Abdominal Trauma/Chronic Abdominal Pain
Types & Causes of Abdominal Trauma?
Injury—blunt or penetrating trauma
Common: liver laceration, ruptured spleen, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal or pancreas injury, stomach or intestine rupture
Blunt: MVA, direct blows, and falls
Penetrating : knife or gunshot
What is IBS?
Chronic abdominal pain or discomfort and alteration of bowel patterns
What is appendicitis?
Inflammation of the appendix
Most common emergent abdominal surgery
What is peritonitis?
Inflammation of the peritoneum
What is gastroenteritis?
Inflammation of mucosa of stomach and small intestine
Manifestations of it?
Classic:
• Guarding and splinting abdomen
• Hard, distended abdomen
• Decreased or absent bowel sounds
• Abrasions or bruising; Cullen’s or Grey Turner’s sign
• Abdominal pain
• Hematemesis or hematuria
• Signs of hypovolemic shock
What are the manifestations of IBS?
Other GI symptoms:
Abdominal pain, nausea, flatulence, mucus in stool, sensation of incomplete evacuation
Non-GI symptoms:
Fatigue, headache, and sleep problems
Diarrhea or constipation; either may predominate or alternate
What causes it?
Fecalith obstructs lumen of appendix resulting in distention, venous engorgement, accumulation of mucus and bacteria leading to gangrene, perforation, and peritonitis
What causes it?
Causes:
Primary—blood-borne organisms
Secondary—perforation of organs that spill contents into peritoneal cavity
Common Cause?
Treatment for abdominal trauma?
Emergency management:
IV access and fluids
NG tube
Monitor for:
• Deterioration of condition
• Need for surgery
Do not remove impaled object
• Stabilize with a bulky dressing
Treatment for IBS?
No single effective therapy; treatment considerations:
Psychologic support
• Cognitive behavior; stress management
Dietary changes
• FODMAP diet
Drugs to regulate stool and reduce pain
• Opioid agonists, antispasmodics, antidepressants, antidiarrheals, or laxatives
+Also see drug alert: alosetron
Manifestations of Appendicitis?
Initially dull periumbilical pain; anorexia, nausea, vomiting
Persistent pain RLQ at McBurney’s point
Fever, localized tenderness, rigidity, rebound tenderness, muscle guarding
pain with cough, sneeze, deep breath
Lie still with right leg flexed
Older adult: less pain, slight fever, right iliac fossa discomfort
Manifestations of peritonitis?
Abdominal pain—most common
Universal sign: tenderness over area involved
Rebound tenderness, muscular rigidity, and spasm —peritoneal irritation
Other: abdominal distention, fever, tachycardia, nausea, vomiting, altered bowel habits
Complications: hypovolemic shock, sepsis, intraabdominal abscess, paralytic ileus, ARDS
Manifestations?
Features: sudden diarrhea, nausea, vomiting, fever, abdominal cramping
What is Chronic Abdominal Pain & Causes of it?
Dull, aching, or diffuse
Common causes: irritable bowel syndrome, chronic pancreatitis, hepatitis, pelvic inflammatory disease, adhesions, vascular insufficiency
Treatment for appendicitis?
Surgery: appendectomy
-Immediate to avoid rupture; peritonitis
-IV fluid and antibiotics
Preoperative:
Administer IV fluid and analgesia
Prevent complications
• Keep NPO
• Monitor VS
• Antiemetics
Postoperative:
General postop care (laparotomy)
Early ambulation; advance diet as tolerated
IV antibiotics if ruptured
Treatment for it?
Preoperative/mild cases or poor surgical risk:
NPO, NG suction, IV fluids, antibiotics, analgesia, antiemetics
Surgery—locate source, drain purulent fluid, repair damaged organ
Postoperative care:
NPO, IV fluid, NG suction, blood, parenteral nutrition, antibiotics, sedatives, opioids, antiemetics
Treatment?
-Treatment: self-limiting
-Oral or IV fluids
-Other: similar to diarrhea
Treatment/Diagnostics for Chronic Abdominal Pain?
Diagnosis: H & P, pain assessment
Endoscopy, CT scan, MRI, laparoscopy, barium studies
-Treatment: depends on underlying cause
Nursing Assessment for peritonitis?
Pain
Abdomen
-Bowel sounds
-Distention
-Guarding
-Nausea
Fever
Hypovolemic shock