abdominal trauma

Question 1

what is the second leading
cause of preventable trauma deaths.

Answer 1

abdominal trauma

Question 2

dead from abdominal trauma can occurs from

Answer 2

massive blood loss or later organ damage complication.

Question 3

T/F It is usually difficult to determine the extent of abdominal trauma in the field

Answer 3

T

Question 4

the abdominal cavity lies from

Answer 4

the diaphragm (superior border) to the base of the pelvis (plane between pubis and sacral base).

Question 5

what are the four quadrant of the abdomen

Answer 5

RUQ, LUQ, RLQ, and LLQ.

Question 6

the cavity of the abdomen is lined with

Answer 6

The cavity is lined with peritoneum, a smooth sheath-like membrane with two layers:
Parietal (outer layer) lines the abdominal cavity, Visceral (inner layer) surrounds some of the
abdominal organs.

Question 7

which cavity of abdomen is very sensitive to irritation

Answer 7

peritoneum

Question 8

the peritoneum can be subdivided how

Answer 8

Retro-peritoneal area: (behind peritoneal cavity) :
kidneys, ureters, bladder, reproductive organs,
inferior vena cava, abdominal aorta, pancreas, a portion of duodenum, colon, rectum
Peritoneal cavity: (space):
liver, gall bladder, bile duct, stomach, spleen,
large intestine small intestines, female reproductive organs

Question 9

what is contain in the retro-peritoneal area

Answer 9

(behind peritoneal cavity) :
kidneys, ureters, bladder, reproductive organs,
inferior vena cava, abdominal aorta, pancreas, a portion of duodenum, colon, rectum

Question 10

what is contain in peritoneal cavity

Answer 10

liver, gall bladder, bile duct, stomach, spleen,
large intestine small intestines, female reproductive organs

Question 11

what is peristalsis

Answer 11

gives normal bowel sounds (gas and fluid passage through narrow digestives tubes) which can be heard with a stethoscope (1 minute each quadrant)

Question 12

what is peritonitis

Answer 12

(Inflammation of peritoneum) “Acute Abdomen”
 Irritation of peritoneal tissues associated with loss of fluids (ie: blood, gastric contents) or changes in abdominal pressure usually caused by enlarged, ruptured, lacerated, sheared organs. This results is absence of peristalsis, and thus bowel sounds.

Question 13

shat is parietal peritoneum

Answer 13

lines the walls of the abdominal cavity)
is innervated by local nerves allowing for localization of source of irritation/pain.

Question 14

what is visceral peritoneum

Answer 14

s innervated by the autonomic system.
Pain / irritation sensations may be more difficult to localize. Sensations felt may be activated by stretch receptors in the presence of distension or forceful contraction of organs. Therefore the viscera would tend to refer their pain
through similar origin sensory skin nerves.

Question 15

visceral peritoneum pain tend to refer through

Answer 15

similar origin sensory skin nerve

Question 16

gall blader inflamation (acute cholecytitisi) referee pain where

Answer 16

R shoulder

Question 17

ruptured spleen (bleed on diaphragm) refered pain where

Answer 17

L shoulder (keh’S sign)

Question 18

location of liver

Answer 18

located right side – ribs 6-10.
produces amino acids, bile salts, glycogen, detoxification,
glycogen storage.

Question 19

location of gall bladder

Answer 19

located below liver, stored bile

Question 20

location of spleen

Answer 20

located left side level of ribs 9-11
Produces monocytes, macrophages, lymphocytes, stores RBC

Question 21

location of pancreas

Answer 21

located inferior/posterior to liver- stomach, retroperitoneal produces insulin

Question 22

location of kidney

Answer 22

left: T11 to L2 vertebral bodies
right: (lower) T12 to L3 vertebral bodies
retroperitoneal, filtration

Question 23

what mesentery

Answer 23

is a delicate tissue derived from peritoneum which suspends nearly all organs. These sheets of mesenteric tissue (also carry the nerves and blood vessels to the organs) allow the organs to hang freely from their mesenteric attachments allowing for mobility / motility of the organs within the abdomen.

