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CATA 262 > Abdominal injuries > Flashcards

Abdominal injuries Flashcards

1
Q

What are the boundaries of the abdomen?

A
  • ant. and post. abdominal cavity walls
  • diaphragm
  • imaginary plane form pubic symphysis to sacrum
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2
Q

The abdomen contains organs that make up the:

A
  • digestive system
  • urinary system
  • genital system
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3
Q

RUQ contains:

A
  • liver
  • r. kidney
  • gall bladder
  • colon
  • pancreas
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4
Q

LUQ contains:

A
  • stomach
  • l. kidney
  • spleen
  • colon
  • pancreas
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5
Q

RLQ contains:

A
  • appendix
  • colon
  • small intestine
  • ureter
  • major v. and a. to r. leg
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6
Q

LLQ contains:

A
  • colon
  • small intestine
  • ureter
  • major v. and a. to l. leg
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7
Q

What are the solid organs of the abdomen?

A
  • Liver
  • Spleen
  • Pancreas
  • Kidneys
  • Ovaries
  • Adrenal gland
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8
Q

What are the roles of the solid organs? and what is the blood supply

A

Enzyme production, blood cleansing, energy production
- rich blood supply: hemorrhaging

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9
Q

What are the hollow organs of the abdomen?

A
  • Gallbladder
  • Stomach
  • small intestine
  • large intestine
  • bladder
  • bile ducts
  • ureters
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10
Q

What do the hollow organs contain and when do S/S present?

A

Food, urine, or bile
S/S are often delayed

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11
Q

Where is the liver located?

A
  • right
  • ribs 6-10
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12
Q

Where is the gall bladder located

A

below liver (right)

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13
Q

where is the speen located

A
  • left
  • lvl of ribs 9-11
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14
Q

where is the pancreas located

A
  • inf/post to liver and stomach
  • retroperitoneal
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15
Q

Where are the kidneys?

A

Left: T11-L2
Right: T12-L3

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16
Q

What happens when hollow organs are rupture?

A

Bleed + spill caustic contents into peritoneal cavity or extra-peritoneal space
- intra-abdominal hemorrhage
- peritonitis (swelling)
- sepsis (toxicity)

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17
Q

How to do a secondary assessment with an abdominal injury

A
  • History
  • MOI - IOS
  • Observe
  • Position: pillow under knees
  • 4 quadrants palpation
  • special tests
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18
Q

What should you ask about when asking for patient history?

A
  • Previous injuries (kidney infection)
  • last intake
  • hematuria (blood in urine)
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19
Q

What should you look out for in MOI

A
  • penetrating or blunt trauma
  • sudden rise in intraabdominal pressure
  • external compression
  • deceleration
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20
Q

What is the most common blunt abdominal trauma?

A

Spleen

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21
Q

What happens in a penetrating trauma?

A
  • uncontrolled hemorrhage
  • organ damage
  • spillage of hollow organ contents
  • irritation and inflammation or abdominal lining
  • liver most common
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22
Q

What happens in a blunt trauma? (causes)

A
  • 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)
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23
Q

What should you ask for pain?

A
  • type
  • OPQRST (onset, provoke, quality, radiation, severity, timing)
  • compare: getting worse/better
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24
Q

What should you check with a female athlete?

A

pregnancy, mentruation

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25
Q

what to look for in an abdominal injury

A
  • looks sick
  • contracting
  • distention
  • contusion
  • scars
  • discolouration
  • redness
  • bruising
  • swelling
  • rigidity
  • masses
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26
Q

What is Cullen’s sign?

A
  • blueish discolouration around bellybutton (umbilicus)
  • indicates peritoneal bleeding (often pancreatic hemorrhage)
  • sign in ruptured ectopic pregnancy
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27
Q

What is Grey Turner’s sign?

A
  • Blueish discolouration of lower flanks and lower back
  • associated w/ retroperitoneal bleeding of pancreas, kidney, or pelvic fx
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28
Q

What is Kehr sign?

A
  • L. shoulder pain while supine
  • diaphragmatic irritation (splenic injury, free air, intra-abd bleeding)
  • classic symptom of ruptured spleen
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29
Q

How to detect kehr’s sign?

A
  • 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
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30
Q

What are you palpating for?

A
  • rigidity
  • guarding
  • rebound tenderness
  • masses
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31
Q

Describe rigidity

A
  • involuntary control of abdominal wall musculature
  • bilateral abdominal muscle spasm
  • no relaxation on expiration
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32
Q

Describe guarding

A
  • voluntary contraction of abdominal wall musculature
  • reflex when pressing
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33
Q

Describe rebound tenderness (blumberg’s sign)

A
  • shaking
  • gentle pressing/quick release
  • pain when lift up, radiating pain = irritation of peritoneum
34
Q

Describe how to palpate masses

A
  • circular mvmts
  • deeper
35
Q

Explain referred pain

A
  • 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
36
Q

Where do you feel the pain for your appendix?

A

around belly button, RLQ

37
Q

Where do you feel the pain for your liver?

A

right shoulder, RUQ

38
Q

Where do you feel the pain for your spleen

A

Left shoulder, LUQ

39
Q

Where do you feel the pain for your kidney?

A

low back

40
Q

Where do you feel the pain for an ulcer

A

upper mid-abdomen or upper back

41
Q

Where do you feel the pain for an aortic aneurysm

A

low back and RLQ

42
Q

Where do you feel the pain for a kidney infection?

