10) ABDMN & Pelvic Flashcards
Cullen’s Sign & aka:
Grey Turner’s sign:
= Periumbilical bruising: contusion/eechymossis, (found w/ ectopic peg/s, anything Center up fucked “Cullen’s center
= R/L-Flank bruising from some type of organ “Turn to side”
A&P) peritoneal space organs:
Retroperitoneal space organs:
pelvic space organs:
= stomach, spleen, gall bladder, liver, pancreas, & intestines
= kidneys, proximal ureters, adrenals & most major ABDMN ves/
= urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, & anal canal Females: uterus, Fallopian tubes, ovaries, and upper vagina. males: prostate
A&P) Retroperitoneal space organs:
= kidneys, proximal ureters, adrenals & most major ABDMN ves/
A&P) pelvic space organs:
= urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, & anal canal Females: uterus, Fallopian tubes, ovaries, and upper vagina. males: prostate
A&P) peritoneal space organs:
= stomach, spleen, gall bladder, liver, pancreas, & intestines
ABDMN Cavity) 1 of largest cavities BUT:
most common reason for blunt abdominal and/or pelvic injuries
= Very little protection (takes Ls to change girth) (little protection)
= MVA
A&P) Circ) ABDMN contents are supplied blood via & located:
= ABDMN aorta located along L-side of S/Col. It sends many branches to discrete organs and the bowel
Abdominal Evisceration:
Treatment:
= (omphalocele } through umbilicus) Omentum 2 layers, S-intest, most likely organ to be exposed
= Remove/cut clothing away from wound area, Wet dressing then dry 4 sided occlusive on top(keep heat inside) could use burn/heat sheet Cover the area with a sterile dressing soaked with sterile normal saline
A&P) GI) Accessory GI organ:
= Liver, Gall blader, Pancreas (pancreotic juice creates buffer into deuodnium),
PT sustained blunt force trauma to their ABDMN & you suspect there could be an internal hemorrhage. PT’s v/s: 78/40, P122, RR22. After starting an IV, how much fluid would you administer to this patient?
Administer small fluid boluses until a return of a radial pulse
Liver) Fn:
Location w/ injury rate
= Detoxifies the blood, Produces bile for digestion, Manufactures clotting factors and is a major storage area for glycogen,
= Most common organ injured in the abdomen
Mom) After 32 weeks and until pregnancy ends, uterus fills:
3rd trimesters anatomical change:
3rd Trimester v/s change:
Possible effects from changes:
Vascular vol/ increase accompanied by <increase in RBC Result:
1= abdominal cavity to level of lower rib margin.
2= Enlarging ABDMMN increases ABDMN P. displaces diaphragm upward
3= Reduced lung capacity, +Circ 45%, +15% CO BPM, CO +40%
4= Anemia <RBC 45% from not keeping up w/ RBC
5= anemia becomes consideration w/ aggressive fluid resuscitation for shock
Spleen) organ class
Location quadrant
= not an accessory GI organ, but part of immune system
= LUQ
A&P) landmarks:
RUQ contains:
LUQ contains:
RLQ contains:
LLQ contains:
= umbilicus, xiphoid process, iliac crests, & pubic prominence.
