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Abdominal Trauma
Topics
Introduction to Abdominal Injury
Abdominal Anatomy and Physiology
Pathophysiology of Abdominal Injury
Assessment of the Abdominal Injury Patient
Management of the Abdominal Injury Patient
Introduction to Abdominal
Injury
Introduction to Abdominal
Injury
One of bodys largest cavities
Multiple vital organs
Large volumes of blood can be lost before
signs and symptoms manifest
Must be alert for signs of transmitted injury:
Deformity, swelling, and ecchymosis
Prevention:
Highway safety
Abdominal Anatomy
and Physiology
Abdominal Anatomy
and Physiology
Boundaries
Superior: Diaphragm
Inferior: Pelvis
Posterior: Vertebral column and posterior and
inferior ribs
Lateral: Muscles of the flank
Anterior: Abdominal muscles
Abdominal Anatomy
and Physiology
Three Specific Spaces
Peritoneal Space
Organs covered by abdominal (peritoneal) lining
Retroperitoneal Space
Organs posterior to the peritoneal lining
Pelvic Space
Organs contained within the pelvis
Abdominal Organs by
Quadrant
Liver
Spleen
Pancreas
Kidneys
Ovaries
Hollow
Stomach
Small intestine
Large intestine
Gall bladder
Bladder
Uterus
Accessory Organs
Liver
Gallbladder
Pancreas
Urinary System
Kidneys
Ureter
Urinary Bladder
Urethra
Immune System
Spleen
Genitals
Ovaries
Fallopian tubes
Uterus
Vagina
Digestive Tract
Function
Churn material to be digested
Excrete digestive juices
Absorb nutrients and water
Digestive Tract
Components
Stomach
Food mixed with HCl and enzymes to form chyme
Small bowel
Duodenum
Jejunum
Ileum
Accessory Organs
Liver
Located in upper right quadrant
Receives 25% of cardiac output
Greatest blood reserve
Function
Detoxifies blood
Removes damaged or aged erythrocytes
Stores glycogen and agents for metabolism
Accessory Organs
Gallbladder
Small hollow organ located behind and beneath
liver
Receives bile
Waste product from reprocessing of red blood cells
Used to digest fatty foods (emulsification)
Accessory Organs
Pancreas
Produces endocrine hormones and exocrine
enzymes
Glucagon
Insulin
Digestive enzymes that return the chyme pH to normal
and break down proteins
Accessory Organs
Spleen
Part of immune system
Located behind stomach and lateral to kidney in
upper left quadrant
Function
Immunology
Stores large volume of blood
Urinary System
Components
Kidneys
Collect waste products in blood stream
Concentrate products into urine
Reabsorb water and salt
Regulate body osmotic balance
Adrenal glands
Superior and attached to kidneys
Component of endocrine system
Release epinephrine and norepinephrine
Urinary System
Ureters
Urinary
bladder
Can contain
as much as
500 mL of
urine
Urethra
Genitalia
Female sexual
organs
Represent an open
passage to the
interior of the
abdominal cavity
Components
Ovaries
Fallopian tubes
Uterus
Vagina
Genetalia
Male sexual
organs
External to the
abdomen
Components
Testes
Penis
Pregnant Uterus
Uterus and
contents grow
rapidly after
conception and
until delivery
Pregnant Uterus
Affects on Maternal Physiology
Increases circulatory blood volume by 45%
Greater volume but fewer red blood cells
Results in relative anemia
Vasculature
Key Vessels
Abdominal aorta
Blood supply to abdomen
Left of spinal column
Iliac arteries
Bifurcation of aorta at the upper sacral level
Vasculature
Portal System
Venous subsystem
Collects venous blood, fluid, and nutrients
absorbed by the bowel
Transports to liver
Detoxification, storage of excess nutrients
Adds deficient nutrients
Abdominal Vasculature
Peritoneum
Serous membrane that surrounds the interior
of most of the abdominal cavity
Covers most of small bowel and some of the
abdominal organs
Small amount of fluid between peritoneal
layers
Mesentery
Omentum
Additional fold
Insulates and protects anterior surface of abdomen
Retroperitoneal Structures
Kidneys
Duodenum
Pancreas
Urinary Bladder
Portion of Colon
Rectum
Major vascular
structures
Pathophysiology of
Abdominal Injury
Pathophysiology of
Abdominal Injury
Mechanism of Injury
Penetrating Trauma
Energy transmitted to surrounding tissue
Results in:
Uncontrolled hemorrhage
Organ damage
Spillage of hollow organ contents
Irritation and inflammation of abdominal lining
Mechanism of Injury
Blunt Trauma
Produces least visible signs of injury
Causes
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
Example: ligamentum teres
