This document provides an overview of abdominal trauma, including anatomy, injury mechanisms, signs and symptoms, and management. It discusses injuries to solid organs like the liver and spleen which can cause heavy bleeding and shock. It also addresses injuries to hollow organs such as the stomach and intestines which can lead to inflammation from spilled contents. The document stresses the importance of promptly evaluating and resuscitating patients with abdominal trauma to prevent death from delayed treatment or diagnosis.

1. Abdominal Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse

2. The Abdomen Everything between diaphragm and pelvis Injuries very difficult to assess because of large variety of structures

3. Abdominal Anatomy Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus Organ located by quadrant

4. Abdominal Anatomy Right Upper Quadrant Liver Gall Bladder Right Kidney Ascending Colon Transverse Colon

5. Abdominal Anatomy Left Upper Quadrant Spleen Stomach Pancreas Left Kidney Transverse Colon Descending Colon

6. Abdominal Anatomy Right Lower Quadrant Ascending Colon Appendix Right Ovary (female) Right Fallopian Tube (female)

7. Abdominal Anatomy Left Lower Quadrant Descending Colon Sigmoid colon Left Ovary (female) Left Fallopian Tube (female)

8. Abdominal Anatomy Organs can be classified as: Hollow Solid Major vascular

9. Solid Organs Liver Spleen Kidney Pancreas When solid organs are injured, they bleed heavily and cause shock

10. Solid Organs Liver Largest abdominal organ Most frequently injured Fractures of ribs 8-12 on right side Bleeding can be either: Slow, contained under capsule Free into peritoneal cavity

11. Solid Organs Spleen Frequently injured with trauma ribs 9-11 on left side Bleeds easily Capsule around spleen tends to slow development of shock Rapid shock onset when capsule ruptures

12. Solid Organs Pancreas Lies across lumbar spine Sudden deceleration produces straddle injury Very little hemorrhage Leakage of enzymes digests structures in retroperitoneal space, causes volume loss, shock

13. Hollow Organs Stomach Gall bladder Large, small intestines Ureters, urinary bladder Rupture causes content spillage , inflammation of peritoneum

14. Hollow Organs Stomach Acid, enzymes Immediate peritonitis Pain, tenderness, guarding, rigidity

15. Hollow Organs Colon Spillage of bacteria May take 6 hrs to develop peritonitis Small Bowel Fewer bacteria May take 24-48 hours to develop peritonitis

16. Major Vascular Structures Aorta Inferior vena cava Major branches Injury can cause severe blood loss ; exsanguination (bleeding out)

17. Abdominal Trauma Many survive to reach hospital Most common factors leading to death Failure to adequately evaluate Delayed resuscitation Inadequate volume Inadequate diagnosis Delayed surgery

18. High Index of Suspicion Mechanism Tachycardia early , hypotension, and pale, diaphoretic skin late Hypovolemic shock with no readily identifiable cause Diffusely tender abdomen Pain in uninjured shoulder

19. Mechanism Look for signs of injury Bruises Tire marks Obvious open injuries Assume any abdominal injury is serious until proven otherwise! Injury above umbilicus also involves chest until proven otherwise

20. Adequate* Assessment key D-eformity C-ontusions A-brasions P-enetrating Injuries *per BTLS Guidelines B-urns T-enderness L-acerations S-welling

21. Blast Injuries Most commonly found in ear, lungs and hollow abdominal organs. Abdominal injuries include hemorrhage and hollow organ rupture.

22. Unexplained Shock Assess vital signs; skin color, temperature; capillary refill Tachycardia; restlessness; cool, moist skin In trauma, signs of shock suggest abdominal injury if no other obvious causes present

23. Signs of Injured Abdomen Diffuse tenderness Pain Pain referred to shoulder = Organ under diaphragm involved (?spleen) Pain referred to back = Retroperitoneal organ involved (?kidney)

24. Abdominal Rigidity NOT reliable Bleeding may not cause rigidity if free hemoglobin absent Bleeding in retroperitoneal space may not cause rigidity

25. Abdominal Trauma Management Most Important fact in treating ALL types of abdominal trauma… Initiation of life support measures including establishment and maintenance of adequate airway, breathing and circulatory support.

26. Abdominal Trauma Management Less important to diagnose exact injury Treat clinical findings-as able Management same regardless of specific organ(s) injured

27. Abdominal Trauma Management Airway C-Spine if mechanism indicates High flow O 2 Assist ventilations if needed Give nothing by mouth

28. Impaled Object Leave in place Shorten if necessary for transport Leave part of object exposed Stabilize

29. Evisceration With large laceration abdominal contents may spill out Do NOT try to replace

30. Evisceration Cover exposed organs with saline moistened multi-trauma dressing Cover first dressing with second DRY dressing or nonpermeable item

31. Genitourinary Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse

32. Urinary System Kidney Ureter Urinary Bladder Urethra

33. Kidney Trauma 50% of all GU trauma

34. Kidney Trauma Penetrating GSW Stab wound Blast injuries similar to other solid organs Rare, usually associated with trauma to other abdominal organs

35. Kidney Trauma Blunt Direct blow to back, flank, upper abdomen Suspect with fractures of 10th - 12th ribs or T 12 , L 1 , L 2 Acceleration/Deceleration Shearing of renal artery/vein

36. Kidney Trauma Signs and Symptoms Gross Hematuria 80% of cases Absence does NOT exclude renal injury Localized flank/abdominal pain Palpable mass

37. Kidney Trauma Signs and Symptoms Tenderness: Lower ribs, upper L-spine, flank Pain: groin, shoulder, back, flank

38. Ureter Trauma Less than 2% of GU trauma Usually secondary to penetrating trauma Indicator Wound to lower back with urine escaping

39. Urinary Bladder Trauma Mechanisms Blunt injury to lower abdomen Seat belts Pelvic fracture Penetrating trauma to lower abdomen or perineum (pelvic floor) Can display hollow or solid organ blast injuries dependant upon urine in bladder

40. Extraperitoneal Bladder Rupture Urine in umbilicus, anterior thighs, scrotum, inguinal canals, perineum Dysuria Hematuria Suprapubic tenderness Swelling, redness secondary to tissue damage from urine

41. Intraperitoneal Bladder Rupture Urgency to void Inability to void Shock Abdominal distension

42. Urethral Trauma Mechanisms Sudden decelerations (bladder shears off urethra) Straddle injuries

43. Urethral Trauma Signs and Symptoms Blood at external meatus Perineal bruising (butterfly bruise) Scrotal hematoma

44. Questions?

45. References Elsayed, N. (1997) Toxicology of overpressure. Mayorga, M. (1997) The pathology of primary blast overpressure injury. Phillips, Y.Y. and Zajtuk, J.T. (1991) The management of primary blast injury. Browner, B.D. (2002) Emergency care and treatment of the sick and injured.