Chest, Abdomen, Pelvis and GI

Question 1

Types of Traumatic Injuries

Answer 1

1. Open (penetrating) trauma = occurs when skin is pierced; internal and external injuries
2. Closed (blunt) trauma = occurs without breaking skin; internal injuries and bruising

Question 2

Anatomy of the Chest

Answer 2

• Ribs: 1-7 true ribs (directly connected to sternum), 8-10 false ribs (indirectly connected), 11-12 floating ribs (not connected)
• Sternum: manubrium = top, body = middle, xiploid process = bottom

Question 3

The Lungs

Answer 3

• separated into lobes: right lung has 3, left lung has 2
• site of gas exchange
• membranes of the lungs: visceral pleura (inside) and parietal pleura (outside)

Question 4

Breathing

Answer 4

• negative pressure system
• diaphragm - innervated by phrenic nerve (C3, C4, C5)
• inhalation - diaphragm + intercostal muscles contract, chest expands
• exhalation - diaphragm + intercostal muscles relax, chest contracts

Question 5

Pneumothorax

Answer 5

• air enters pleural space, puts pressure on lung
• 4 types: spontaneous (occurs due to bleb rupture); tension (pneumothorax has progressed for so long that it puts pressure on vena cava and impedes venous return); traumatic (pneumothorax that results from trauma); hemorrhages/pneumothorax (air and/or blood builds up in pleural space)
• can result in lung collapsing

Question 6

Sucking Chest Wound

Answer 6

• penetrating trauma that creates new cavity for air to move in and out of thoracic cavity
• Treatment = flutter valve

Question 7

Flail Chest

Answer 7

• 3 or more ribs broken in 2 or more places on 1 side of the chest
• signs and symptoms: paradoxical chest movement (the diaphragm moves opposite its normal movements) and crepitus (grinding, creaking, cracking, grating, crunching, or popping that occurs when moving a joint)
• treatment = BVM as internal splint

Question 8

Commotio Cortis

Answer 8

• blunt force trauma occurring at upstroke of t-wave, disrupts rhythm of the heart, results in v-fib
• WE CAN SHOCK

Question 9

Traumatic Asphyxia

Answer 9

• crush injury to the chest, causes back flow of blood from right atrium and vena cava into jugular veins
• signs and symptoms: JVD, craniocervical cyanosis, subconjuctival hemorrhage
• treatment = high flow O2

Question 10

Abdomen Anatomy

Answer 10

• look at image
• capital = solid, lowercase = hollow
• RUQ: LIVER, PANCREASE, gallbladder, intestines
• RLQ: appendix, intestines
• LUQ: PANCREASE, SPLEEN, stomach, intestines
• LLQ: intestines

Question 11

Retroperitoneal Spaces

Answer 11

• kidneys, adrenal glands, bladder, rectum, uterus

Question 12

Right Upper Quadrant Physiology

Answer 12

• liver = excretes bile to metabolize lipids
• gallbladder = storage vessel for excess bile
• pancreas = exocrine and endocrine gland rolled into one (exocrine = releases enzymes to aid in metabolization of food; endocrine = regulates BGL by secreting insulin and glucagon)

Question 13

Left Upper Quadrant Physiology

Answer 13

• stomach = secretes various gastric juices to metabolize food (highly acidic gastric juices are prevented from exiting stomach by esophageal and pyloric sphincter)
• spleen = filters and recycles old blood cells, storage site of T cells and B cells

Question 14

More Physiology

Answer 14

• small intestine = site of nutrient absorption from food; separated into duodenum, jejunum, ileum
• large intestine = reabsorbs water from waste, separated into ascending, transverse, descending, and sigmoid colon
• kidneys = filter waste from blood, regulate fluid and electrolyte balance; produces urine as method of excreting nitrogenous waste

Question 15

Pathway of Digestion

Answer 15

1. oropharynx
2. esophagus
3. stomach
4. small intestine (D, J, I)
5. large intestine (A, T, D, S)
6. rectum
7. anus

Question 16

Gastritis

Answer 16

• stomach inflammation
• causes: infection (bacterial, viral, fungal), alcohol abuse, certain drugs (NSAIDS, cocaine)
• signs and symptoms: abdominal pain/bloating, N/V, burning sensation in stomach

Question 17

GERD

Answer 17

= gastroesophagael reflux disease

• esophageal sphincter of stomach weakens or opens abnormally, allows stomach acid/contents to flow back into esophagus
• signs and symptoms: heart burn = burning in center of chest/abdomen; difficulty swallowing, sensation of lump in throat, chronic cough

