lecture 10: abdominal injuries Flashcards
1
Q
what are the boundaries of the abdomen
A
anterior and posterior cavity walls
diaphram
imaginary plane from pubic symp to sacrum
2
Q
whatr are the 4 quda
A
UR UL
RL LL
3
Q
the adbdoman contain organs that make up what 3 systems
A
digestive
urinary
genital
4
Q
what does the RUQ contain
A
liver right kidney gall colon pancrease
5
Q
what does the LUQ contain
A
stomach left kidnet speen colon opacnrease
6
Q
what does the RLQ cotnain
A
appexid colon small intestint ureter major ven and arter for right lef
7
Q
what does LLQ contain
A
colon
small in terniso r
urerer
maajor artery and vein or left lft
8
Q
what are the solid organs of the abdomen
A
Liver Spleen Pancreas Kidneys Ovaries Adrenal
9
Q
which is more [prone to injuries
A
solid or
10
Q
whart are some roles of solid organs
A
-enzyme productioon
blood cleansing
energy production
11
Q
sicne the solid organs have rich blood supply,,, when there is an injury they are more likely to
A
hemmoraging
12
Q
what are the hollow organs
A
Gallbladder Stomach Small intestine Large intestine Bladder Bile ducts Ureters
13
Q
which organs will often have delayed SS
A
hollow
14
Q
what is the liver location and landmark
A
right side
ribs 6-10
15
Q
what is the gal bladder location and landmark
A
below liver
16
Q
what is the spleen location and landmark
A
left side
ribs 9-11
17
Q
what is the pancrease location and landmark
A
inferior posterior to lvier stomach, retroperitoneal
18
Q
true or false: spleen injuries arent dangerous
A
flase
19
Q
what is the landmark for the left kidneys
A
t11-l2 vertebreas
20
Q
what is the landmark for right kidney
A
t12 to l3
21
Q
hllow organs spill their caustic contents which can result in
A
intra-abdominal hemorrahage
peritonitis
sepsis (toxicity)
22
Q
what are the intervention steps for someone with a abdominal issue
A
UABC (rule out spinal and concussion)
focussed
VITALS ARE IMPOSTANT
23
Q
what is a foccused secondary assessment for abdomnial injury
A
hisotry
MOI and IOS
observe and put pillo under knees
4 quad palpation and special test
24
Q
an athlete with an abdominal injiry will have a… (vitals)
A
rapid pulse
low BP
rapid, shallow breathing
25
when hisotry taking what is important to consider
MOI :penetrating or blunt
Any prveious kidney infection
last intake
hematueria (blood in urine)
26
if there is plain in upper left quadrant what are you expectig
spleen=danger
27
what is the most commonly effected orgaan of penetratinf trauma
liver
28
what does penetrating trauma result in
Uncontrolled hemorrhage
Organ damage
Spillage of hollow organ contents
Irritation and inflammation of abdominal lining
29
what are the causes of blunt trauma
Deceleration (Contents damaged by change in velocity)
Compression (Organs trapped between other structures)
Shear (Part of an organ is able to move while another
part is fixed)
30
if you have a female athelete with abdominal pain, what is imporatnt to ask
if pregnant
| if mentrual cycle
31
what are some symtoms you can ask for abdonamal
```
fever
neauas
chills
general confition
reffered pain
```
32
what are the observations
```
Athlete looks sick?
Contracting
Distention
Contusion
Scars
Masses (especially if
previous injuries there)
Discoloration
Redness
Bruising
Swelling
Rigidity
```
33
what is collens sign
above belly button
indications pertineal bleeding, often pancratic hemmoriat
=sign in ruptured ectopic pregnancy
34
what is grey turners sign
```
Bluish discoloration of lower
flanks, lower back; associated
with retroperitoneal bleeding of
pancreas, kidney, or pelvic
fracture.
```
35
what is kehr signs
Left shoulder pain when supine
| caused by disapgragmic irrtation (ssign of ruptured spleen)
36
whar is the test for kehlr signs
Athlete supine
Elevate the LE (Trendelenburg position)
Delayed classic symptom of a ruptured spleensign
(30min) of spleen injury once elevated
Severe LEFT shoulder pain
From blood or irritant in peritoneal cavity
CATA 262 29
37
true or false: umbilical hernials get worse when valsave method
true , creates internal pressure
38
what is the comfortable position for abdominal injruies
Usually, supine with a pillow under the
knees is the most comfortable for most
athletes.
For those who do not find this position
comfortable, then the therapist must find
another position that relieves the pain.
39
what is ridigity in the quadratnts
invulentary control of abdominal wall musculartor (no relaxion)
40
what is guarding
voluntary contraction of the abdominal wall muscularature (relax when pressing)
41
what is rebound tenderness
shaking, gentle pressing
| if pain when lift up, radiating pain= irritation of the peritoneum
42
how to perform rebound tenrerness
HOW: the AT maintains hand pressure
over an area of tenderness. The AT then
releases the hand pressure suddenly. Pain
denotes a positive test.