RUQ =gallbladder, right kidney, most of the liver, some small bowel, a portion of the ascending & transverse colon, small portion of pancreas
LUQ = stomach, spleen, left kidney, most of pancreas, portions of the liver, small bowel, transverse & descending colon
RLQ =Appendix, Portions of urinary bladder, small bowel, ascending colon, rectum, (right ovary)
LLQ =sigmoid colon, portions of the urinary bladder, small bowel, descending colon, rectum, (left ovary)
A&P) LLQ contains:
LLQ =sigmoid colon, portions of the urinary bladder, small bowel, descending colon, rectum, (left ovary)
A&P) RUQ contains:
=gallbladder, right kidney, most of the liver, some small bowel, a portion of the ascending & transverse colon, small portion of pancreas
A&P) LUQ contains:
LUQ = stomach, spleen, left kidney, most of pancreas, portions of the liver, small bowel, transverse & descending colon
A&P) RLQ contains:
RLQ =Appendix, Portions of urinary bladder, small bowel, ascending colon, rectum, (right ovary)
A&P) Circ) ABDMN aorta & its major branches
gastric, superior and inferior mesenteric, splenic, hepatic, renal, gonadal, and iliac
Blunt Trauma) 3 most common associated mechanisms:
Deceleration, Crushing, Compression: Hollow organs
Blunt Trauma) Deceleration & commonly w/:
Crushing & commonly w/:
Compression & commonly w/:
= Shear Injuries} AAA, ligament of teres (around liver shearing it)
= Solid organs} vascular & bleed a lott (Liver & Spleen most rich)
= Hollow organs
Trauma) Blunt) Most frequently injured ABDMN structures w/ %:
Next most frequently injured ABDMN structures:
= 40 percent of splenic injury & little >than 20% of hepatic injury.
= Bowel & kidneys
Bright red hemorrhage without pain in a female that is in her third trimester most likely describes:
Placenta Previa
Bruising around the umbilical region is known as:
Cullen’s Sign
Mom) the uterus fills the abdominal cavity to the level of the lower rib margin. The enlarging uterus increases intra-abdominal pressure and displaces the diaphragm upward.
The displacement reduces:
= By 32 weeks and until the pregnancy ends
= lung capacity at same time that physiologic changes of pregnancy require an increase in tidal volume.
Detachment of the placenta from the uterine wall during pregnancy is called:
Abruptio placentae
A&P) Digestive tract:
Components of the digestive tract include:
= 25ft-long hollow muscular tube for digestion & waste products
= stomach, small bowel (duodenum, jejunum, and ileum), large bowel (or colon), rectum, and anus.
Limited chest wall movement b/c pain maybe from:
The principles of managing the abdominal injury patient include:
= peritonitis or blood irritating the diaphragm
= treatment of hidden hemorrhagic shock from MOI
Mom) Uterine enlargement displaces most of the ABDMN contents upward as the growing uterus rises out of the pelvis and its upper border extends above the umbilicus @:
the uterus fills the ABDMN cavity to the Lvl of the lower rib margin. The enlarging uterus increases intra-abdominal P. & displaces the diaphragm upward @:
= During the 2nd trimester (12 to 24 weeks)
= By 32 weeks and until the pregnancy ends
Ecchymosis around either L/R-ABDMN flank area is known as:
Grey Turner’s Sign
evisceration, occurs most frequently through
the anterior abdominal wall and is usually associated with a large and deep laceration
A&P) gallbladder:
Fn:
Bile helps emulsify:
= small hollow organ located behind & beneath the liver RUQ
= receives bile & stores it until it is needed for digesting fatty food. It then contracts & secretes bile through the bile duct & into the duodenum.
= (break apart and suspend) ingested fats that would otherwise remain as indigestible clumps during the digestive process.
A&P) GI) ABDMN cavity is bordered by:
Abdominal Cavity is divided into 3 spaces:
= Diaphragm, Spine & inferior ribs, Muscles of back, ABDMN muscles
= Peritoneal space, Retroperitoneal space, Pelvic space
A&P) GI) Peritoneal space:
Retroperitoneal space:
Pelvic space:
= Peritoneal space: ABDMN peritoneal
= Retroperitoneal space: Kidneys behind Peritoneum
= Holds 1.5Ls, True pelvis holds pelvic organs
A&P) GI) Starts & Ends@:
Parastalisis:
Digestion Tract:
= Mouth to anus
= GI moving stuff down
= 25ft-long hollow muscular tube for digestion & waste products
Penetrating Trauma) GSW-%s of injured parts:
Stabs-%s of injured parts:
= S-intestine 50%, Colon 40%, Liver 30%, ABDMN vasc/ structures 25%
= Liver 40%, S-intest 30%, Diaphragm 20%, Colon 15%
small bowel is the most frequently injured hollow abdominal organ during penetrating trauma because it rests anteriorly and just under the anterior abdominal muscles and omentum.
