Running head: MARIA HAS BEEN IN A CAR ACCIDENT

Maria has been in a car accident

Anthony Beauchamp
University of South Florida
Anatomy and Physiology for Health Professionals II
BSC2086 SPRING 2016
Don R. Hilbelink, Ph.D
March 06, 2016

MARIA HAS BEEN IN A CAR ACCIDENT

Maria has been in a car accident

Maria was brought into the E.R. with blunt abdominal injuries following a MVA. Her
symptoms include abdominal pain in the upper left quadrant and left shoulder pain. A FAST
(focused abdominal ultrasonography in trauma) assessment should be performed to reveal any
free fluid in the peritoneal space (Doody et al., 2005). Marias Kehrs sign symptoms point to a
lacerated spleen. Kehrs sign is a referred pain caused by irritation to the inferior diaphragm by
hematoma typically from a ruptured spleen. The pain impulses track along the phrenic nerve and
radiate to the left shoulder ("Kehrs sign," n.d.). A contrast-enhanced computed tomography
(CECT) ought to be performed to confirm the initial diagnosis and assess the extent of the
damage. The spleen is a highly vascular organ and trauma to this organ can cause serious and
life threatening bleeding if it is not detected right away. The spleen functions as a filtration
system for the blood, filtering out cellular debris, micro-organisms, and old red blood cells, it is
also an essential part of the immune system, white blood cells and platelets are stored here. It sits
on the left side high on the posterior wall behind the stomach and beneath and in front of the
diaphragm (Anatomy.TV, n.d.). Despite it seemingly protected location, tucked up under the
diaphragm within the thoracic cage, the spleen is the most frequently injured organ in blunt
abdominal trauma (Doody et al., 2005; Shamim, Razzak, Umer, & Chawla, 2011; Silvis, Plakke,
Tice, & Black, 2012).
Second to spleen injury, the liver is another commonly injured organ in blunt abdominal
trauma. The liver is a large organ that lies mainly on the right side immediately below the
diaphragm with a portion laying over the stomach. Injury to the liver can also be life threatening
if bleeding is serious enough. The liver has a number of important functions in the body by
storing glycogen and vitamins, it aids in digestion by producing bile for emulsifying fats, it is

MARIA HAS BEEN IN A CAR ACCIDENT

also responsible for breaking down and removing toxins and producing albumin, essential for
blood clotting (Anatomy.TV, n.d.). If Marias liver was ruptured in the accident she would feel
pain and rigidity on the right side of her abdomen. There is a possibility of right side Kehrs sign
in the right shoulder, for the same reasons as with the spleen but with the hematoma irritating the
right side of the diaphragm.
Gallbladder injuries are rare primarily because it is pretty well protected by the liver, ribs
intestines and omentum (Soderstrom, Maekawa, DuPriest Jr, & Cowley, 1981). The
gallbladders main function is to store bile created by the liver and release it into the duodenum
to aid in digestion.
Advancements in technology like ultrasound and computed tomography along with
improved medical assessments make it possible for a majority of patients with blunt abdominal
trauma to undergo non-operative management (NOM) of their injuries, provided that the patient
is hemodynamically stable (Ahmed & Vernick, 2011; Prichayudh et al., 2014; Iaselli et al.,
2015; Swaid et al., 2014; Boyuk et al., 2012; Silvis et al., 2012). A majority of patients who
experience abdominal trauma can may be able to avoid surgery. Maintaining the patients
hemodynamic stability, continual monitoring of vital signs, and the administering additional
transfusions if necessary, may allow the patient to recover fully without surgical intervention.
Had Maria undergone a splenectomy, she would be facing some risks or complications
once she decides to get pregnant. In some studies, women who have experienced splenectomies
were at risk of complications during labor, for instance necessitating blood transfusions, the need
for cesarean delivery, preeclampsia, and complications with sedation and anesthesia during
labor. Higher risk of pneumonia during pregnancy also showed to be a factor of splenectomy
(Gershovitz et al., 2011). Given that the normative treatment for visceral injuries is the NOM

MARIA HAS BEEN IN A CAR ACCIDENT

approach, Maria most likely has her spleen intact. Her primary concern should be her
thyroidectomy. Of the many complications related to the removal of the thyroid, there are
obstetric complications that Maria needs to consider. Studies have shown that women who have
undergone thyroidectomy have undergone higher rates of fertility treatment. There is also an
association between thyroidectomy and placental abruption, preterm delivery, PROM,
malpresentations and twin gestations (Cohen, Levy, Wiznitzer, & Sheiner, 2011, p. 316).
The hormones typically produced by the thyroid have to be replaced artificially with
levothyroxine after total removal of the thyroid. During pregnancy, the body requires higher
doses of these hormones making it hard to regulate how much the patient is going to require for
normal function and fetal growth (Krhin & Besic, 2012). There seem to be many differing
opinions of how to regulate the doses of L-thyroxine during pregnancy. It would seem obvious
that since pregnant women require different dosages throughout her pregnancy, continual
monitoring of hormone levels would allow for better regulation for each individuals needs.
Maria has been through quite a lot in the past few months. Right now her main concern
should be to heal from her auto accident injuries, continue to be regular with her follow up visits
to her doctors and continue her regular prescriptions provided by her caregivers. She will need to
be in continual contact with her endocrinologist as well as with her obstetrician once she is ready
to become pregnant. She would be considered a high risk pregnancy, and strict compliance to
medical advice is imperative.

MARIA HAS BEEN IN A CAR ACCIDENT

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