Chapter 27 - Thorax and Abdomen Flashcards
sternal/true ribs
7 upper ribs (joined to sternum by costal cartilage)
false ribs
ribs 8-10 (common cartilage that joins 7th rib before attaching to sternum)
floating ribs
ribs 11-12
unattached to sternum, do have muscular attachments
external intercostals __________ the diaphragm during ________
external intercostals elevate the diaphragm during inspiration
internal intercostals _________ the rib cage to assist with _____
internal intercostals depress the rib cage to assist with expiration
what nerve innervates the diaphragm
phrenic nerve
Right lung, # of lobes
3
left lung, # of lobes
2
Air transportation system
Trachea–> R&L primary bronchi –> secondary bronchi –> alveoli
what happens during diaphragm contraction
dome flattens, increases volume of thorax, causes inspiration
flow of blood
deoxygenated blood to right atrium to tricuspid valve to right ventricle to pulmonary valve to pulmonary artery & lungs to pulmonary vein to left atrium to mitral valve to left ventricle to aortic valve to aorta
thymus function
produces lymphocytes, which migrate to other lymphatic tissue to respond to foreign substances
kidneys (location, function)
slightly above iliac crest (T12-L3)
fx: filter metabolic wastes, ions, drugs from blood and expels via urination
contains adrenal glands on top
adrenal glands
secrete epinephrine, norepinephrine, cortisol, estrogen, aldosterone, androgen
ureters and urinary bladder (location)
bladder lies posterior to pubic symphysis
liver (location and functions)
upper right quadrant, 2 major right and left lobes
digestive and excretory functions, absorbs and stores excessive glucose, processes nutrients, detoxifies harmful chemicals, secretes bile (neutralize and dilute stomach acid & digest fat)
gallbladder (location and function)
inferior surface of liver
stores bile
pancreas (location and function)
located between small intestine and spleen
secretes pancreatic juice (critical in digestion), produces insulin and glucagon
stomach location
upper left quadrant
makes chyme
small intestine
duodenum to jejunum to ileum
digestion and absorption
large intestine
cecum to colon to rectum
appendix
extends off of cecum
it is where chyme is converted to feces
spleen
upper left quadrant, below diaphragm
lymphatic organ
resevoir for RBC’s, regulates # of RBC’s in circulation, destroys ineffective cells, produces antibodies and lymphocytes
prevention of injuries to thorax and abdomen
protective equipment,
strengthen core
empty hollow organs prior to practice
important questions to ask in a history
difficulty breathing? blood in urine? difficulty or pain with urination?
observations you should notice
breathing, symmetry of chest movement, swelling, deformity, cyanotic, guarding ab muscles, lowered BP, rapid weak pulse
Upper Right Quadrant
liver, pancreas, kidney, lung
Upper Left Quadrant
heart, spleen, kidney, stomach, lung
Lower Right
Appendix, ureter, bladder, colon, gonads
Lower Left
ureter, bladder, colon, gonads
bleeding or irritation inside abdomen cavity causes
board like rigidity in the abdomen, not voluntarily relaxable
cardiac/lung/splenic refers pain
left shoulder
diaphragmatic pain refers to
shoulders
liver/gallbladder refers pain to pain
right shoulder, upper left quadrant
appendix refers pan to
McBurney’s point
S1-S2 (heart)
systole (blood to body/lungs)
S2-S1 (heart)
diastole (filling of heart)
S1 (heart)
closing of atrioventricular valves (mitral and tricuspid)
S2 (heart)
closing of semilunar valves (aortic & pulmonic)
Aortic valve (where is it located)
2-ICS, RSB
2nd intercostal space, right sternal border
tricuspid
LLSB
lower left sternal border
Pulmonic valve
2ICS, LSB
2nd intercostal space, left sternal border
mitral
