Abdominal injuries Flashcards
What are the boundaries of the abdomen?
- ant. and post. abdominal cavity walls
- diaphragm
- imaginary plane form pubic symphysis to sacrum
The abdomen contains organs that make up the:
- digestive system
- urinary system
- genital system
RUQ contains:
- liver
- r. kidney
- gall bladder
- colon
- pancreas
LUQ contains:
- stomach
- l. kidney
- spleen
- colon
- pancreas
RLQ contains:
- appendix
- colon
- small intestine
- ureter
- major v. and a. to r. leg
LLQ contains:
- colon
- small intestine
- ureter
- major v. and a. to l. leg
What are the solid organs of the abdomen?
- Liver
- Spleen
- Pancreas
- Kidneys
- Ovaries
- Adrenal gland
What are the roles of the solid organs? and what is the blood supply
Enzyme production, blood cleansing, energy production
- rich blood supply: hemorrhaging
What are the hollow organs of the abdomen?
- Gallbladder
- Stomach
- small intestine
- large intestine
- bladder
- bile ducts
- ureters
What do the hollow organs contain and when do S/S present?
Food, urine, or bile
S/S are often delayed
Where is the liver located?
- right
- ribs 6-10
Where is the gall bladder located
below liver (right)
where is the speen located
- left
- lvl of ribs 9-11
where is the pancreas located
- inf/post to liver and stomach
- retroperitoneal
Where are the kidneys?
Left: T11-L2
Right: T12-L3
What happens when hollow organs are rupture?
Bleed + spill caustic contents into peritoneal cavity or extra-peritoneal space
- intra-abdominal hemorrhage
- peritonitis (swelling)
- sepsis (toxicity)
How to do a secondary assessment with an abdominal injury
- History
- MOI - IOS
- Observe
- Position: pillow under knees
- 4 quadrants palpation
- special tests
What should you ask about when asking for patient history?
- Previous injuries (kidney infection)
- last intake
- hematuria (blood in urine)
What should you look out for in MOI
- penetrating or blunt trauma
- sudden rise in intraabdominal pressure
- external compression
- deceleration
What is the most common blunt abdominal trauma?
Spleen
What happens in a penetrating trauma?
- uncontrolled hemorrhage
- organ damage
- spillage of hollow organ contents
- irritation and inflammation or abdominal lining
- liver most common
What happens in a blunt trauma? (causes)
- deceleration: contents damaged by change in velocity
- compression: organs trapped btwn other structures
- shear: part of organ is able to move while other part is fixed (e.g. ligamentum teres of liver)
What should you ask for pain?
- type
- OPQRST (onset, provoke, quality, radiation, severity, timing)
- compare: getting worse/better
What should you check with a female athlete?
pregnancy, mentruation
what to look for in an abdominal injury
- looks sick
- contracting
- distention
- contusion
- scars
- discolouration
- redness
- bruising
- swelling
- rigidity
- masses
What is Cullen’s sign?
- blueish discolouration around bellybutton (umbilicus)
- indicates peritoneal bleeding (often pancreatic hemorrhage)
- sign in ruptured ectopic pregnancy
What is Grey Turner’s sign?
- Blueish discolouration of lower flanks and lower back
- associated w/ retroperitoneal bleeding of pancreas, kidney, or pelvic fx
What is Kehr sign?
- L. shoulder pain while supine
- diaphragmatic irritation (splenic injury, free air, intra-abd bleeding)
- classic symptom of ruptured spleen
How to detect kehr’s sign?
- athlete supine w/ elevated LE (trendelenburg position)
- delayed (30min) sign of spleen injury
- sever l. shoulder pain
- in a few mins of elevation: indication of presence of blood or irritant in peritoneal cavity
What are you palpating for?
- rigidity
- guarding
- rebound tenderness
- masses
Describe rigidity
- involuntary control of abdominal wall musculature
- bilateral abdominal muscle spasm
- no relaxation on expiration
Describe guarding
- voluntary contraction of abdominal wall musculature
- reflex when pressing
Describe rebound tenderness (blumberg’s sign)
- shaking
- gentle pressing/quick release
- pain when lift up, radiating pain = irritation of peritoneum
Describe how to palpate masses
- circular mvmts
- deeper
Explain referred pain
- Parietal peritoneum (lines walls of abdominal cavity) innervated by local n.: localization of source of pain
- Visceral peritoneum (covers abdominal organs) innervated by autonomic system: more difficult to localize pain
Where do you feel the pain for your appendix?
around belly button, RLQ
Where do you feel the pain for your liver?
right shoulder, RUQ
Where do you feel the pain for your spleen
Left shoulder, LUQ
Where do you feel the pain for your kidney?
low back
Where do you feel the pain for an ulcer
upper mid-abdomen or upper back
Where do you feel the pain for an aortic aneurysm
low back and RLQ
Where do you feel the pain for a kidney infection?
costovertebral angle
Where do you feel the pain for pancreatitis?
upper abdomen
General S/S of abdominal injury
- rigid, tender, rebound tenderness
- guarding
- pain radiating to shoulder
- back pain (kidney)
- blood in urine
- nausea or vomiting
- rapid, shallow breathing
- rapid pulse
- low BP
- shock
What are the key vitals for abdominal injury
- rapid pulse
- low BP
- rapid, shallow breathing
The athlete should not:
eat/drink/take medication
RTP?
mild blunt abdominal trauma (contusion) may RTP after 15mins if:
- symptoms resolve
- vitals return to baseline
- normal bowel sounds
- no referred pain
- local pain doesn’t interfere w/ play
- risk of re-injury is minimized w/ protection
- sideline test of efforts are negative
What is an appendix
- vermiform (worm-like)
- vestigial organ (remnant)
- longer in children
What is appendicitis?
