Abdominal Trauma Basic Trauma Course
Abdominal Organs The spleen, liver, kidneys, and pancreas are solid organs. The stomach, small intestine, colon, and gallbladder are hollow organs. Solid organs fracture when injured, hollow organs collapse or rupture.
Mechanism of Injury • The mechanism of injury and forces involved direct attention toward certain organ involvement and should heighten a clinician's suspicion regarding certain injuries. • Blunt Trauma • The most common type of blunt trauma to the abdomen is motor vehicle crashes (MVC). • Compression and Deceleration are two common energy forces is blunt trauma to the abdomen. ● The organs most frequently injured include the spleen (40% to 55%), liver (35% to 45%) and retroperitoneal hematoma (15%). ● Penetrating Trauma • Penetrating trauma may occur from a stab, impalement, or missile event. • The size, shape, and length of the stabbing instrument help to estimate intraabdominal damage. • Stab wounds most commonly involve the liver (40%), small bowel (30%), diaphragm (20%), and colon (15%).
Abdominal Assessment • Patient assessment remains the most important means of detecting abdominal trauma. • The four-step abdominal examination is essential, consisting of: • Inspection • Auscultation • Percussion • Palpation
Hepatic Injury • The liver's size and location make it particularly susceptible to injury. • It is one of the most commonly injured organs in abdominal trauma from both penetrating and blunt sources • Blunt liver injury should be suspected in any patient with a lower chest or abdominal injury, especially on the right side of the abdomen. • Signs and symptoms of hepatic injury may include: • Right upper quadrant pain • Abdominal wall muscle rigidity, spasm, or involuntary guarding • Rebound tenderness • Hypoactive or absent bowel sounds • Signs of hypovolemic shock such as tachycardia; cool, pale, clammy skin; hypotension
Splenic Injury • The spleen is an elongated ovoid body located in the LUQ of the abdomen. • It is in close proximity to ribs 7 through 10, which makes it vulnerable to injury when ribs are fractured. • Splenic injury is graded on a scale from I to V • Operative management is reserved for unstable patient with splenic injury, GSWs of the spleen, or splenic injuries that violate all layers of the splenic capsule. • Signs and Symptoms • Signs of hemorrhage or hypovolemic shock • Pain in left shoulder • Tenderness in ULQ abd • Abd wall muscle rigidity, spasm, or guarding
Bowel Injury • Trauma to the large bowel is one of the most lethal forms of abdominal injury because of the probability of sepsis related to fecal contamination of the abdomen. • Signs and symptoms of small or large bowel injury may include: • Peritoneal irritation manifested by abdominal wall muscle rigidity, spasm, involuntary guarding, rebound tenderness or pain • Evisceration of the small bowel • Signs of hypovolemic shock • Gross blood from the rectum • If performed, the DPL may show presence of bile, feces, or food fibers
Gastric/Esophageal Injury • Gastric & Esophageal injury is rare, generally a result of penetrating trauma. • Signs and symptoms of gastric injury include: • severe epigastric or abdominal pain, LUQ pain, tenderness, and signs of peritonitis secondary to release of gastric contents. • Medical management includes gastric decompression through placement of a nasogastric tube and surgical intervention. • Signs and symptoms of esophageal injury include: • Subcutaneous emphysema, peritoneal irritation, pain throughout abdomen, radiating to neck, chest and shoulders.
Bladder/ Urethral Injury • MOI usually blunt trauma. • Most bladder ruptures occur with pelvic fractures. • Urethral trauma most common in males. • Urethral injury also most commonly occur with pelvic fracture. • Contraindication to catheter insertion is Blood at the meatus.
Renal Injury • MOI is most commonly blunt trauma. • Most common injury is the renal contusion. • Suspect if there are fractures to the posterior ribs or lumbar vertebrae.
Abdominal Vasculature Injury • Majority of severe damage to the vascular system occurs with penetrating trauma. • The primary goal in management of patients with abdominal vascular injuries should be aggressive resuscitation and early control of hemorrhage.
Treatment Modalities • Cannulate two veins with large-caliber catheters and infuse isotonic crystalloid solution. • Administer blood, as indicated. • It there are no contraindications, insert a urinary catheter to monitor output. • If there are no contraindications, you may need to insert a gastric tube to decompress the stomach of air, prevent aspiration, remove stomach contents, or check for bleeding. • Cover any open wounds. • If there is an impaled object, do not remove it. Stabilize the object as best as possible. • Administer antibiotics if indicated. • Prep for surgical procedures. • Ongoing Reassessment.