cardiac apex
5ICS, LSB
5th intercostal space, left sternal border
blood flow
body tissues superior/inferior vena cava right atrium tricuspid valve right ventricle pulmonary semilunar valves pulmonary trunk pulmonary arteries lung tissue pulmonary veins left atrium bicuspid valve left ventricle aortic semilunar valves aorta -body tissues-->vena cava -(coronary arteries-->heart tissue, coronary sinus cardiac veins, right atrium)
Cheyne-Stokes
rate speeds up and then slows down over a 1-3 minute period
Biots
a series of breaths at a normal rate are followed by a complete cessation of breathing
Apneustic
pauses in the respiratory cycle at full inspiration
thoracic
occurs without diaphragmatic breathing
wheezes/rhonchi
continuous music-like sounds with a high pitch
rales
crackling/bubbly sounds
positions for auscultation of lower lung lobes
bottom 3/4 of posterior fields
positions for auscultation for left axilla
lingula
positions for auscultation for right axilla
right middle lobe
positions for auscultation upper lobes
anterior chest and top 1/4 of posterior fields
normal bowel sounds
liquid like gurgling sounds created by peristaltic actions
about 8 gurgles per minute
absent or diminished bowel sounds
paralytic lieus or peritonitis, swelling
high pitched tinkling bowel sounds
intestinal obstruction
Rib contusion etiology
blow to ribcage may contuse intercostal muscles or produce a fracture. Breathing is very painful
rib contusion s/sx
sharp pain during breathing, point tenderness and pain elicited when rib cage is compressed
rib contusion management
rule out fx (x-ray), RICE and anti-inflammatory agents
Rib Fx etiology
direct blow, violent muscle contractions, compression of ribcage,
most common: ribs 5-9
stress fx: repeated arm movements/ coughing/laughing
flail chest
fracture 3+ consecutive ribs on the same side
rib fx s/sx
pn w/ breathing, point tender, crepitus w/ palpation
rib fx management
x-ray, rest, bracing or ace wrap,
hypostatic pneumonia
occurs when an individual does not take full inspiration because of pain
costochondral separation & dislocation etiology
direct blow to anterolateral aspect of thorax or indirectly sudden twist or fall on a ball that compresses the rib cage
pn is localized in junction of rib cartilage and rib
costochondral separation s/sx
sharp pain, hard to breathe, point tender, swelling, rib deformity, crepitus
costochondral separation/dislocation management
rest and immobilization (healing takes 1-2 months)
sternum fx etiology
high-impact blow to the chest (more likely to occur in car accidents than athletics)
may also cause contusion to the underlying cardiac muscle
sternum s/sx
point tender at site of fx, exacerbated by deep inspiration or forceful expiration.
signs of shock, weak rapid pulse, could indicate internal injury
sternum management
x-rays, monitor for signs of heart trauma
muscle injury etiology
direct blows, sudden torsion
muscle injury s/sx
pain w/ active motion, pain during breathing, laughing, coughing, or sneezing
muscle injury management
apply cold, immobilize
Breast injury etiology
violent up and down lateral movements of the breasts can bruise or strain them
stretch cooper’s ligaments
Runner’s nipples
shirt causes abrasion when running
bicyclist’s nipples
combination of cole and evaporation of sweat
breast injury management
wear a sports bra
breast cancer
self examinations every month
clinical exams every 3 years
pneumothorax
pleural cavity becomes filled with air that has entered through an opening in the chest
may cause pain, difficulty breathing, anoxia
anoxia
absence of oxygen
tension pneumothorax
pleural sac on one side fills with air and displaces the lung and the heart toward the opposite side, which compresses the opposite lung.
