Pathologies of thorax and abdomen and anatomy

Question 1

what does the thorax do

Answer 1

it protects vital internal organs (heart & lungs)

Question 2

What are the 3 categories of the ribs

Answer 2

• true ribs (ribs 1-7) “sternal ribs”
• false ribs (8-10) (indirectly attach to the sternum)
• floating ribs (11-12)
• coastal cartilage (lacks Blood flow and risk of injury due to age)

Question 3

what are the 3 anatomical structures that make up the sternum

Answer 3

• manubrium
• body
• xiphoid process (avoid when doing CPR)

Question 4

What is the function of the ribs

Answer 4

• provides attachment for the muscles of the neck, thorax, upper abdomen, and back
• elasticity of false/floating ribs allows rib cage movement for respiratory activity

Question 5

What happens in Inspiration

Answer 5

external intercostals contract > diaphragm contracts > expansion of ribs moves sternum upward & outward

Question 6

What happens in expiration

Answer 6

external intercostals relax > internal intercostals & abdominal contracts for active expiration > diaphragm relaxes > ribs & sternum depress

Question 7

Rib Fx etiology

Answer 7

• direct blow = Fx @ point of contact
• Indirect trauma = general compression of ribs
• violent muscle contraction
• coughing/ laughing
• overuse= stress fx

Question 8

Rib Fx s/s & care

Answer 8

s/s: TTP, pain on inhalation, pain on A/P and lateral compression
Care:
- referral
- swathe, arm @ side- compression/reduce movement
- Px: 3-4wks
- sequelae: hemothorax/pneumothorax

Question 9

Costochondral Fx/ separation etiology

Answer 9

as in Rib Fx- blunt trauma, compression injury

Question 10

Costochondral Fx/ separation pathology

Answer 10

rib cartilage disrupted/ displaced

Question 11

Costochondral Fx/ separation s/s

Answer 11

• deformity @ rib/cartilage junction
• pain on inspiration & thoracic movement
  -crepitus
  Px: out for 4-8wks

Question 12

Pneumothorax “collapsed lung” types

Answer 12

traumatic, spontaneous, and tension

Question 13

Pneumothorax etiology for traumatic

Answer 13

puncture to chest wall, sucking wound or rupture of lung tissue

Question 14

Pneumothorax etiology for spontaneous

Answer 14

idiopathic in tall, thin young men (Marfan syndrome)
- secondary spontaneous= result of disease: cancer, congestive heart failure, emphysema

Question 15

Pneumothorax etiology for tension

Answer 15

Pleural cavity fills with air with each inhalation

Question 16

Pneumothorax “collapsed lung” pathology

Answer 16

lung collapses, mediastinum shifts away

Question 17

Pneumothorax “collapsed lung” s/s

Answer 17

-sudden onset of sharp chest pain, especially with inhalation, (shortness of breath), anoxia, absent or lessened breath sounds

Question 18

Pneumothorax “collapsed lung” care

Answer 18

• Xray to diagnose
  -simple: oxygen supplementation or chest tube
• tension: pneumothorax treated emergently w/inserting bore needle into space at the midclavicular line, allowing trapped air to escape

Question 19

Spontaneous (tension)

Answer 19

-Divers susceptible
- negative pressure is compromised as diver holds breath and ascends
- lung compression, limiting blood flow back to heart= tension pneumothorax
s/s: sharp pain on affected side, cyanosis, rapid, shallow breathing

Question 20

Hemothorax “punctured lung”

Answer 20

• blood in pleural cavity
  s/s: pain, dyspnea, coughing up frothy blood (sputum), low BP, shock

Question 20

Abdominal quadrants

Answer 20

UR quadrant: liver, pancreas, kidneys, lung
UL quadrant: heart, spleen, kidneys, stomach, lung
LR quadrant: appendix, ureter, bladder, colon, gonads
LL quadrant: ureter, bladder, colon, gonads

Question 21

Ruptured spleen function

Answer 21

-largest lymphatic organ, filters damaged blood cells and platelets, destroys bacteria
- protrudes below ribs and can become exposed

Question 22

Ruptured spleen etiology

Answer 22

severe abdominal blow or physical activity during systemic infection “fall on a ball”

Question 23

Ruptured spleen s/s

Answer 23

abdominal rigidity, nausea, vomiting, Kehr’s sign, shock

Question 24

Ruptured spleen care

Answer 24

- Refer to E.D. - tx for shock (lay flat or with elevated torso)

Question 25

Ruptured spleen prevention

Answer 25

no Px or competition with mono - 4-6 weeks no Px, MD will order ultrasound

Question 26

Kidney contusion etiology

Answer 26

severe blow to mid back (T12-L3)

Question 27

Kidney contusion s/s

Answer 27

back rigidity, nausea, vomiting, shock, hematuria

Question 28

Kidney TX

Answer 28

immediate referral to E.D. if suspected rupture

Question 29

Solar plexus (Celiac) injury "wind knocked out" etiology

Answer 29

blow to or falling onto abdomen

Question 30

Solar plexus (Celiac) injury pathology

Answer 30

spasm of diaphragm, hypoxia/apnea

Question 31

Solar plexus (Celiac) injury s/s

Answer 31

startled appearance, shock, loud gasping. referred pain to abdomen and chest

Question 32

Solar plexus (Celiac) injury care

Answer 32

"inhale through nose, exhale through mouth- breathe with me" - if no improvement 4-6 cycles, suspect abdominal hemorrhage

Question 33

Ruptured bladder prevention

Answer 33

urinate prior to activity

Question 34

Ruptured bladder etiology

Answer 34

-very rare - direct blunt force trauma to pelvis, superior to pubic symphysis

Question 35

Ruptured bladder s/s

Answer 35

- inability to urinate - abdominal rigidity - blood from urethra - nausea, vomiting, shock

Question 36

liver contusion etiology

Answer 36

blow to right abdomen (not hollow, makes dull sound rather than drumlike)

Question 37

appendicitis etiology

Answer 37

-inflammation due to infection, lymph swelling, fecal obstruction - more common in males 15-25

Question 38

appendicitis s/s

Answer 38

diffuse, nonspecific pain that becomes focal, mild fever, abdominal rigidity + rebound tenderness + iliopsoas MMT

Question 39

appendicitis care

Answer 39

no food/ refer

Question 40

Inguinal/ femoral hernia etiology

Answer 40

-congenital, acquired through direct trauma or exercise - 5-7x more likely in men

Question 41

Inguinal/femoral hernia s/s

Answer 41

-feelings of weakness & drawing/pulling - pain w/coughing, exercising, or bending over - burning sensation

Question 42

inguinal/femoral hernia care

Answer 42

surgical - return to light activity after 3wks

Question 43

Sudden cardiac death syndrome etiology

Answer 43

most often= congenital cardiovascular abnormality - non cardiac causes: drug use

Question 44

Sudden cardiac death syndrome s/s

Answer 44

-most exhibit no symptoms - chest pain during exertion -heart palpitations

Question 45

Sudden cardiac death syndrome prevention

Answer 45

pre-participation physical screening