Mesenteric system
membrane vascular GI blood feeder
A&P) Hollow organs such as the:
Commonly injured by:
Hollow organ damage can cause:
= stomach, both bowels, rectum, urinary bladder, gallbladder & uterus
= rupturing from blunt trauma (also tear w/ penetration)
= hemorrhage/spillage into the peritoneal’s &pelvic spaces
A&P) Intrathoracic )Major vessels:
= Descending aorta & inferior organ shears are worst injuries
A&P) True Abdomen:
= Deoudum, S(illium longest & narrowest) &L interesting (illium longest & narrowest), deud/juj distal lower GI,
A&P) retroperitoneal :
Kidneys:
= Kidneys, Aorta
= RAAS system, secrete arythoportine hormone to tell bone to dev RBC, mineral reg,
A&P) kidneys) located:
Blood:
Fn:
= the retroperitoneal portions of L&RUQ
= receive their blood supply from the abdominal aorta
= Reg pH, osmostasis, RAAS, reg Na
A&P) Mom)Last trimester:
Supine Hypotension syndrome:
Rx of syndrome)
= uterus sig/ in size & weight; may compress vena cava <Preload
= Reduces venous return to heart; induces hypotension in supine
= place PT to side 15-30 degrees or lateral displacement (left pull right push)
Liver) Prone to what injuries:
Most common place injured
= deceleration injuries / shearing force
= Ligamentum Teres Hepatis (Ligament of teres from utero,)
A&P) GI) Lower GI System:
To overcome Lower esophageal & bottom pallor & bottom Sphincter
= duodenjejunal junction, to include the rest of the small intestine, large intestines, & rectum/anus.
= 20ml to overcome Lower esophageal Sphincter & bottom stomach pallor Sphincter
Mallory-Weiss Tears:
(common w/ bulimia), Lower sphincter & espohagus is erroded away from acid
Pelvis) Tee-Pod
Sam-Splint
= best mechanical pelvic sling/binder (mechanical advantage)
= good, like a belt but no mechanical advantage
Pelvis) 1. Pelvic Fracture:
2. why so severe:
3. Finding Fracture:
= Potential life-threatening hemorrhage w/ pelvic organs, can loose 2Ls,
= Fractures sharp edges that shred inside
= fracture gives -> obvious deformity in shape
A&P) pelvis) fn:
= supports the inferior ABDMN cavity & offers lateral & posterior protection to organs & structures in the lower portion of the peritoneal space as well as those in the pelvic space.
Penetrating Trauma) Commonly
Don’t take knife out ABCs upon FMC if:
If moving w/ heartbeats:
= GSW, Knifes, Sticks, Metals,
= if dead already (Crime scene, taking out makes worst)
= don’t stabilize like others (stabilizing impedes heart’s beats)
Peritoneum:
parietal peritoneum:
visceral peritoneum:
= ABDMN membrane lining cavity & organs (resembles lung’s pleura & Fns similarly)
= The portion that lines the cavity
= the portion that covers ABDMN organs
Mom) Placenta Previa:
= placenta dev/ before uterus so cervix dilates & tears placenta after dropping mucus plug (treat internal hemorrhage for shock & pad vagina)
Mom) Abruptio Placentae:
= VERY PAINFUL trauma (can be fall onto but or car crash) placenta rips away from uterine way, bright red hem rips away cervix, concealed no leaking,
Mom) Uterine trauma/Rupture:
Rarity & S/S:
= “baby canon” usually seatbelts used wrong: Actual tearing/rupture, of uterus; occurs w/ onset of labor or blunt ABDMN trauma (Most common death 3rd trimester)
= rare occurrence; extremely high maternal & fetal mortality rate, Can see all of kid, major hemorrhage
Mom) Uterine Inversion:
Rx:
How common
= pulling umbilicus prolapse uteris,
= slowly work back into w/ glove CUPPED so can’t puncture through,
= More kids more likely to happen
Priapism:
Rx:
= Painful and prolonged erection of penis Injury consistent with a spinal cord injury PSNS (increase PSNS tone & vaso-dialation)
= Can happen with medical , 2 needles to decompress, Can be necrotic & eventually surgically removed
Rectal foreign body
rectum goes up & turns so gets stuck
Ruptured Diaphragm) RX
= INTUBATE QUICKLY BOCHDELCK left side of diaphragm, Rapid detection, Place the patient’s torso in an elevated position, Try to decrease the use of a BVM, ET intubation early!