SOB, chest pain on one side of the injury, absence of breath sounds, cyanosis, distention of the neck veins, deviated trachea, total lung collapse
hemothorax
presence of blood within pleural cavity
caused by tearing or puncturing
pain, difficulty breathing, cyanosis, violent blow/compression,
traumatic asphyxia
violent blow/compression of the rib cage
causes cessation of breathing
s/sx: purple discoloration of upper trunk/head, bright red eye color, mouth-to-mouth resuscitation and medical attention
hyperventilation etiology
rapid rate of ventilation due to anxiety-induced stress or asthma
causes decreased CO2 in blood
hypcapnia
decreased CO2 in the blood
Hyperventilation S/sx
struggling to breathe
hyperventilation management
help them concentrate on breathing in and out
DO NOT BREATHE IN A PAPER BAG
heart contusion etiology
heart is compressed between sternum and spine by strong outside force
heart contusion s/sx
severe shock and heart pain possibly arrhythmias that cause a decrease cardiac output - can be followed by death
heart contusion management
hopsital ER, CPR, treat for shock
Sudden Death Syndrome in Athletes
most common cause is a type of congenital heart disease
Hypertrophic cardiomyopathy
thickened cardiac muscle with no chamber enlargement and extensive myocardial scarring
causes increased ventricular arrhythmia
Anomalous origin of the coronary artery
one of the arteries originates in an unusual spot, causing flow complications
Marfan’s Syndrome
abnormality of CT that results in weakening of the structure of the aorta and cardiac valves
can lead to rupture
mitral valve prolapse associated with
HCM, and Marfan’s
Coronary Artery Disease
atherosclerosis
narrowing of the artery due to hypercholesterolemia
Right Ventricular Dysplasia
enlargement of the right ventricle causes a disturbance in heart beat
Cardiac Conduction System Abnormalities
may result from abnormalities of sinus or AV nodes
Aortic Stenosis
usually associated with a heart murmur
can cause a fall in BP and cardiac collapse during exercise
could also be caused by: drugs, vascular event, head trauma, obstructive respiratory disease
Sudden Death Syndrome in Athletes s/sx
no sx before death,
cardiac conditions: pain, heart palpitations, syncope, nausea, sweating, heart murmurs, SOB, malice, fever
Sudden Death Syndrome in Athletes prevention
counseling, screening, early identification, diagnostic test have found to be ineffective
Commotio Cordis Etiology
Cardiac arrest caused by blunt impact to chest
young athletes at risk
depolarization phase - 15-30 sec prior to the peak of the T-wave
Commotio Cordis s/sx
ventricular fibrillation
immediate death - 50%
collapsing
Commotio cordis management
resuscitation of the, CPR, AED
Kidney contusion etiology
external force
kidney contusion s/sx
signs of shock, nausea, vomiting, rigidity of black muscles, hematuria
kidney contusion management
hospital observation, gradual increase of fluid intake,
controllable contusion - 2 weeks of bed rest w/ close surveillance
kidney stones
crystalline mineral salts (calcium, phosphate, uric acid) in the urinary tract
Ureters, Bladder and Urethra contusions etiology
only occurs if it is distended by urine.
hematuria
usually seen with running
“runner’s bladder”
Proteinuria
abnormal concentrations of protein in urine.
Ureters, bladder, and urethra contusion s/sx
pain/discomfort, rigidity, nausea, vomiting, signs of shock
kidney injury s/sx
blood coming from urethra and passing of a great quantity of bloody ruine
Bladder contusion refers pain
to lower trunk (upper thigh)
Cystitis
inflammation of the bladder (UTI).
acute cystitis (painful urination, chills, fever)
tx with antibiotics
Urinary Tract Infection
caused by staphylococcus bacteria or chlamydia
UTI s/sx
frequent, burning, painful urination
tx w/ antibiotix
Preventing UTI
fluid intake, sanitary habits,
Urethritis
inflammation of the urethra, caused by gonorrhea or non-gonococcal organisms.
