Abdominal of Trauma

Abdominal Trauma

The abdomen is the Black Box

I.e., it is impossible to know what specific
injuries have occurred at initial evaluation
The key to saving lives in abdominal trauma
is NOT to make an accurate diagnosis, but
rather to recognize that there is an abdominal
injury

Anatomy and Physiology

Signs and Symptoms of Abdominal Injuries

Blunt Trauma
Significant mechanism
Abdominal pain
Distension
Discoloration of abdomen or
flank
Unexplained shock
Bent steering wheel
Seat belt signs
Peritoneal signs

Penetrating trauma
Visible truncal injury
including chest or abdomen
Abdominal pain
Bleeding
Impaled object
Evisceration
Shock

Peritoneal Signs

Significant abdominal tenderness on palpation

Involuntary guarding
Percussion tenderness
Diminished or absent bowel sounds

Causes of Abdominal Injuries

BLUNT TRAUMA

Motor vehicle
accidents
Auto vs. pedestrian
Falls
Blast injuries

PENETRATING
TRAUMA

Gunshot wounds
Stab wounds
Shrapnel wounds
Impalements

Diagnostic Procedures

Diagnostic Peritoneal Lavage (DPL)

Ultrasound (FAST)
CT Scan
Laparoscopy

Types of Injuries

Blunt and penetrating abdominal injuries may be

associated with extensive damage to the viscera resulting
in massive blood loss.
Blunt or penetrating abdominal injuries are related to the:

Type of force applied

Tissue density of structure injured (e.g., fluid-filled, gas-filled,
solid, or encapsulated)

The liver and spleen are the most commonly injured

organs from blunt trauma.
The liver, small bowel and stomach are the most
commonly injured organs from penetrating trauma.

Blunt Abdominal Trauma

Compressive or shearing
forces may deform and
rupture abdominal
organs
Bruising across the
lower abdomen is
characteristic of a seat
belt injury
Visible signs may not
reflect severity of
underlying injury

The Seat Belt Sign

Blunt Abdominal Trauma

Flank ecchymosis from internal bleeding

Penetrating Abdominal Trauma

Visible wounds may

not reflect severity of
underlying injury
Significant internal
bleeding likely
Bowel injury likely
Patient may be in
shock

Impalement Injury

Impalement Injuries Care

DO NOT REMOVE
OBJECT OR EXERT ANY
FORCE UPON IT!
Severe bleeding may
occur causing shock
Check pulses distal to
impaled object
Immobilize the object
Apply bulky support
bandages to hold in place

Evisceration

Extrusion of abdominal contents

secondary to penetrating abdominal
trauma

Management of Evisceration Injuries

Use sterile side of dressing to place protruding

organs near the wound (NOT into wound)
Cover organs and wound completely with sterile or
clean moist dressing
DO NOT APPLY PRESSURE TO WOUND or
expose internal parts
Tie dressing tails loosely around wound
Prepare evacuation to surgical assets

Hepatic Injuries

Because of its size and location, the liver is frequently

injured when force is applied to the abdomen.
The friability of liver tissue, the extensive blood supply,
and the blood storage capacity cause hepatic injury to
result in profuse hemorrhage.
SIGNS AND SYMPTOMS

Upper right quadrant pain

Abdominal wall muscle rigidity, spasm, or involuntary
guarding
Rebound tenderness
Hypoactive or absent bowel sounds
Signs of hemorrhage and/or hypovolemic shock

Splenic Injuries

Injury to the spleen is usually associated with blunt trauma, but

may also be associated with penetrating trauma.
Fractures of the left 10th to 12th ribs are associated with
underlying damage to the spleen.
The most serious splenic injury is a severely fractured spleen or
vascular tear, producing splenic ischemia and massive blood
loss.
SIGNS AND SYMPTOMS

Signs of hemorrhage or hypovolemic shock

Pain in the left shoulder (Kehr's sign)
Tenderness in the upper left quadrant
Abdominal wall muscle rigidity, spasm, or involuntary guarding

Hollow Organ Injuries

Forces causing trauma to hollow organs may result in

either blunt or penetrating injuries.
The small bowel is the hollow organ most frequently
injured. Deceleration may lead to shearing, which
causes avulsion or tearing of the small bowel.
Seat belts causing compression have resulted in rupture
of the small bowel or colon.
SIGNS AND SYMPTOMS

Peritoneal irritation
Evisceration of the small bowel or stomach
Diagnostic Peritoneal Lavage (DPL) may show presence of
bile, feces, or food fibers

Renal Injuries

The most common injury to the kidney is a blunt

contusion, Suspect renal injury if there are fractures of
the posterior ribs or lumbar vertebrae.
Renal parenchyma can be damaged by shearing and
compression forces causing lacerations or contusion.
SIGNS AND SYMPTOMS

Ecchymosis over the flank

Flank or abdominal tenderness elicited during palpation
Gross or microscopic hematuriathe absence of hematuria
does not rule out renal injury

Bladder and Urethral Injuries

The majority of bladder injuries are blunt.

If a distended bladder ruptures are perforated, urine is likely to
extravasate into the abdomen.
Most ruptures of the bladder occur in association with pelvic
fractures.
Urethral trauma is more common in males than females because
the male urethra is longer and less protected.
SIGNS AND SYMPTOMS

Suprapubic pain
Urge, but inability to urinate
Hematuria (may be microscopic)
Blood at the urethral meatus
Blood in scrotum
Rebound tenderness