Pathologies of thorax and abdomen and anatomy Flashcards
what does the thorax do
it protects vital internal organs (heart & lungs)
What are the 3 categories of the ribs
- true ribs (ribs 1-7) “sternal ribs”
- false ribs (8-10) (indirectly attach to the sternum)
- floating ribs (11-12)
- coastal cartilage (lacks Blood flow and risk of injury due to age)
what are the 3 anatomical structures that make up the sternum
- manubrium
- body
- xiphoid process (avoid when doing CPR)
What is the function of the ribs
- provides attachment for the muscles of the neck, thorax, upper abdomen, and back
- elasticity of false/floating ribs allows rib cage movement for respiratory activity
What happens in Inspiration
external intercostals contract > diaphragm contracts > expansion of ribs moves sternum upward & outward
What happens in expiration
external intercostals relax > internal intercostals & abdominal contracts for active expiration > diaphragm relaxes > ribs & sternum depress
Rib Fx etiology
- direct blow = Fx @ point of contact
- Indirect trauma = general compression of ribs
- violent muscle contraction
- coughing/ laughing
- overuse= stress fx
Rib Fx s/s & care
s/s: TTP, pain on inhalation, pain on A/P and lateral compression
Care:
- referral
- swathe, arm @ side- compression/reduce movement
- Px: 3-4wks
- sequelae: hemothorax/pneumothorax
Costochondral Fx/ separation etiology
as in Rib Fx- blunt trauma, compression injury
Costochondral Fx/ separation pathology
rib cartilage disrupted/ displaced
Costochondral Fx/ separation s/s
- deformity @ rib/cartilage junction
- pain on inspiration & thoracic movement
-crepitus
Px: out for 4-8wks
Pneumothorax “collapsed lung” types
traumatic, spontaneous, and tension
Pneumothorax etiology for traumatic
puncture to chest wall, sucking wound or rupture of lung tissue
Pneumothorax etiology for spontaneous
idiopathic in tall, thin young men (Marfan syndrome)
- secondary spontaneous= result of disease: cancer, congestive heart failure, emphysema
Pneumothorax etiology for tension
Pleural cavity fills with air with each inhalation
Pneumothorax “collapsed lung” pathology
lung collapses, mediastinum shifts away
Pneumothorax “collapsed lung” s/s
-sudden onset of sharp chest pain, especially with inhalation, (shortness of breath), anoxia, absent or lessened breath sounds
Pneumothorax “collapsed lung” care
- Xray to diagnose
-simple: oxygen supplementation or chest tube - tension: pneumothorax treated emergently w/inserting bore needle into space at the midclavicular line, allowing trapped air to escape
Spontaneous (tension)
-Divers susceptible
- negative pressure is compromised as diver holds breath and ascends
- lung compression, limiting blood flow back to heart= tension pneumothorax
s/s: sharp pain on affected side, cyanosis, rapid, shallow breathing
Hemothorax “punctured lung”
- blood in pleural cavity
s/s: pain, dyspnea, coughing up frothy blood (sputum), low BP, shock
Abdominal quadrants
UR quadrant: liver, pancreas, kidneys, lung
UL quadrant: heart, spleen, kidneys, stomach, lung
LR quadrant: appendix, ureter, bladder, colon, gonads
LL quadrant: ureter, bladder, colon, gonads
Ruptured spleen function
-largest lymphatic organ, filters damaged blood cells and platelets, destroys bacteria
- protrudes below ribs and can become exposed
Ruptured spleen etiology
severe abdominal blow or physical activity during systemic infection “fall on a ball”
Ruptured spleen s/s
abdominal rigidity, nausea, vomiting, Kehr’s sign, shock
Ruptured spleen care
- Refer to E.D.
- tx for shock (lay flat or with elevated torso)
Ruptured spleen prevention
no Px or competition with mono
- 4-6 weeks no Px, MD will order ultrasound
Kidney contusion etiology
severe blow to mid back (T12-L3)
Kidney contusion s/s
back rigidity, nausea, vomiting, shock, hematuria
Kidney TX
immediate referral to E.D. if suspected rupture
Solar plexus (Celiac) injury “wind knocked out” etiology
blow to or falling onto abdomen
Solar plexus (Celiac) injury pathology
spasm of diaphragm, hypoxia/apnea
Solar plexus (Celiac) injury s/s
startled appearance, shock, loud gasping. referred pain to abdomen and chest
Solar plexus (Celiac) injury care
“inhale through nose, exhale through mouth- breathe with me”
- if no improvement 4-6 cycles, suspect abdominal hemorrhage
Ruptured bladder prevention
urinate prior to activity
Ruptured bladder etiology
-very rare
- direct blunt force trauma to pelvis, superior to pubic symphysis
Ruptured bladder s/s
- inability to urinate
- abdominal rigidity
- blood from urethra
- nausea, vomiting, shock
liver contusion etiology
blow to right abdomen (not hollow, makes dull sound rather than drumlike)
appendicitis etiology
-inflammation due to infection, lymph swelling, fecal obstruction
- more common in males 15-25
appendicitis s/s
diffuse, nonspecific pain that becomes focal, mild fever, abdominal rigidity
+ rebound tenderness
+ iliopsoas MMT
appendicitis care
no food/ refer
Inguinal/ femoral hernia etiology
-congenital, acquired through direct trauma or exercise
- 5-7x more likely in men
Inguinal/femoral hernia s/s
-feelings of weakness & drawing/pulling
- pain w/coughing, exercising, or bending over
- burning sensation
inguinal/femoral hernia care
surgical
- return to light activity after 3wks
Sudden cardiac death syndrome etiology
most often= congenital cardiovascular abnormality
- non cardiac causes: drug use
Sudden cardiac death syndrome s/s
-most exhibit no symptoms
- chest pain during exertion
-heart palpitations
Sudden cardiac death syndrome prevention
pre-participation physical screening