s/sx: include pain on urination along with urethral discharge
tx w/ antibiotics
GI Bleeding
bloody stools;
caused by: gastritis, iron-deficiency anemia, ingestion of aspirin, stress, bowel irrigation, colitis
colitis
inflammation of the colon caused by ulceration of the mucosal lining of the colon
colitis s/sx
abdominal pain w/ colic, watery stools that contain pus
dehydration, intermittent fever, and possible hemorrhage and perforation
liver contusion etiology
hard blow to the right side of the rib cage
can cause tear or contusion (esp if enlarged)
hepatitis
inflammation of the liver due to viral infection or alcohol consumption
can lead to cirrhosis
liver contusion s/sx
hemorrhage and shock
liver contusion refers pain to
pain below right scapula, right shoulder, and substernal area
sometimes to left side of the chest
immediately refer to physician
Pancreatitis etiology
may be acute or chronic and often related to blockage of pancreatic duct
acute pancreatitis s/sx
necrosis, suppuration, gangrene, hemorrhage
suppuration
undergo the formation of pus
chronic pancreatitis s/sx
jaundice, diarrhea, mild to moderate pain that radiates to the back
acute pancreatitis management
rehydrate, reduce pain, tx for shock, medication, prevention of secondary infection; surgery if duct is blocked
chronic pancreatitis management
difficult to manage; large doses of analgesics, administer pancreatic enzymes, low fat diet
Dyspepsia
indigestion
dyspepsia etiology
digestive upset, emotional stress, esophageal and stomach spasms, inflammation of mucosal lining of the esophagus or stomach
dyspepsia s/sx
increased secretion of HCl, nausea, flatulence
dyspepsia management
eliminate certain foods, avoid stressors,
management of vomiting
drink fluids to prevent dehydration, anti nausea medications
gastroenteritis
food poisoning
food poisoning etiology
infectious organisms from food or drink
food poisoning s/sx
nausea, vomiting, cramps, diarrhea, anorexia
staph infections can last
3-6 hours
salmonella infections may last
24-48 hours
food poisoning management
fluid replacement, electrolyte replacement, may need an IV, bed rest,
foods: clear strained broth, bouillon, soft cooked eggs, bland cereals may be given
peptic ulcer etiology
acids secreted in the stomach destroy mucous lining (stomach or small intestine); often occur in those people who experience extreme anxiety for a long period of time
peptic ulcer s/sx
gnawing pain in the epigastric region (1-3 hours after a meal)
Dyspepsia, heartburn, nausea, vomiting
pain lasts minutes not hours
peptic ulcer managment
antacids can help neutralize gastric secretions
surgery
Gastroesophageal Reflux
backward flow of acidic gastric contents into the esophagus
malfunction of lower esophageal sphincter
may cause inflammation
Gastroesophageal Reflux s/sx
heartburn, retrosternal pain, can progress to gripping chest pain, burning feeling, sour liquid taste in throat
difficulty swallowing
Gastroesophageal Reflux management
medication, surgery if medication does not help
diarrhea etiology
abnormal stool looseness or passage of a fluid, unformed stool
problems in diet, inflammation of intestinal lining, GI infection, ingestion of certain drugs
diarrhea s/sx
abdominal cramps, nausea, vomiting, frequent elimination of stools (3-20/day), loss of appetite, light brown/gray foul smelling stool;
weakness due to dehydrations
Constipation etiology
lack of abdominal muscle tone, insufficient moisture in the feces, not enough fiber, poor bowel habits, nervousness
constipation s/sx
feeling of fullness, cramping or pain in lower abdomen, straining to defecate, may rupture vessel and cause anal bleeding
constipation management
eat cereals, fruits, vegetables, fats
determine cause of emotional stress
avoid laxatives
IBS
Irritable Bowel Syndrome
IBS etiology
psychological factors often determine how the individual experiences and handles the condition
IBS s/sx
abdominal pain relieved with defecation, alteration in stool frequency, form, passage; passage of mucus and abdominal bloating and distention
IBS management
modify diet, antidiarrheal or antispasmodic meds, psychological counseling
appendicitis etiology
can be chronic or acute
caused by fecal obstruction, lymph swelling, cardioid tumor
often occurs in males age 15-25
could rupture and cause peritonitis
appendicitis s/sx
mild to severe pain in the lower abdomen, nausea, vomiting, low grade fever
rigidity at McBurney’s point,
appendicitis management
surgical removal
hemorrhoids etiology
varicosities of the hemorrhoidal venous plexus of the anus
chronic constipation or straining may stretch anal veins resulting in protrusions and bleeding or a thrombus
hemorrhoids s/sx
painful nodular swelling swear the sphincter of the anus; slight bleeding and itching;
self limiting will healing 2-3 weeks
hemorrhoids management
