CH 19

• Organs in the abdominal cavity

  • Solid: liver, spleen, pancreas, kidney, ovaries
  • Hollow: gallbladder, stomach, ureter, large/small intestine, fallopian tubes, urinary bladder, uterus
• Gastrointestinal system


  Responsible for the digestion process
• Digestion


  1. Begins when food is chewed

  2. Saliva breaks down food

  3. Stomach is the main digestive organ

  4. Gastric juices (HCl, pepsin, rennin) break down food in the stomach

  5. Liver assists in digestion by secreting bile to help digest lipids in the small intestine, filters toxic substances, creates glucose stores, produces substances necessary for blood clotting and immune function

  6. Gallbladder is a reservoir for bile, which is secreted into the duodenum of the small intestine for digestion of fatty foods

  7. Small intestine (duodenum, jejunum, ileum)

  8. Colon (large intestine) receives undigested food waste from the small intestine
• Spleen


  • Located in the abdomen but doesn't have a digestive function
  • Acts as a blood filter, removes old blood cells, holds a reserve of blood and produces antibodies
• Urinary system


  • Controls the discharge of waste materials filtered from the blood by the kidneys
  • Can lower blood pressure by removing sodium and water from the body
  • Can increase blood pressure by retaining water, increasing blood volume
  • Kidneys, ureters, urinary bladder, urethra
• Peritoneum


  • Parietal peritoneum lines the walls of the abdominal cavity
  • Visceral peritoneum covers the organs themselves
  • The presence of foreign material between the layers of peritoneum can irritate the peritoneum, causing peritonitis
• Acute abdomen


  Sudden onset of abdominal pain, often associated with severe, progressive problems
• Peritonitis


  Can cause ileus (paralysis of muscular contractions that normally propel material through the intestine), retained gas and feces causing distention and obstruction, loss of fluid can cause low blood pressure and shock
• Visceral pain


  Involves hollow organs, difficult to localize, causes include organs contracting too forcefully or being distended
• Parietal/rebound pain


  Involves the peritoneum, steady aching pain that increases with movement, caused by inflammation of the peritoneum
• Somatic pain


  Originates from peripheral nerve tracts, localized pain that is deeply felt, caused by irritation or injury to tissue
• Referred pain


  Pain originating in one location but perceived in a distant location, usually occurs after initial visceral, parietal, or somatic pain
• Diverticulitis


  Inflammation of small pouches called diverticula that develop along the walls of the intestines, caused by reduced fiber intake leading to more solid stools, increased intestinal contractions, and fecal matter getting caught in the colon walls
• Cholelithiasis


  Formation of gallstones in the gallbladder, can cause cholecystitis (inflammation of the gallbladder)
• Appendicitis


  Inflammation of the appendix, causes sudden pain that begins on the right side of the lower abdomen or around the navel and often shifts to the lower right abdomen
• Parietal peritoneum


  Supplied by the same nerves that supply the skin of the abdomen, can perceive sensations like pain, touch, pressure, heat and cold
• Referred pain


  Felt in one part of the body other than its actual source, due to connections between the somatic and autonomic nervous systems
• Peptic ulcer disease (PUD)

  Protective layer of mucus lining erodes into the stomach and duodenum, allowing acid to eat into the organ, causes burning or gnawing pain in the upper abdomen
• Gallstones


  May form and block the gallbladder's outlet, leading to cholecystitis
• Pancreatitis


  Inflammation of the pancreas, causes pain in the upper left/right quadrant that radiates to the back
• Appendicitis


  Inflammation or infection in the appendix, causes generalized, dull, diffusing pain located in the umbilical area with rebound tenderness
• Gastrointestinal hemorrhage


  Symptom of another disease, not a disease itself, can occur in the upper or lower GI tract
• Esophagitis


  Inflammation of the esophageal lining, can be caused by infection or acids from the stomach
• GERD (Gastroesophageal reflux disease)


  The sphincter between the stomach and esophagus opens up, allowing stomach acid to move into the esophagus
• Esophageal varices


  Esophageal blood vessels drain into the liver, when the liver fails the pressure within the blood vessels surrounding the esophagus increases, can suddenly rupture causing severe bleeding
• Mallory Weiss Syndrome


  Junction between the esophagus and the stomach tears, causing severe bleeding
• Gastroenteritis


  Bacterial or viral infection that usually enters the body through contaminated food, causes diarrhea, nausea, dehydration
• Hemorrhoids


  Result from conditions that increase pressure on the rectum or irritate it, can be internal (painless, mild bleeding) or external (painful with bright red bleeding)
• Cystitis


  Bacterial infection of the bladder, causes lower abdominal pain, urgency and frequency in urination with pressure and pain around the bladder
• Kidney failure


  • Irreversible damage to the kidneys, usually from chronic kidney disease, causes uremia (abnormally high levels of waste products in the blood)
  • Signs include fatigue, nausea, loss of appetite
  • Requires dialysis or kidney transplant
• Kidney stones


  Can grow over time and cause blockage, leading to pressure buildup and swelling in the kidneys, causes mild to extreme flank pain radiating to the groin
• Acute kidney failure


  Sudden decrease in kidney function, can be reversible with prompt diagnosis and treatment, causes include hemorrhage, dehydration, trauma, sepsis
• Chronic kidney failure


  Progressive and irreversible damage, often caused by hypertension and diabetes, requires dialysis
• Abdominal aortic aneurysm (AAA)


  Weak areas in the aorta behind the peritoneum can result in an aneurysm, signs include a pulsating mass in the abdomen and back pain, if it ruptures it can cause massive hemorrhage
• Pneumonia


  Especially in the lower lungs, can cause ileus and abdominal pain
• Hernia


  Protrusion of an organ through an opening into a body cavity where it does not belong, can be reducible or strangulated (a serious medical emergency)
• Secondary assessment of acute abdominal pain

  1. Start in the quadrant next to the area of pain and work towards it

  2. Use four fingers close together to depress the skin about 1 cm and move clockwise to the next area

  3. Ask patient to place their own hand under the area if it is ticklish

  4. Proceed to deep palpation, 2-3 cm

  5. DR GERM! (Vital signs)
• Emergency medical care for acute abdomen

  • Cannot treat the underlying cause, treat for shock if present
  • Provide low-flow oxygen to decrease nausea and anxiety
  • Dialysis is the only definitive treatment for chronic kidney failure, filters the blood and cleans it of toxins
• Somatic Pain is pain in your muscles, skin, or bone. This pain is focused on a specific area and could be the type of pain you feel with movement, when experiencing a headache, or when you cut your skin. Visceral Pain is pain experienced in your internal organs and it can be harder to centralize or identify.
• Duodenum


  The first part of the small intestine in the gastrointestinal tract, approximately 25-30 cm (10-12 in) long, where most digestive enzymes are released and most nutrient absorption occurs.