Abdominal Trauma Flashcards
Right Upper Quadrant Structures
Liver
Gallbladder
Ascending and transverse colon
Left Upper Quadrant Structures
Spleen Stomach Left lobe of the liver Left colonic flexure Transverse colon
Left Lower Quadrant Structures
Sigmoid Colon
Portion of descending colon
Portion of duodenum
Right Lower Quadrant Structures
Cecum
Appendix
Portion of ascending colon
Retroperitoneum
Posterior to the “true abdomen”. Contains aorta, inferior vena cava, pancreas, kidneys, ureters, ascending and descending colon and duodenum.
Types of Solid Organs
Liver, Spleen, Kidneys, and Pancreas
Types of Hollow Organs
Gallbladder, Stomach, Small intestine, Large intestine, Bladder
Abdominal vasculature
abdominal aorta, common iliac arteries, femoral arteries, renal arteries, portal vein, inferior vena cava
Contraindications to NG placement
nasal, midface or cribiform plate fracture
Contraindications to Foley placement
blood at urinary meatus, high riding prostate, perineal hematoma, concurrent pelvic injury or fracture
Inspection of abdomen includes
Observe for gross abnormalities, Contour, Symmetry, Visible Pulsations, Skin color/discolorations, back and flank, pelvic or perineal bleeding/drainage, general respiratory rate, pattern and depth; change in respiratory effort.
Contour
Rounded, flat, scaphoid, distended or pregnant if distended think of 6Fs.
Fluid, Fat, Flatus, Feces, Fetus, Fibroid.
Decreased and absent bowl sounds general indicate……
peritoneal irritation from enteric contents, bile, pancreatic juice, or intraperitoneal blood. May also cause ileus.
Borborygmi
hyperactive bowel sounds
Bowel sounds in the chest
diaphragmatic rupture
Vascular sounds in the abdomen
A bruit can be noted if artery is partially occluded
Percussion Sounds
Dull vs Tympanic
Dull: Organ margins, accumulation of free fluid
Tympanic: Air, gas
Balance’s Sign
shifting of dullness over LUQ when patient lies on left side; suggestive of splenic rupture.
Pulsatile/Palpable masses are emergent if found were?
Slightly left of umbilicus
Other tests for rebound tenderness
Cough tenderness, percussion, heel drop test,
Heel drop test AKA…
Markel sign
What is heel drop test
Have pt stand on their toes and drop their heels. If this aggravates the pain, consider it positive. Same test on a supine patient. Gently pick up the leg and tap the heel. If pt winces, suspect peritoneal inflammation
Prostate location can indicate…
presence of urethral tear
Peritoneal irritation signs
board-like abdomen described as increased rigidity of the abdominal wall or palpable rigidity.
Diminished or absent bowel sounds
Involuntary guarding
Sever focal pain, rebound tenderness
Kehr’s Sign
Referred pain in the left shoulder suggest peritoneal or diaphragmatic irritation; usually noted with splenic rupture.
Cullen’s sign
Bluish discoloration around the umbilicus suggests intra or retroperitoneal hemorrhage
Grey-Turner’s Sign
Discoloration of the lower abdomen and flanks is believed to believed to be due to the infiltration of etraperitoneal tissues with blood. Seen in acute hemorrhagic pancreatitis or renal trauma.
On KUB, Loss of Psoas shadow suggests…
retroperitoneal injury