Acute Abdomen
Temple College
EMS Professions
Acute Abdomen
General name for presence of signs,
symptoms of inflammation of
peritoneum (abdominal lining)
Acute Abdomen
• Determining exact cause irrelevant in prehospital care
• Important factor is recognizing acute
abdomen is present
History
• Where do you hurt?
– Know locations of major organs
– But realize abdominal pain locations do not
correlate well with source
History
• What does pain feel like?
– Steady pain - inflammatory process
– Crampy pain - obstructive process
History
• Was onset of pain gradual or sudden?
– Sudden = perforation, hemorrhage, infarct
– Gradual = peritoneal irritation, hollow organ
distension
History
• Does pain radiate (travel) anywhere?
– Right shoulder, angle of right scapula = gall
bladder
– Around flank to groin = kidney, ureter
History
• Duration?
– > 6 hour duration = ? surgical significance
• Nausea, vomiting? Bloody? “Coffee Grounds”?
Any blood in GI tract =
Emergency until proven otherwise
History
• Change in urinary habits? Urine appearance?
• Change in bowel habits? Appearance of
bowel movements? Melena?
History
• Regardless of underlying cause vomiting or
diarrhea can be a problem because of
associated volume loss
History
• Females
– Last menstrual period?
– Abnormal bleeding?
In females, abdominal pain = Gyn problem
until proven otherwise
Physical Exam
• General Appearance
– Lies perfectly still  inflammation, peritonitis
– Restless, writhing  obstruction
• Abdominal distension?
• Ecchymosis around umbilicus, flanks?
Physical Exam
• Vital signs
– Tachycardia ? Early shock (more important
than BP)
– Rapid shallow breathing peritonitis
Tilt test should be done with nontraumatic abdominal pain
Physical Exam
• Palpate each quadrant
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Work toward area of pain
Warm hands
Patient on back, knee bent (if possible)
Note tenderness, rigidity, involuntary
guarding,voluntary guarding, masses
Physical Exam
• Bowel Sounds
– Listen 1 minute in each quadrant
– Listen before feeling
– Absent bowel sounds  ileus, peritonitis, shock
Auscultating bowel sounds has no pre-hospital
value in trauma patients
Management
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Airway
High concentration O2
Anticipate vomiting
Anticipate hypovolemia
Nothing by mouth
No analgesics, sedatives
Management
• In adults > 30, consider possibility of
referred cardiac pain.
• In females, consider possible gyn problem,
especially tubal ectopic pregnancy
Appendicitis
• Usually due to obstruction with fecalith
• Appendix becomes swollen, inflamed 
gangrene, possible perforation
Appendicitis
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Pain begins periumbilical; moves to RLQ
Nausea, vomiting, anorexia
Patient lies on side; right hip, knee flexed
Pain may not localize to RLQ if appendix in
odd location
• Sudden relief of pain = possible perforation
Duodenal Ulcer Disease
• Steady, well-localized epigastric pain
• “Burning”, “gnawing”, “aching”
• Increased by coffee, stress, spicy food,
smoking
• Decreased by alkaline food, antacids
Duodenal Ulcer Disease
• May cause massive GI bleed
• Perforation = intense, steady pain, pt lies
still, rigid abdomen
Kidney Stone
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Mineral deposits form in kidney, move to ureter
Often associated with history of recent UTI
Severe flank pain  radiates to groin, scrotum
Nausea, vomiting, hematuria
Extreme restlessness
Abdominal Aortic Aneurysm
• Localized weakness of blood vessel wall
with dilation (like bubble on tire)
• Pulsating mass in abdomen
• Can cause lower back pain
• Rupture shock, exsanguination
Pancreatitis
• Inflammation of pancreas
• Triggered by ingestion of EtOH; large
amounts of fatty foods
• Nausea, vomiting; abdominal tenderness;
pain radiating from upper abdomen straight
through to back
• Signs, symptoms of hypovolemic shock
Cholecystitis
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Inflammation of gall bladder
Commonly associated with gall stones
More common in 30 to 50 year old females
Nausea, vomiting; RUQ pain, tenderness;
fever
• Attacks triggered by ingestion of fatty foods
Bowel Obstruction
• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias, fecal
impactions, tumors
• Crampy abdominal pain; nausea, vomiting
(often of fecal matter); abdominal
distension
Esophageal Varices
• Dilated veins in lower part of esophagus
• Common in EtOH abusers, patients with
liver disease
• Produce massive upper GI bleeds