Ruptured Diaphragm) S/S
Auscultation:
= L-side BOCHDELCK most commonly, GI organs push through site of rupture & into thoracic cavity thus “tension pneumo” effect
= LISTEN TO GI SOUNDS “blop blop blop” is indication
Kids) Do what w/ kid’s booster/car seat:
WHALE We Have A Lil Emergency} has basic info, kids parents info, med info
= NEVER TRANSPORT W/ KID IN CAR SEAT & CUT DAT BIH
= We Have A Lil Emergency} has basic info, kids parents info, med info
Seat belts) Severity:
w/ kids Lumbar fractures
w/ kids down & under can hang
= Internal shearing, crushing, bursts, INTERNAL SHOCK
= w/ kids Lumbar fractures (chance) L2-4 from seat belts shoulder straps not on & folding over
= can hang
Mom) Trauma) Seatbelt across baby:
Proper SB placement goes:
best way to save kid w/ mom:
When most death/deformities happen:
= kill baby
= over illiac crest, some adapters made goes across femurs instead
= save mom before kid b/c mom shunts parasite so is save mom
= 1st trimester
Mom) progressive uterine enlargement displaces most of the abdominal contents upward as the growing uterus rises out of the pelvis and its upper border extends above the umbilicus.
second trimester (12 to 24 weeks)
A&P) Solid organs:
subject to what trauma:
if the capsule is disrupted by penetrating trauma or torn by the mechanism of blunt trauma:
= spleen, liver, pancreas, and kidneys
= blunt & penetrating; prone to contusion, range minimal bleeding - rupture
= unrestricted hemorrhage can occur.
Liver) 1 restrained from moving? by?
2 Responsible for
3 Size in cavity
= Restrained from forward motion by ligamentum teres
= detoxifying blood, removing damaged RBCs, & storing glycogen
= The largest organ in the abdominal cavity
Spleen) is:
Injuries to the spleen common with:
Kehr’s Sign:
= Largest organ of LYMPH-system, Very vascular, removes abnormal RBC from the circulatory system. Stores iron
= common with blunt force trauma to the left flank region
= pain into the left shoulder classic of ruptured spleen
Supine Hypotensive Disorder
Baby laying on inferior vena cava & descending artery
Testicular Torsion:
Severity:
S/S:
Prehospital treatment:
= Twisting of spermatic cord; Severe testicular & ABDMN pain, More common during infancy & beginning of adolescence
= Can kill & from sepsis ~4hours till necrotic
= Acute severe testicular pain (usually limited to one testicle) scrotum
Super tender & swollen, N/V/Dizzy common
= Pain & N/V rx
A&P) Circ) The abdominal aorta bifurcates at & into & eventually become what exiting where:
= upper sacral Lvl into large iliac arteries that eventually become the femoral arteries as they traverse and then exit the pelvis.
ABDMN cavity is bound superiorly by the:
When considering the pathophysiology of abdominal injury, remember:
= Diaphragm
= The abdomen is bound by muscles rather than skeletal structures
Peritoneum) def:
Inflammation to it:
= fine fibrous tissue surrounding interior of most of ABDMN cavity, most small bowel, & some ABDMN organs (Peritoneal space)
= Peritonitis
A&P) Circ) Inferior vena cava is located:
Fn:
= along R-side of the S/Cl
= drains venous blood from lower EXTRMS & ABDMN relatively parallel to the arterial system, returning it to the heart. T
1 killer of pregnant females
Trauma
The division of the abdominal cavity containing organs or portions of organs covered by the peritoneum is called the:
Peritoneal space
The small bowel is composed of the:
Duodenum, jejunum, and ileum.
