Bring a large pot of salted water to a boil. Add 12 ounces fettuccine and cook according to package directions until al dente. Drain and set aside.
While the water heats and the pasta cooks, heat a large skillet over medium-high heat. Add 2 tablespoons of the butter. Pat 1 pound shrimp dry, toss with 1 teaspoon Cajun seasoning and 1/2 teaspoon paprika, then add the shrimp to the skillet in a single layer. Cook until pink and opaque, about 2–4 minutes total, turning once. Remove the shrimp with a slotted spoon and set aside.
Reduce the skillet heat to medium and add the remaining 6 tablespoons butter. When melted, add 4 sliced green onions, 1/4 cup diced yellow pepper, 1/4 cup diced green pepper, 1 cup sliced mushrooms, and 12 ounces sliced andouille sausage. Cook, stirring occasionally, until the sausage is browned and the vegetables are softened, about 4–6 minutes.
Add 4 minced garlic cloves and 1/2 cup diced tomato to the skillet and cook, stirring, for about 1 minute until fragrant.
Pour in 1 cup heavy cream and bring to a gentle simmer over medium heat. Cook, stirring occasionally, until the sauce has thickened slightly, about 3–5 minutes.
Stir in 1 teaspoon lemon juice, 1/3 cup freshly grated Parmesan, and 1 tablespoon chopped fresh parsley. Stir until the Parmesan melts into the sauce. Taste and season with salt and pepper as needed.
Remove the skillet from the heat. Add the cooked fettuccine and the reserved shrimp to the skillet and toss gently to coat the pasta and shrimp evenly with the sauce.
Serve immediately.