- inflammation of appendix
- general pain then localized around umbilicus and finally RLQ
- pain on palpation of McBurney’s point (btwn umbilicus and ASIS)
- pain when extending thigh and resisted flexion of thigh
What is a ruptured appendix?
- abdominal pain that keeps increasing
- nausea, vomiting, rigidity
- passive flexion of thigh eases pain (relaxing psoas m.)
Blow to external genitalia: scrotum
- severe pain
- possible ruptured testicle/blood around testes
- pain steady/increasing after 15-20mins: send to MD
- ice pack during transport
- ruptured testes = surgery
What is being winded? (dx)
reflex diaphragmatic spasm
MOI, S/S, and Tx of being winded
MOI: direct blow to neural solar plexus of epigastric region
S/S: temporary respiratory paralysis
Tx: loosen restrictive clothing + gentle hip/knee flexion
What does the diaphragm separate?
The thoracic cavity from the abdominal cavity
Dx and MOI of diaphragmatic rupture
L>R 4X more likely
- abdominal contents spill into thoracic cavity
MOI: severe abdominal blunt trauma
S/S of Diaphragmatic rupture
Peritonitis, respiratory distress, referred pain, muffle lung fields on affected side, bowel sounds in chest cavity
Tx of diaphragmatic rupture
911, O2, surgical intervention
What is collar sign (hourglass sign)
a sign of diaphragmatic rupture
- herniated organs at lvl of diaphragm
Stomach contusion/rupture: dx and MOI
Dx: rare but possible occurrence
MOI: severe/direct blunt abdominal trauma
Stomach contusion/rupture: S/S
Guarding, rebound tenderness, absent bowel sounds, rigidity, chemical or bacterial peritonitis
Stomach contusion/rupture Tx
911, urgent transport, tx for shock, O2, position of comfort
Intestinal contusion/rupture: dx and MOI
Dx: rare but possible occurrence
MOI: severe/direct blunt trauma
Intestinal contusion/rupture: S/S and Tx
S/S: guarding, rebound tenderness, absent bowel sounds, rigidity, chemical or bacterial peritonitis
Tx: 911, urgent transport, tx shock, O2, comfortable position
Liver contusion/rupture Dx and MOI
Dx: more common
MOI: direct blunt trauma to right side (ribs 6-10)
Liver contusion/rupture S/S
- shock signs (tachycardia, hypotension)
- RUQ, pain/referred to shoulder
Liver contusion/rupture Tx
- rest
- observe stability
- if unstable: 911, O2, shock
Spleen contusion/rupture Dx and MOI
Dx: most common (from blunt trauma), most freq death from abd injury
- at inc. injury when enlarged by disease (mononucleosis)
MOI: blunt trauma to left ribs 9-11
Spleen contusion/rupture S/S
- sharp LUQ pain
- abdominal distention
- referred pain to l. shoulder (Kerh’s sign)
- shock signs
- acutely, might be delayed for hrs/days
Spleen contusion/rupture TX
911, O2, position of comfort
Kidney contusion/rupture Dx and MOI
Dx: contusion more common
MOI: direct blunt trauma to post. lower back
Kidney contusion/rupture S/S
local/referred pain, low back pain, blood in urine
Kidney contusion/rupture Tx
Local ice if contusion, O2, position of comfort, refer to medical facility
Kidneys: medical emergencies
- Kidney stones
- Infection
Pancreas contusion/rupture Dx and MOI
Dx: contusion/rupture possible w/ injury to surrounding organs
MOI: local trauma inferior to stomach/liver
Pancreas contusion/rupture S/S
local pain, referred pain ant. to post. at lvl of pancreas
Pancreas contusion/rupture tx
local ice if contusion, O2, position of comfort, refer to medical facility
For penetrating trauma, always assume:
object has penetrated the peritoneum, entered abdominal cavity and possibly injured organs
Penetrating trauma S/S
- pain
- nausea + vomiting
- lie very still w/ legs drawn up
- bleeding
Penetrating trauma tx
- stabilize object
- dry, sterile dressing
- vitals: pallor, cold sweat, rapid-thready pulse, low BP
- O2
- protect spine
what is Abdominal evisceration?
Opened abdominal wound from which internal organs or fat protrude
Abdominal evisceration tx
- 911
- remove clothing to expose wound
- keep organs covered, moist, and warm (sterile saline solution + gauze, then cover w/ occlusive dressing)