Question 24

solid structural abdominal organ

Answer 24

liver, spleen, pancreas (retro) kidney (retro),
adrenal, ovaries

Question 25

hollow structural abdominal organ

Answer 25

gall bladder, bile ducts, bladder, ureters, stomach, large intestin, small intestine

Question 26

which type of organ bleed and spill their caustic content into peritoneal cavity or extr-periotoneal space

Answer 26

hollow

Question 27

what is the result of hollow organ ruptured

Answer 27

All organs would bleed when ruptured, but hollow organs also spill their caustic contents into peritoneal cavity or extra- peritoneal space. This result in intra-abdominal hemorrhage, peritonitis, and sepsis (toxicity).

Question 28

which type of injury to stomach Is easier to detect

Answer 28

Penetrating trauma injuries are easier to detect (usually causing bleeding to the intestine).

Question 29

which type of trauma on abdomen is often missed

Answer 29

Blunt trauma often missed but treated as per clinical findings and MOI usually from compressive or shear injuries.

Question 30

winded DX, MOI,SS,TX

Answer 30

DX: reflex diaphragmatic spasm  MOI: blow to the neural solar
plexus of the epigastric region  SS: temporary respiratory paralysis  TX: loosen restrictive clothing ,
gentle hip/knee flexion

Question 31

stomach contusion/rupture DX/MOI/SS/TX

Answer 31

DX: rare but possible occurrence
 MOI: severe /direct blunt abdominal
trauma
SS: classicalabdominalfindings: guarding, rebound tenderness, absent bowel sounds, rigid abdomen, chemical or bacterial peritonitis
 TX: 911 urgent transport, Tx for shock,O2, position of comfort

Question 32

intestinal contusion/rupture DX/MOI/SS/TX

Answer 32

 DX: rare but possible occurrence
 MOI: severe /direct blunt abdominal trauma  SS: classical abdominal findings:
guarding, rebound tenderness,
absent bowel sounds, rigid
abdomen, chemical or bacterial peritonitis
 TX: 911 urgent transport, Tx for shock,O2, position of comfort

Question 33

liver contusion/rupture DX/MOI/SS/TX

Answer 33

DX: more common
 MOI: direct blunt trauma right side
ribs 6-10
 SS: shock signs: tachycardic, hypotensive,, RUQ pain / ref. to shoulder?
 TX: rest, observe if stable, if potentially unstable with S/S 911,O2, tx shock

Question 34

spleen contusion/rupture DX/MOI/SS/TX

Answer 34

DX: most common injured organ with blunt trauma most frequent cause of death related to abdominal injury spleen is at increase injury when enlarged by disease (eg: mononucleosis)
MOI: blunt trauma left side ribs 9-11 (remember: “ 9-11”)


  
SS: TX:
sharp ULQ pain, abdominal distension,
referred pain to L shoulder (Kehr’s sign)
shock signs, can occur acutely-might be delayed for hours or even days
acute SS pain / shock signs: 911, O2, position of comfort, suspect: transport to emerg 911

Question 35

pancreas contusion/rupture DX/MOI/SS/TX

Answer 35

DX: contusion / rupture possible
with injury to surrounding organs  MOI: local trauma inferior to
stomach/liver
 SS: local pain, referred pain ant to
post at level of pancreas
 TX: local ice if contusion, O2,
position comfort, refer to medical facility

Question 36

kidneys contusion/rupture DX/MOI/SS/TX

Answer 36

DX: contusion more common, rupture
possible with peritoneal signs
 MOI:Direct blunt trauma to posterior lower back: Left kidney T-11 to L2
Right kidney T12 to L3 (lower)
 SS: local/referred pain, low back pain, blood in urine
 TX: local ice if contusion, O2, position comfort, refer to medical facility

Question 37

what can indicate an intra abdominal mass

Answer 37

increase pain on palpation when head flexed indicative of abdominal muscle injury

Question 38

what indicate a peritoneal irritation

Answer 38

pelvis shake increase pain

Question 39

how long is the auscultation for abdominal quadrant

Answer 39

1 min/quadrant

Question 40

what is psoas sign

Answer 40

testappendixbyresistivehipflexion

Question 41

what is obturator sign

Answer 41

flex thigh 90 deg rotate femur IR/E
 Pain indicative of small bowel strangulation

Question 42

TREATMENT for ACUTE ABDOMEN

Answer 42

Calm patient
 911
 ABC
 Oxygen
 Position patient
 Monitor vitals
 Tx shock
 Nothing to eat / drink ,
 No medications

Question 43

which condition refer pain in lower back

Answer 43

kidney rupture/contusion