palliative and serves to eliminate discomfort until healing occurs
scrotal contusion etiology
very painful, nauseating, disabling condition
scrotal contusion s/sx
hemorrhage, fluid effusion, muscle spasm
scotal contusion management
reduce testicular spasm by having athlete in a seated position, apply cold pack
spermatic cord torsion etiology
results from the testicle’s revolving in the scrotum after a direct blow; or from coughing or vomiting
spermatic cord torsion s/sx
acute testicular pain, nausea, vomiting, inflammation
spermatic cord torsion management
immediate medical attention (could cause atrophy of testicle)
Traumatic Hydrocele of the Tunica Vaginalis etiology
excessive fluid accumulation caused by a severe blow to the testicluar region; venous plexus on posterior aspect of testicle can become engorged, creating a varicocele; rupture of venous plexus results in accumulation of blood in scrotum (hematocele)
Traumatic Hydrocele of the Tunica Vaginalis s/sx
pain, swelling in the scrotum
Traumatic Hydrocele of the Tunica Vaginalis management
cold packs applied to scrotum, refer to physician
Vaginitis etiology
inflammation caused by microorganisms; non STI causes include bacterial infections, strong chemicals from douching, irritation from tampon, poor hygiene habits
Vaginitis s/sx
purulent, bloody, vaginal discharge. Strong odor with itching. frequent urination (painful), vagina is red and painful to touch
vaginitis management
STI: antibiotic/antifungal meds
educate about correct hygiene and cleanliness
Spleen Injury etiology
due to fall or direct blow on spleen,
mono will cause the spleen to enlarge
spleen injury s/sx
shock, abdominal rigidity, nausea, voming
spleen injury management
conservative, non-op tx w/ a week of hospitalization.
full return at 4 weeks
surgery: 3 months recovery
removal: 6 months recovery
Abdominal Muscle strains MOI
sudden twisting of trunk or reaching overhead;
causes severe pain or hematoma formation
Abdominal wall contusion etiology
common in collision sports; catchers/goalies
abdominal wall contusion s/sx
hematoma, pressure causing pain and tightness
abdominal wall contusion management
cold pack, ace wrap,
check for signs of internal injury
Hernia etiology
portrusion of abdominal viscera through a portion of the abdominal wall
inguinal hernia
most common in males
femoral hernia
most common in females
hernia s/sx
natural weakness aggravated by either strain or a direct blow
pain and prolonged discomfort, superficial protrusion in groin area, pain increased with coughing, feel weak and pulling sensation in groin area
hernia management
surgery
blow to solar plexus etiology
transitory paralysis of the diaphragm “wind knocked out”
blow to solar plexus s/sx
stops respiration and leads to anoxia, athlete is unable to inhale- may cause hysteria
blow to solar plexus management
loosen nothing, talk to athlete, bend athletes knees, encourage them o relax by initiating short inspirations and long expirations
stitch in side etiology
constipations, gas, overeating, spasm of diaphragm, poor conditioning, weak abdominal muscles, distended spleen, breathing issue
stitch in side s/sx
cramp like pain that develops on either left or right costal angle during hard physical activity
management
relaxation of spasm
stretch arm on affected side or flex trunk forward while tightening abdominal muscles
hypochondriac region
below cartilage (ribs-costocartilage) R and L
epigastric region
between hypochondriac regions
lumbar region
middle L and R
above iliac crests
umbilical region
middle section, over umbilicus
iliac region
L and R on top of iliac crests
hypogastric
below umbilicus
accelerated pulse is described as
> 150 bpm, casuses pressure on the base of the brain and shock
bounding pulse
pulse that quickly reaches a higher intensity than normal then quickly disappears
causes: ventricular systole and reduced peripheral pressure
deficit pulse
pulse in which the number of beats counted at the radial pulse is less than that counted over the heart itself
cardiac arrhythmia
high tension pulse
force of the beat is increases; increased amount of pressure is required to inhibit the radial pulse
cerebral trauma
low tension pulse
short, fast, faint pulse having rapid decline
heart failure; shock
rate of fewer than 10 breaths per minute
bradypnea
rate of more than 30 breaths per minute
tachypnea
labored breathing
dyspnea
explain the electrical wiring of the heart
signal starts at SA node - triggers atriums to contract, travels to AV node, triggers the ventricles to contract, signal runs through bundle of His to Purkinje fibers.
P wave
represents atria contracting to pump blood into ventricles
QRS complex
The QRS complex represents ventricular depolarization and contraction
T wave
is normally a modest upwards waveform representing ventricular repolarization
