lecture 10: abdominal injuries Flashcards
what are the boundaries of the abdomen
anterior and posterior cavity walls
diaphram
imaginary plane from pubic symp to sacrum
whatr are the 4 quda
UR UL
RL LL
the adbdoman contain organs that make up what 3 systems
digestive
urinary
genital
what does the RUQ contain
liver right kidney gall colon pancrease
what does the LUQ contain
stomach left kidnet speen colon opacnrease
what does the RLQ cotnain
appexid colon small intestint ureter major ven and arter for right lef
what does LLQ contain
colon
small in terniso r
urerer
maajor artery and vein or left lft
what are the solid organs of the abdomen
Liver Spleen Pancreas Kidneys Ovaries Adrenal
which is more [prone to injuries
solid or
whart are some roles of solid organs
-enzyme productioon
blood cleansing
energy production
sicne the solid organs have rich blood supply,,, when there is an injury they are more likely to
hemmoraging
what are the hollow organs
Gallbladder Stomach Small intestine Large intestine Bladder Bile ducts Ureters
which organs will often have delayed SS
hollow
what is the liver location and landmark
right side
ribs 6-10
what is the gal bladder location and landmark
below liver
what is the spleen location and landmark
left side
ribs 9-11
what is the pancrease location and landmark
inferior posterior to lvier stomach, retroperitoneal
true or false: spleen injuries arent dangerous
flase
what is the landmark for the left kidneys
t11-l2 vertebreas
what is the landmark for right kidney
t12 to l3
hllow organs spill their caustic contents which can result in
intra-abdominal hemorrahage
peritonitis
sepsis (toxicity)
what are the intervention steps for someone with a abdominal issue
UABC (rule out spinal and concussion)
focussed
VITALS ARE IMPOSTANT
what is a foccused secondary assessment for abdomnial injury
hisotry
MOI and IOS
observe and put pillo under knees
4 quad palpation and special test
an athlete with an abdominal injiry will have a… (vitals)
rapid pulse
low BP
rapid, shallow breathing
when hisotry taking what is important to consider
MOI :penetrating or blunt
Any prveious kidney infection
last intake
hematueria (blood in urine)
if there is plain in upper left quadrant what are you expectig
spleen=danger
what is the most commonly effected orgaan of penetratinf trauma
liver
what does penetrating trauma result in
Uncontrolled hemorrhage
Organ damage
Spillage of hollow organ contents
Irritation and inflammation of abdominal lining
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)
if you have a female athelete with abdominal pain, what is imporatnt to ask
if pregnant
if mentrual cycle
what are some symtoms you can ask for abdonamal
fever neauas chills general confition reffered pain
what are the observations
Athlete looks sick? Contracting Distention Contusion Scars Masses (especially if previous injuries there) Discoloration Redness Bruising Swelling Rigidity
what is collens sign
above belly button
indications pertineal bleeding, often pancratic hemmoriat
=sign in ruptured ectopic pregnancy
what is grey turners sign
Bluish discoloration of lower flanks, lower back; associated with retroperitoneal bleeding of pancreas, kidney, or pelvic fracture.
what is kehr signs
Left shoulder pain when supine
caused by disapgragmic irrtation (ssign of ruptured spleen)
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
true or false: umbilical hernials get worse when valsave method
true , creates internal pressure
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.
what is ridigity in the quadratnts
invulentary control of abdominal wall musculartor (no relaxion)
what is guarding
voluntary contraction of the abdominal wall muscularature (relax when pressing)
what is rebound tenderness
shaking, gentle pressing
if pain when lift up, radiating pain= irritation of the peritoneum
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.
how to find masses
ciurcular motion (deeper palpation)
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
if you have appendix issue, where is reffered pain
around belly button (RLQ)
if you have liver issue, where is reffered pain
right shoulder RUQ
if you have spleen issue, where is reffered pain
left shoulder (LUQ)
if you have kidney issue, where is reffered pain
low back
if you have ulcer issue, where is reffered pain
upper mod abdoment or upper back
if you have aortic aneurysm issue, where is reffered pain
low back and RLQ
if you have kidney issue, where is reffered pain
costovertebral angle (low back)
if you have pancreas issue, where is reffered pain
upper abdomen
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
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
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
athletes withmild blunt abdominal trauma (contusion) may RTp after how long 15 min
what is appendicities
inflamation
Smarts as general pain and gradually locatluzes to umbiliic in LRQ
where will vyou feel pain with appendicities
pain on palpation of MCBurney’s point (2/3 between umbilical and ASIS)
how can you ellicit pain for aappendicities
Extending the thigh (active and passive) and resisted
flexion of thigh elicits pain
what is ruptured appendix
abdominal pain that keeps on increasing
nausea, rigitidy
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
what is winded caused by
direct blow to the neural solar plexus of epigastric region
what are the SS of beig windex
temporary repirtaty paralysisi
what is the treatment for Tx windedd
loosen restrictive clothing and do gentle hip/knee flexion
explain diaphragmic rupture
Dx: L>R diaphragm rupture 4X more likely,
abdominal contents spill in thoracic cavity
what are the SS of diapgramic rupture
peritonitis, respiratory distress,
referred pain, muffled lung fields on
affected side, bowel sounds in chest cavity
treatment of diaphragmitc rupture
911, 02, urgent surgical intervention
what is thje collar sign
hourglass sign
sign of a diaagraph ripsure
(hernitated organs)
are stomch contisuions.ruptures rare or common
rate
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
for someone with a stomach contusion, do you get o2 wiht the bvm
no , since they are breakthing on their own
intestinal contusion is same as stmach contusion
true or false: liver contusions are more common
true
what is the MOI for liver rupture/contusion
durect blunt to right side (6-10 ribs)
what are the signs and symptoms of liver contsusiin
S/S: shock signs: tachycardic, hypotensive, RUQ
pain/ref to shoulder?
what is the most tcommon injuryed organ with blunt trauma
spleen
what is the MOI for spleen rupture
blunt left trauma left side ribs
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
what is more common, kidney contision or rupture
contusion
what are SS of kidney contusion
local/reffered pain, low back pain, blood in urine
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)
what nis the MOI for pancreas contision
local trauma inferior to stomach.liver
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
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
WHAT IS abdominal evisceration
opened abdominal from wich organs and fat protrude
what do you cover a abdomial evsceiration by
mositerior (steril solution), sterile cause or with occulsive dressing
