Week 6 Flashcards
What are the layers of the abdominal wall?
External oblique
external oblique fascia
rectus abdominus muscle
transverse abdominus muscle
what are the 9 regions of the abdomen
R hypochondriac - Epigastric - L hypochondriac
R Lumbar - Ubillical - L Lumbar
R Illiac - Hypogastric - L Illiac
what is in the retroperitoneal space in the abdominal cavity?
Kidneys, ureters, bladder, reproductive organs, inferior vena cava, abdominal aorta, pancreas
what is in the peritoneal space in the abdominal cavity?
Bowel, spleen, liver, stomach, gall bladder
what is in the pelvic cavity space in the abdominal cavity?
Rectum, ureters, pelvic vascular plexus, femoral arteries, femoral veins, pelvic skeletal structures, reproductive organs
what are the abdominal mechanisms of injury?
Blunt mechanisms:
- Forces
- > compression/shearing/deceleration
- Sources
- > MVA’s/falls/assults/blasts
Penetrating mechanisms:
- Low energy
- High energy
What are risk factors of intra-abdominal injuries?
- High speed MVA
- Pedestrian v vehicle
- hypotension <100 at any time
- ## presence of chest or pelvic injuries
What are causes of abdo pain?
Visceral pain:
Caused by stretching of fibres in walls/capsules of hollow/solid organs
Parietal pain :
irritation of nerves in the parietal peritoneum, usually anterior abdo wall
Referred pain:
Pain presentign away from noxious stimuli
What are the presentations of abdo visceral pain?
Presentation:
steady ache to vague discomfort to excruciating colicky pain
present along midline
may be referred
may have sweating/nausea/vomiting/tachycardia
What are the presentations of abdo parietal pain?
aggrivated by respiration, thoracic and abdo movements
Presentation:
- sharp, localised, constant
- guarding, legs raised, decreased mvmt
- localised peritonitis develops, rigidity and tenderness
what are some examples of referred abdo pain?
Diaphragm irritation can be shown as shoulder pain
Biliary tract disease can present as - right infrascapular pain
What is Kehrs sign?
occurance of acute pain at the shoulder tip due to the presence of blood in the peritoneum, irritating diaphragm when supine.
Left shoulder tip pain is an indication of a ruptured spleen
What is left shoulder tip pain in abdo trauma a sign of?
ruptured spleen
What are clinical features of abdominal injuries?
Cullens sign - bruising around belly button
Grey Turners sign - bruising on side of body
- distended or irregularly shaped
- bruising of the abdo and flank
- tenderness
- pain
- pain other than injury site
- pain radiating to either shoulder
- guarding
- fetal position
- weak peripheral pulse
- abdo cramping
- rigid/hard abdo
what are some abdo injury types?
solid organ hollow organ vascular abdo evisceration genitourinary
what are considerations around ruptured spleen?
often caused with trauma to ribs 9-11
capsule around spleen can promote slow development of shock
rapid shock onset when capsule ruptures
where is the pancrease located?
transversely across lumbar spine
often injured by compression of styeering wheel
what is a complication of pancreas rupturing?
bleeds little but leaks pancreatic enzyme which can damage organs
what injury can damage kidneys?
direct blow to back, flank of upper abdomen
Suspect in fractures of 10-12 ribs
What is a symptom of kidney injury?
hypovolaemia
blood in urine
what is a sign of bladder rupture?
blood at urethral opening or signs of trauma to the region
what are causes of rectal bleeding?
sexual assult haemorrhoids colitis ulcers digestive tract
What are causes abdominal compartment syndrome?
Direct pressure of
- vascular structures
- the diaphragm
- adbo wall
Causes:
intra-abdo:
- ruptured AAA
- bleed/trauma
Retroperitoneal
- pelvic bleeds
- ruptured AAA
Abdo wall:
- burn eschar
What are the types abdominal compartment syndrome?
Primary:
a process involving the abdo itself leading to intra-abdo hypertension. eg. penetrating trauma/haemorrhage
Secondary:
intra-abdo hypertension (without abdo injury)
Strongly related to fluid resus - infusion >3L