43
how to find masses
ciurcular motion (deeper palpation)
44
what are some abdominal special tets
```
Psoas test
Obturator sign
Shake pelvis
Hematuria
Intra abdominal mass
Cough sign
Rovsing's sign
Blumberg’s sign (rebound tenderness)
Murphy’s sign
```
45
if you have appendix issue, where is reffered pain
around belly button (RLQ)
46
if you have liver issue, where is reffered pain
right shoulder RUQ
47
if you have spleen issue, where is reffered pain
left shoulder (LUQ)
48
if you have kidney issue, where is reffered pain
low back
49
if you have ulcer issue, where is reffered pain
upper mod abdoment or upper back
50
if you have aortic aneurysm issue, where is reffered pain
low back and RLQ
51
if you have kidney issue, where is reffered pain
costovertebral angle (low back)
52
if you have pancreas issue, where is reffered pain
upper abdomen
53
what ate the general signs and symtoms of abdominal injruy
```
Rigid, tender, rebound tenderness
Athlete protects abdomen (guarding)
Pain radiating to the shoulder
Back pain (kidney injury)
Blood in urine
Nausea and vomiting
Rapid, shallow breathing
Rapid pulse
Low BP
```
54
what are ACUTE ss of abdomen
```
Tachycardic Fluid loss
Hypotensive Bowel inactivity
Abdominal tenderness Tense/distended abdomen
Attemps at stomach emptying Rapid shallow breathing
Rebound tenderness Stomach irritated
Rigid abdomen Guarding
Decreased bowel sounds Coliky pain
Gas – feces retention Peritonitis
Abdominal wall injury Infection
Pain with respirations Constipation
Local/diffuse pain Fever
Back pain (without any back trauma)
Referred pain to the shoulder
Parietal vs. Visceral peritoneum
Nausea/vomiting/loss of appetite****
Pain on movement (athlete remains still to decrease pain)
Shock: rapid pulse (tachycardia)/CATA 262 hypotensive
```
55
what is the treatment for abdonal
```
Maintain the airway, UABCd’s
Calm athlete
Oxygen (check SpO2)
Treat for shock
Control any external bleeding
Place the athlete in a comfortable position
Transportation
Nothing to eat/drink
No medications
```
56
athletes withmild blunt abdominal trauma (contusion) may RTp after how long 15 min
57
what is appendicities
inflamation
| Smarts as general pain and gradually locatluzes to umbiliic in LRQ
58
where will vyou feel pain with appendicities
pain on palpation of MCBurney's point (2/3 between umbilical and ASIS)
59
how can you ellicit pain for aappendicities
Extending the thigh (active and passive) and resisted
| flexion of thigh elicits pain
60
what is ruptured appendix
abdominal pain that keeps on increasing
| nausea, rigitidy
61
if a male has a blow to the scrotum and pain is stead of increasing 15-20 minutes, what do you do
send to MD
62
what is winded caused by
direct blow to the neural solar plexus of epigastric region
63
what are the SS of beig windex
temporary repirtaty paralysisi
64
what is the treatment for Tx windedd
loosen restrictive clothing and do gentle hip/knee flexion
65
explain diaphragmic rupture
Dx: L>R diaphragm rupture 4X more likely,
| abdominal contents spill in thoracic cavity
66
what are the SS of diapgramic rupture
peritonitis, respiratory distress,
referred pain, muffled lung fields on
affected side, bowel sounds in chest cavity
67
treatment of diaphragmitc rupture
911, 02, urgent surgical intervention
68
what is thje collar sign
hourglass sign
sign of a diaagraph ripsure
(hernitated organs)
69
are stomch contisuions.ruptures rare or common
rate
70
what are the signs and simptooms of stomach contusion
S/S: classical abdominal findings: guarding,
rebound tenderness, absent bowel sounds, rigid
abdomen, chemical or bacterial peritonitis
71
for someone with a stomach contusion, do you get o2 wiht the bvm
no , since they are breakthing on their own
72
intestinal contusion is same as stmach contusion
73
true or false: liver contusions are more common
true
74
what is the MOI for liver rupture/contusion
durect blunt to right side (6-10 ribs)
75
what are the signs and symptoms of liver contsusiin
S/S: shock signs: tachycardic, hypotensive, RUQ
| pain/ref to shoulder?
76
what is the most tcommon injuryed organ with blunt trauma
spleen
77
what is the MOI for spleen rupture
blunt left trauma left side ribs
78
what are the ss of spleen ocontusion
S/S: sharp ULQ pain, abdominal distention,
referred pain to left shoulder (Kerh’s sign),
shock signs, can occur acutely – might be
delayed for hours or even days
79
what is more common, kidney contision or rupture
contusion
80
what are SS of kidney contusion
local/reffered pain, low back pain, blood in urine
81
what is the MOI for kidneys
MOI: direct blunt trauma to posterior lower back
Left kidney T11 to L2
Right kidney T12 to L3 (lower)
82
what nis the MOI for pancreas contision
local trauma inferior to stomach.liver
83
what are ss of penetratin trauma
Pain
Nausea/ Vomiting
Athlete will prefer to lie very still with his/her
legs drawn up because it hurts to move or
straighten the legs
Athlete might complain about every bump
during transport
If major vesses are cut or solid organs are
lacerated, bleeding may be rapid and severe
84
what to do for penetrating trauma
Do not attempt to remove the object
Inspect the athlete’s back and sides for exit wounds
Stabilize the object with supportive bandaging around
the it to control external bleeding and minimize
movement of the object
Dry, sterile dressing to all open wounds
Check vitals (pallor, cold sweat, rapid-thready pulse,
low BP
Treat for shock
O2 via non-rebreather mask
keep warm with blanket
Ensure that you protect the spine
Transportation to emergency dept
85
WHAT IS abdominal evisceration
opened abdominal from wich organs and fat protrude
86
what do you cover a abdomial evsceiration by
mositerior (steril solution), sterile cause or with occulsive dressing
