Organs commonly found in RUQ
Liver
Gallbladder
Duodenum
Small portion of pancreas
Organs commonly found in LUQ
Stomach
Spleen
Pancreas
Organs commonly found in RLQ
Portions of small and large intestines
Transverse colon
Appendix
Organs commonly found in LLQ
Large intestines
Small intestines
Descending colon
Left half of transverse colon
Hollow organs
Stomach Gallbladder Intestines Ureters Urinary bladder
Solid organs
Liver
Spleen
Pancreas
Kidneys
Pneumoperitoneum
Air in the peritoneal cavity. May occur as a result of ruptured hollow organ, perforated peptic ulcer, recent abd sx, or ruptured abscess.
Compression injuried
Deform hollow organs, increasing the pressure within the abd cavity. Can cause rupture of small intestine or diaphragm due to dramatic change in pressure.
Ex : typically poorly placed lap belt or run over/rolled over by vehicles or objects
Which organs are at the highest risk of injury with crush injuries?
Solid organs - kidneys, liver, spleen
Crush injuries
Result of external factors at the time of impact
Deceleration injuries
When a person or vehicle strikes a large immovable mass. Injuries can occur before impact.
Kehr sign
Left shoulder pain caused by blood in the peritoneal cavity due to rupture of the spleen
Signs and symptoms of closed abd injuries
Pain Tachycardia Tachypnea Hypotension Shallow respirations Distention Bruises Crepitus in lower ribs Guarding Firmness of palpation
Pain that follows the angle from the lateral part of the hip to the midline of the groin can be result of damage to :
Kidneys or ureters
Pain primarily located in RLQ indicates
Inflamed or ruptured appendix
Pain from ___ due to direct injury or inflammation can be found just under the margin of the ribs on the right side or between the shoulder blades.
gallbladder
Grey Turnery sign
bruises in RUQ, LUQ, or flank and suggest injury to liver, spleen, or kidney.
Cullen sign
Bruising around umbilicus. Sign of significant internal abdominal bleeding.
Correct position of seat belt
Below the anterior superior iliac spines of the pelvis and against the hip joints
Gunshot wounds most commonly involve injury to
small bowel, colon, liver, and vascular structures
Stab wounds most frequently injure
Liver, small bower, diaphragm, and colon
Suspect kidney damage if the patient has a hx or physical evidence of :
Abrasion, laceration, contusion, or hematoma to flank region.
Penetrating wound below rib cage and above the hip or upper abdomen.
Fx on either side of lower rib cage or lower thoracic or upper lumbar vertebrae
Suspect liver puncture when :
Lower right ribs are fractured, especially 7th-9th
Suspect spleen laceration when :
Fx of 9th-10th ribs on left side are present or reports of LUQ tenderness, hypotension, tachycardia.
Symptoms of pancreatic injuries
Vague upper and midabdominal pain that can radiate to the back.
Due to delayed presentation and variable symptoms, maintain a high suspicion for duodenal injury in :
High-speed deceleration crashes
Child thrown from bicycle
Child strikes abd on handlebars
s/s of stomach rupture
Burning epigastric pain
Rigidity
Rebound tenderness
s/s of duodenal injury
Abdominal pain
N/V
Fever
All may not develop for hours to days
Bladder injuries are usually associated with :
pelvic fx from MVC, falls from heights, and physical assault to lower abd.
Testicular injuries present following trauma to :
thighs, buttocks, penis, lower abd, and pelvic.
Vascular structures found in the retroperitoneal space include :
Descending aorta and its branches
Superior inferior phrenic arteries
Inferior vena cava
Mesenteric vessels
Signs of bleeding in abdomen
Abdomen rigidity
Cullen sign
Signs of shock
Clues to intra-abdominal trauma include
sxs of shock not proportional to obvious external evidence or estimated blood loos
Hypotension, tachycardia, and confusion may not develop until the patient has lost more than ____.
40% of circulating blood volume
Somatic pain
Pain from skin and muscles, joint ligaments, and tendons.
Described as sharp and localized are of injury.
Pain usually respond well to medications such as opioids and NSAIDS
Visceral pain
Pain from organs inside the body w/ injury or illness. Often described as a deep ache w/ cramping. Can radiate to other locations such as back and chest.
Three main areas where visceral pain is felt :
Thorax
Abdomen
Pelvis
Management of closed/blunt abdominal injuries
Spinal immobilization Supplemental oxygen via NRB or positive pressure ventilation via BVM if needed Establish IV Treat for shock Keep warm Prompt transport to ED
General procedure for care of blunt abd wound :
Inspect pt’s back and sides for exit wounds
Apply a dry, sterile dressing to all open wounds
If penetrating object is still in place, apply bulking dressings and secure w/ stabilizing bandage.
Establish two 18-gauge IV lines and administer isotonic crystalloid solutions to maintain systolic BP of 80-90 mmHG.
General rules for treatment of injuries involving external male genitalia :
Make pt as comfortable as possible.
Use sterile, moist compresses to cover areas that have been stripped of skin.
Apply direct pressure with dry, sterile gauze dressings to control bleeding.
Always identify and take avulsed part to hospital.
Label bag w/ pt’s name
Management of female genitalia injuries
Treat any lacerations, abrasion, and avulsion w/ moist, sterile compresses.
Local pressure to control bleeding and diaper-type bandage to hold dressing in place.
Leave any FB in place and stabilize w/ bandages.