A

costovertebral angle

43
Q

Where do you feel the pain for pancreatitis?

A

upper abdomen

44
Q

General S/S of abdominal injury

A
  • 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
45
Q

What are the key vitals for abdominal injury

A
  • rapid pulse
  • low BP
  • rapid, shallow breathing
46
Q

The athlete should not:

A

eat/drink/take medication

47
Q

RTP?

A

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

48
Q

What is an appendix

A
  • vermiform (worm-like)
  • vestigial organ (remnant)
  • longer in children
49
Q

What is appendicitis?

A
  • 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
50
Q

What is a ruptured appendix?

A
  • abdominal pain that keeps increasing
  • nausea, vomiting, rigidity
  • passive flexion of thigh eases pain (relaxing psoas m.)
51
Q

Blow to external genitalia: scrotum

A
  • severe pain
  • possible ruptured testicle/blood around testes
  • pain steady/increasing after 15-20mins: send to MD
  • ice pack during transport
  • ruptured testes = surgery
52
Q

What is being winded? (dx)

A

reflex diaphragmatic spasm

53
Q

MOI, S/S, and Tx of being winded

A

MOI: direct blow to neural solar plexus of epigastric region
S/S: temporary respiratory paralysis
Tx: loosen restrictive clothing + gentle hip/knee flexion

54
Q

What does the diaphragm separate?

A

The thoracic cavity from the abdominal cavity

55
Q

Dx and MOI of diaphragmatic rupture

A

L>R 4X more likely
- abdominal contents spill into thoracic cavity
MOI: severe abdominal blunt trauma

56
Q

S/S of Diaphragmatic rupture

A

Peritonitis, respiratory distress, referred pain, muffle lung fields on affected side, bowel sounds in chest cavity

57
Q

Tx of diaphragmatic rupture

A

911, O2, surgical intervention

58
Q

What is collar sign (hourglass sign)

A

a sign of diaphragmatic rupture
- herniated organs at lvl of diaphragm

59
Q

Stomach contusion/rupture: dx and MOI

A

Dx: rare but possible occurrence
MOI: severe/direct blunt abdominal trauma

60
Q

Stomach contusion/rupture: S/S

A

Guarding, rebound tenderness, absent bowel sounds, rigidity, chemical or bacterial peritonitis

61
Q

Stomach contusion/rupture Tx

A

911, urgent transport, tx for shock, O2, position of comfort

62
Q

Intestinal contusion/rupture: dx and MOI

A

Dx: rare but possible occurrence
MOI: severe/direct blunt trauma

63
Q

Intestinal contusion/rupture: S/S and Tx

A

S/S: guarding, rebound tenderness, absent bowel sounds, rigidity, chemical or bacterial peritonitis
Tx: 911, urgent transport, tx shock, O2, comfortable position

64
Q

Liver contusion/rupture Dx and MOI

A

Dx: more common
MOI: direct blunt trauma to right side (ribs 6-10)

65
Q

Liver contusion/rupture S/S

A
  • shock signs (tachycardia, hypotension)
  • RUQ, pain/referred to shoulder
66
Q

Liver contusion/rupture Tx

A
  • rest
  • observe stability
  • if unstable: 911, O2, shock
67
Q

Spleen contusion/rupture Dx and MOI

A

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

68
Q

Spleen contusion/rupture S/S

A
  • sharp LUQ pain
  • abdominal distention
  • referred pain to l. shoulder (Kerh’s sign)
  • shock signs
  • acutely, might be delayed for hrs/days
69
Q

Spleen contusion/rupture TX

A

911, O2, position of comfort

70
Q

Kidney contusion/rupture Dx and MOI

A

Dx: contusion more common
MOI: direct blunt trauma to post. lower back

71
Q

Kidney contusion/rupture S/S

A

local/referred pain, low back pain, blood in urine

72
Q

Kidney contusion/rupture Tx

A

Local ice if contusion, O2, position of comfort, refer to medical facility

73
Q

Kidneys: medical emergencies

A
  • Kidney stones
  • Infection
74
Q

Pancreas contusion/rupture Dx and MOI

A

Dx: contusion/rupture possible w/ injury to surrounding organs
MOI: local trauma inferior to stomach/liver

75
Q

Pancreas contusion/rupture S/S

A

local pain, referred pain ant. to post. at lvl of pancreas

76
Q

Pancreas contusion/rupture tx

A

local ice if contusion, O2, position of comfort, refer to medical facility

77
Q

For penetrating trauma, always assume:

A

object has penetrated the peritoneum, entered abdominal cavity and possibly injured organs

78
Q

Penetrating trauma S/S

A
  • pain
  • nausea + vomiting
  • lie very still w/ legs drawn up
  • bleeding
79
Q

Penetrating trauma tx

A
  • stabilize object
  • dry, sterile dressing
  • vitals: pallor, cold sweat, rapid-thready pulse, low BP
  • O2
  • protect spine
80
Q

what is Abdominal evisceration?

A

Opened abdominal wound from which internal organs or fat protrude

81
Q

Abdominal evisceration tx

A
  • 911
  • remove clothing to expose wound
  • keep organs covered, moist, and warm (sterile saline solution + gauze, then cover w/ occlusive dressing)

CATA 262 (10 decks)

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