ABDOMINAL TRAUMA

Question 1

Pertinent Anatomy of the patient with Abdominal Trauma.

Answer 1

(1) The abdomen is traditionally divided into three regions
(a) Intrathoracic (enclosed by lower ribs and immediately distal to the
diaphragm) containing:
1) Liver (Solid)
2) Gallbladder (Solid but contained)
3) Spleen (Solid)
4) Stomach (Hollow)
5) Transverse colon (Hollow)
(b) True abdomen contains the large and small intestines, a portion of the liver, and the bladder. In females, the uterus, fallopian tubes, and ovaries are
considered part of the pelvic portion of the true abdomen.
(c) The retroperitoneal abdomen lies behind the thoracic and true portions of the abdomen.
1) It is separated by the retroperitoneal membrane from the other abdominal regions.
2) This area includes the kidneys, ureters, pancreas, posterior duodenum, ascending
and descending colon, abdominal aorta, and the inferior vena cava.
3) Because of its location away from the anterior body surface, injuries here are difficult to evaluate in the field.

Question 2

Type of Injury:
1) evidence of injury, which may give a false sense of security.
2) Patients with multiple lower rib fractures are notorious for having severe
intraabdominal injuries without significant abdominal pain.
3) When mechanisms of trauma or associated injuries such as lower rib fractures or
significant gluteal wounds suggest possible intra- abdominal injury, do not be
fooled by the patient’s lack of abdominal pain or tenderness.
4) Be prepared to treat hypovolemic shock from occult intra-abdominal bleeding.

Answer 2

Blunt Force Trauma

Question 3

Signs and Symptoms

Answer 3

(1) Hypotensive shock syndrome: Intra- abdominal injuries may present as unexplained hypotension or shock. Hypovolemic shock may be the sole presenting sign.
(2) Peritonitis syndrome: Peritonitis implies that a hollow viscus has been disrupted or that the pancreas has been injured.
(a) Fever, tachycardia, diffuse abdominal pain and tenderness and ileus are the
common findings.
(3) Serial exams should include vital signs (including tilts), Secondary survey, Digital rectal exam, Pelvic (vaginal) exam in women.

Question 4

Differential Diagnosis

Answer 4

(1) Differential is what resulted from the ABD Trauma i.e. liver fx, splenic rupture,
esophageal rupture.
(2) Hypovolemic shock
(3) Wound infection, sepsis and/or peritonitis

Question 5

Lab

Answer 5

(1) CBC/DIFF (monitor HCT Q 6-8 hrs)
(2) Routine UA (do micro if dip is + for blood)
(3) Type and screen

Question 6

RAD

Answer 6

(1) Ultrasound

(2) CT with contrast

Question 7

Treatment

Answer 7

(1) O2 if saturation < 94%
(2) NPO
(3) IV (Crystalloid solutions) 0.9% NaCl, Ringers Monitor I&O (insert foley if no GU
trauma, stop if any resistance is felt.)
(4) IV antibiotics (Broad Spectrum) if signs of infection/peritonitis
(5) Pain meds (monitor for respiratory distress if using morphine)
(6) PROPAQ monitor
(7) Consider NG tube with intermittent suction

Question 8

Initial Care

Answer 8

Initial care will be as symptoms dictate. Could vary from minor trauma, to live threatening requiring
MEDEVAC

Question 9

Type of Injury:
Common injuries include splenic rupture and liver fractures (Solid Intrathoracic
organs)

Answer 9

Direct Blow

Question 10

Type of Injury:

Defined as organ traction beyond a point of internal fixation.

Answer 10

Crush

Question 11

Type of Injury:
Associated with high speed MVA’s and falls from heights. Common injuries
include duodenal and aortic rupture.

Answer 11

Deceleration injury

Question 12

Type of Injury:

Can result from Gunshot and Stab wounds

Answer 12

Direct penetration-

Question 13

Type of Injury:

Projectile breaks apart upon impact

Answer 13

Fragmentation -

Question 14

Type of Injury:

transmitted to neighboring organs from the bullet’s mass and velocity (blast effect

Answer 14

Shock waves -