A&P) Liver) Fn:
Sends the blood/nutrient/fluid mixture:
= detoxifies fluid, stores excess nutrients, & adds them when they’re deficient.
= into inferior vena cava just below heart.
Mom) when changes become visual:
Physical changes durning & w/:
= 8 weeks is when most show (most common death in 1st trimester)
= 2nd trimester, uterine enlargement displaces most ABDMN contents upward. (resp, constipation, ect)
Baby & Mom have own blood supply & shoud never mix
CO +, BP & SV decreases, 3rd comes norm usuall
Trauma saves mom before kid so best way to save kid is save momBoddy shunts blood from baby when mom in shock
A&P) Mom)
= 50mLs-1.5Ls in uterus
= Baby & Mom have own blood supply & shoud never mix
= Moms uterine arteries back side pumps blood into placenta
A&P) Baby)
= Baby & Mom have own blood supply & should never mix
= Babys blood has higher oxy affinity & steal blood
= 2 arteries & 1 vein on umbilical’s cord) vein bigger than artery (smilely pic) Vein brings oxy & art deoxy}
Wartons jelly wraps cord} heat sensitive & shrinks “baby heat shrink”
Umbilical catheterization } IV access via umbilical
Amniotic sac: “baby sac”
A&P) GI) upper GI contains
Mouth, pharynx, esophagus, stomach and the duodenum.
A&P) urinary system consists:
System use:
= kidneys, ureters, urinary bladder, & urethra
= water filter & wasting
A&P) M/B)
Umbilical catheterization } IV access via umbilical
Amniotic sac: “baby sac”
Pubic bone to fundus each cm is a week gestation to 20
Fetal heart tones can be heard at 20 weeks (ask where found) find 2 humps & go lateral)
A&P) GI) What separates the upper & lower GI system?
The Ligament of Treitz @ duodnium Jujinuim junction
Most common ABDMN organ injured w/ stabbing to ABDMN region:
Liver
Structure separating the upper & lower GI system?
Ligament of Treitz
You are taking care of a female patient that has been involved in a serious motor vehicle accident. The patient is complaining of severe “tearing” abdominal pain and states she is eight months pregnant. Which of the following would you suspect this patient is most likely suffering from?
Abruptio Placentae
!!! Murphy’s signs:
= Suspected gall bladder infection→ cupping under rib w/ pressure with breath causing pain
!!! McBurny’s point:
= RLQ pain w/ rebound tenderness ⅔ of way from umbilicus to illicac
Aaroon’s sign:
= Epigastric pain during palpation to McBurney’s point
Rovsing’s sign:
= RLQ pain w/ palpation to LLQ
Psoas sing:
=Pain to RLQ when patient tries to reaise R leg against resistance
Hematemesis:
Hypotyposis:
= vomiting blood
= coughing blood
Hematochezia:
Melana:
= Pooping bright red stool
= Pooping dark black stool
Hematemesis:
= vomiting blood
Hypotyposis:
= coughing blood
Hematochezia:
= Pooping bright red stool
Melana:
= Pooping dark black stool (150mL of blood to make)
Tympany percussion sound:
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach
Dull percussion sound:
= “thud” , Medium intensity, medium pitched, medium duration, located in solid organs
Ascites:
Borborygmi:
Hyperperistalsis:
= bulges in flanks across abdomen indicating CHF
= loud prolonged “gurgling” (healthy GI) but can= hyperperistalsis
= more bowl sounds> + GI m-nt causing diarrhea/cramps
Normal bowel sounds consist:
More frequent sounds indicate:
Decreased or absent sounds suggest:
= Variety high-pitched gurgles & clicks occurring every 5-15 secs
= + GI m-nt possibly indicating diarrhea or early intestinal obstruction
= Paralytic ileus/peritonitis. Listen at least 2mins if abdomen is silent