Question 18

Esophageal Varices

Answer 18

• enlarged or swollen veins in the lining of esophagus
• causes: alcohol abuse, thrombus, Budd-Chlari syndrome (blockage of certain veins in liver), schistosomiasis parasitic infection (infection in intestines or urinary tract)
• signs and symptoms: can be asymptomatic, hematemesis (vomiting of blood), melena (dark feces containing partly digested blood), dizziness/LOC

Question 19

Gastrointestinal Bleeds

Answer 19

• Upper GI bleed = bleeding from esophagus to duodenum; signs and symptoms = melena, hematemesis
• Lower GI bleed = bleeding from jejunum to anus; signs and symptoms: hematochezia (bright blood through the anus)
• Both: signs and symptoms = abdominal pain, weight loss, weakness

Question 20

Peritonitis

Answer 20

• inflammation of peritoneum as a result of a bacterial or fungal infection or an existing condition
• peritoneum: visceral pleura and parietal pleura
• signs and symptoms: abdominal pain/tenderness, bloating/distention, fever, N/V, loss of appetite, diarrhea, constipation

Question 21

Diverticulitis

Answer 21

• diverticula = out pouches of the lining of digestive system (most common in lower part of colon)
• diverticula become inflamed or infected
• risk factors: aging, obesity, sedentary lifestyle, smoking
• signs and symptoms: N/V, fever, abdominal pain/tenderness, constipation

Question 22

Cholecystitis

Answer 22

• inflammation of the gallbladder, usually caused by bile buildup as a result of gallstones blocking cystic duct
• signs and symptoms: severe RUQ pain, epigastric pain, abdominal tenderness, N/V, fever

Question 23

Appendicitis

Answer 23

• inflammation of appendix
• life threatening - esp. if it ruptures
• signs and symptoms: rebounding RLQ pain, dull pain in umbilical region, fever, N/V, loss of appetite, abdominal swelling

Question 24

Ulcerative Colitis

Answer 24

• type of inflammatory bowel disease
• chronic inflammation and ulceration of innermost lining of colon and rectum
• risk factors: age, race or ethnicity, family history
• signs and symptoms: diarrhea, rectal bleeding, abdominal pain, weight loss, fever

Question 25

Crohn's Disease

Answer 25

- excessive inflammation, usually in ileum or colon, caused by abnormal immune response - signs and symptoms: diarrhea, abdominal pain, loss of appetite, weight loss, fever, bloody stool

Question 26

Aortic Aneurysm

Answer 26

- AAA = abdominal aortic aneurysm - weakening of aortic wall causing outpouching of blood and bulging of aorta - causes: hypertension, CAD, hyperlipidemia, infection, trauma - signs and symptoms: different BP in each arm (ascending), pulsating mass in abdomen (abdominal), tearing chest/back pain, hypotension, shortness of breath

Question 27

Renal Calculi

Answer 27

- aka kidney stones - form as a result of urine becoming highly concentrated, allowing minerals to stick together and crystalize - signs and symptoms: severe side/flank pain, pain in lower quadrants and/or groin, painful urination, discolored urine (pink, red,brown), polyuria or oliguria

Question 28

Evisceration

Answer 28

- condition in which an abdominal organ protrudes through the skin and is exposed to external environment - caused by trauma - treatment: wet than dry sterile dressing, sterile occlusive covering area

Question 29

Anatomy of the Pelvis

Answer 29

- includes fused bones of the spine, typically wider in females (ligaments loosen during labor) - functions to protect the organs it encloses - look at image

Question 30

Abdominopelvic organs

Answer 30

- bladder = storage of urine - prostate = gland present in males that sits around urethra where it connects to the bladder and releases prostatic fluid - uterus = aka the womb, organ in females that houses a fetus during pregnancy

Question 31

Pelvic Fractures

Answer 31

- many different types - caused by high MOI - life threatening: can damage organs within and lead to heavy blood loss - treatment: c-spine, pelvic wrap - later compression (side), AP compression (bottom), vertical shear

Question 32

Special Considerations

Answer 32

- Geriatric patients = brittle bones, decreased immunity, extensive medical history - colostomy/hestomy bags - pediatric patients = decreased immunity, organs not fully developed - gastrostomy tube = brings nutrition directly to the stomach - foley catheters - drains urine - NPO orders = nothing through the mouth