Mechanism of Injury
Blast Injuries
Blunt and penetrating MOIs
Irregular shaped shrapnel and debris
Pressure wave
Compresses and relaxes air-filled organs
Contuses or ruptures organs
Pathophysiology of
Abdominal Injury
Pathophysiology of
Abdominal Injury
Injury to the Abdominal Wall
Skin and muscles transmit blunt trauma to
internal structures
Erythema
Swelling and ecchymosis occur over several hours
Pathophysiology of
Abdominal Injury
Injury to the Abdominal Wall
Trauma to thorax, buttocks, flanks, and back may
penetrate abdomen Lower chest may injure
spleen, liver, stomach, or gallbladder
Diaphragmatic tears:
Herniation of abdominal contents into thorax
Pathophysiology of
Abdominal Injury
Injury to the Hollow Organs
May rupture with compression from blunt forces
May tear due to penetrating trauma
Spillage of contents
Retroperitoneal space
Peritoneal space
Pelvic space
Pathophysiology of
Abdominal Injury
Injury to the Solid
Organs
Dense and less
strongly held
together
Prone to contusion
Bleeding
Fracture (rupture)
Unrestricted
hemorrhage if organ
capsule is ruptured
Pathophysiology of
Abdominal Injury
Specific Organs
Spleen
Pain referred to left
shoulder
Pancreas
Pain radiates to back
Kidneys
Pain radiates from flank
to groin and hematuria
Liver
Ligamentum Teres
Pathophysiology of
Abdominal Injury
Injury to the Vascular Structures
Abdominal aorta and vena cava
Prone to direct blunt or penetrating trauma
May be injured in deceleration injuries
Pathophysiology of
Abdominal Injury
Injury to the Mesentery and Bowel
Provides bowel with circulation, innervation, and
attachment
Disrupts blood vessels supplying the bowel
Leads to ischemia, necrosis, or rupture
Pathophysiology of
Abdominal Injury
Injury to the Peritoneum
Delicate and sensitive lining of anterior abdomen
Peritonitis
Inflammation of the peritoneum due to:
Bacterial irritation
Due to torn bowel or open wound
Chemical irritation
Caustic nature of digestive enzymes
Urine initiates inflammatory response
Symptoms
Pathophysiology of
Abdominal Injury
Injury to the Pelvis
Serious skeletal injury
Life-threatening hemorrhage
Potential injury to pelvic organs
Ureters
Bladder
Urethra
Female Genitalia
Prostate
Rectum
Anus
Pathophysiology of
Abdominal Injury
Injury During Pregnancy
Trauma is the number one killer of pregnant
females
Penetrating abdominal trauma accounts for 36% of
maternal mortality
Gunshot wounds account for 4070% of penetrating trauma
Pathophysiology of
Abdominal Injury
Changing
dimensions of
uterus:
Protects
abdominal
organs
Endangers
uterus and
fetus
Pathophysiology of
Abdominal Injury
Injury During Pregnancy
Maternal Changes
Increasing size and weight of uterus
Increasing maternal blood volume
Protects mother from hypovolemia
3035% of blood loss necessary before signs of shock
Pathophysiology of
Abdominal Injury
Injury During Pregnancy
Risk of uterine and fetal injury increases with the
length of gestation
Penetrating trauma may cause fetal and maternal
blood mixing
Blunt trauma complications
Uterine rupture
Abruptio placentae
Premature rupture of amniotic sac
Pathophysiology of
Abdominal Injury
Injury to Pediatric Patients
Children have poorly developed abdominal
musculature and smaller diameter
Rib cage more cartilaginous
Transmits injury to organs beneath easier
Shock
Compensate well for blood loss
May not show signs and symptoms until 50% of blood is
lost
If auto crash
Determine if seatbelts
used properly
Interior signs of impact
Mark C. Ide
Right impact
Liver, ascending colon, and pelvis
Left impact
Spleen, descending colon and pelvis
Gunshot Wounds
Type and caliber of weapon
Check whether assailant still on scene
OPQRST Assessment
Characteristics of pain
Tenderness versus rebound tenderness
SAMPLE History
Vital Assessment
Evaluate for
Progressive peritonitis
Progressive hemorrhage
BP and capillary refill
Pulse rate and pulse oximetry
Mental status
Skin condition
Ineffective aggressive fluid resuscitation
Indications
Evisceration
If SBP <60 mmHg
Intra-abdominal
bleeding
Shock
Incremental inflation
titrated to BP and
Pulse
Oxygenation:
High-flow O2
Consider PPV by BVM if hypoxia ensues
Summary
Introduction to Abdominal Injury
Abdominal Anatomy and Physiology
Pathophysiology of Abdominal Injury
Assessment of the Abdominal Injury Patient
Management of the Abdominal Injury Patient