or menstrual period
  32. Dysmenorrhea
    Strong uterine cramps that cause the severe pain during menstruation
  33. Mittelschmerz
    • Abdominalpelvic pain in the middle of menstrual cycle
    • Caused by irritation of the peritoneum by the small amount of bleeding associated with the rupture of ovarian tissue that occurs with release of the mature ovum
  34. Ovarian Cyst
    A fluid-filled sac that forms inside or on an ovary
  35. Endometritis
    An inflammation of the endometrium
  36. Endometriosis
    A condition in which endometrial tissue grows outside the uterus
  37. Pelvic Inflammatory Disease (PID)
    An infection on the female reproductive tract
  38. Urology
    The branch of medicine that studies the urinary system in females and the genitourinary system in males
  39. Hematuria
    Blood in the urine
  40. Kidney Stones or Renal Calculi
    Crystals of substances such as calcium, uric acid, struvite, and crystine that are formed from metabolic abnormalities
  41. Kidney Failure or Renal Failure
    • Acute Renal Failure (ARF)- period of days and results in significant decrease in urine elimination
    • Chronic Renal Failure (CRF)- period of years; accumulation of waste products and fluids
  42. Dialysis
    An artificial process used to remove water and waste substances from the blood when the kidneys fail to function properly