abdominal trauma Flashcards
what is the second leading
cause of preventable trauma deaths.
abdominal trauma
dead from abdominal trauma can occurs from
massive blood loss or later organ damage complication.
T/F It is usually difficult to determine the extent of abdominal trauma in the field
T
the abdominal cavity lies from
the diaphragm (superior border) to the base of the pelvis (plane between pubis and sacral base).
what are the four quadrant of the abdomen
RUQ, LUQ, RLQ, and LLQ.
the cavity of the abdomen is lined with
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.
which cavity of abdomen is very sensitive to irritation
peritoneum
the peritoneum can be subdivided how
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
what is contain in the retro-peritoneal area
(behind peritoneal cavity) :
kidneys, ureters, bladder, reproductive organs,
inferior vena cava, abdominal aorta, pancreas, a portion of duodenum, colon, rectum
what is contain in peritoneal cavity
liver, gall bladder, bile duct, stomach, spleen,
large intestine small intestines, female reproductive organs
what is peristalsis
gives normal bowel sounds (gas and fluid passage through narrow digestives tubes) which can be heard with a stethoscope (1 minute each quadrant)
what is peritonitis
(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.
shat is parietal peritoneum
lines the walls of the abdominal cavity)
is innervated by local nerves allowing for localization of source of irritation/pain.
what is visceral peritoneum
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.
visceral peritoneum pain tend to refer through
similar origin sensory skin nerve
gall blader inflamation (acute cholecytitisi) referee pain where
R shoulder
ruptured spleen (bleed on diaphragm) refered pain where
L shoulder (keh’S sign)
location of liver
located right side – ribs 6-10.
produces amino acids, bile salts, glycogen, detoxification,
glycogen storage.
location of gall bladder
located below liver, stored bile
location of spleen
located left side level of ribs 9-11
Produces monocytes, macrophages, lymphocytes, stores RBC
location of pancreas
located inferior/posterior to liver- stomach, retroperitoneal produces insulin
location of kidney
left: T11 to L2 vertebral bodies
right: (lower) T12 to L3 vertebral bodies
retroperitoneal, filtration
what mesentery
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.
solid structural abdominal organ
liver, spleen, pancreas (retro) kidney (retro),
adrenal, ovaries
hollow structural abdominal organ
gall bladder, bile ducts, bladder, ureters, stomach, large intestin, small intestine
which type of organ bleed and spill their caustic content into peritoneal cavity or extr-periotoneal space
hollow
what is the result of hollow organ ruptured
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).
which type of injury to stomach Is easier to detect
Penetrating trauma injuries are easier to detect (usually causing bleeding to the intestine).
which type of trauma on abdomen is often missed
Blunt trauma often missed but treated as per clinical findings and MOI usually from compressive or shear injuries.
winded DX, MOI,SS,TX
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
stomach contusion/rupture DX/MOI/SS/TX
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
intestinal contusion/rupture DX/MOI/SS/TX
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
liver contusion/rupture DX/MOI/SS/TX
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
spleen contusion/rupture DX/MOI/SS/TX
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
pancreas contusion/rupture DX/MOI/SS/TX
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
kidneys contusion/rupture DX/MOI/SS/TX
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
what can indicate an intra abdominal mass
increase pain on palpation when head flexed indicative of abdominal muscle injury
what indicate a peritoneal irritation
pelvis shake increase pain
how long is the auscultation for abdominal quadrant
1 min/quadrant
what is psoas sign
testappendixbyresistivehipflexion
what is obturator sign
flex thigh 90 deg rotate femur IR/E
Pain indicative of small bowel strangulation
TREATMENT for ACUTE ABDOMEN
Calm patient
911
ABC
Oxygen
Position patient
Monitor vitals
Tx shock
Nothing to eat / drink ,
No medications
which condition refer pain in lower back
kidney rupture/contusion
