2Abdominal Anatomy The Abdominal Cavity Lies between the diaphragm and the pelvisBounded by the lower ribs, abdominal muscles, and vertebral columnContains the abdominal viscera (internal organs)
3Abdominal Anatomy Solid Organs Hollow Organs ~ more often & easily injured~ cause rapid death due to large blood supply which causes internal bleeding~ spleen, liver, kidneys, pancreasHollow Organs~ injuries are rare because tubes are hollow~ assist in transporting substances from one organ to another~ stomach, gall bladder, sm & lg intestines, bladder
4The PeritoneumA continuous sheath of tissue which covers the entire abdominal cavity and all visceral organs
5The Abdominal Quadrants The abdomen is divided into 4 regions – or quadrants: RUQ (right upper quadrant), RLQ (right lower quadrant), LUQ (left upper quadrant), LLQ (left lower quadrant)This makes it easier to locate organs in the abdominal cavity
6Right Upper QuadrantRight lobe of liverGallbladderRight kidneySmall IntestineLarge Intestine
10Abdominal Anatomy Stomach Positioned between the esophagus & small intestinesHolds and breaks down food for digestionProduces HCl (hydrochloric acid) to break down food into chyme.
11Abdominal Anatomy Liver Located under the diaphragm Produces bile enzyme which is important for digesting fatsAbsorbs excess glucose from the bloodstream and stores it in the form of glycogenHelps to cleanse the body of poisons and waste (detox)Functions can be impaired by alcohol abuse – cirrhosisHepatitis – inflammation caused by a viral infection..reduces liver efficiency
12Abdominal Anatomy Found just beneath the liver GallbladderFound just beneath the liverAccessory organ to the liver.Storage area for bile produced by the liverGallstones - solid deposits of cholesterol or calcium salts - sometimes form in some individuals, leading to severe abdominal pain
13Abdominal Anatomy Pancreas Found below the stomach surrounded by the intestineSecretes hormones used in the digestive process, particularly insulin and glucagon which lowers and elevates blood sugar levels.
14Abdominal Anatomy Spleen Lies between the 9th -11th ribs on the left sideLargest of the lymphoid organsCleanses blood cells from bacteria, foreign matter, viruses, toxins from the bloodStoring of excess blood cells for later useProduces red blood cells in the fetusStores blood platletsNot necessary for survival and is often removed if injured or damaged because of the threat of bleeding from the organ
15Abdominal anatomy Small Intestines Approx. 6 feet long Responsible for food digestionWhere nutrient exchange takes place
16Abdominal Anatomy Large Intestine or Colon Removes undigestable materials and excess water from the body
17Abdominal Anatomy Appendix Located in the right lower quadrant of the abdomen near the right hip boneAppendage attached to the large intestine near the beginning of the large intestineIts purpose is unknownSometimes becomes inflamed (appendicitis) leading to abdominal distress and infectionIs usually removed surgically if this occurs
18Abdominal Anatomy Kidneys Located at the rear of the abdominal cavity Cleanse blood of toxins and other waste materialProduces urineBlood supply is inadequate, can cause hypertension from chemical constriction of body’s blood vesselsResponsible for maintaining acid-base in body, which if changed causes body system to shut down eventually resulting in death
19Abdominal Anatomy Ureters Bladder Carry urine to the bladder from the kidneysBladderStores urine for excretion
20Abdominal Muscles Abdominal muscles provide protection for organs Rectus AbdominusGives “washboard” affectAction – flex the vertebral column
21Abdominal Muscles Internal Obliques Action – Laterally flex the vertebral columnRotate vertebral column to the same side
22External Obliques Laterally flex the vertebal column to the same side Rotate vertebral column to the opposite side
23Transverse AbdominisHolds internal organs in cavity
24Anatomy - Thorax Located between the abdomen and the neck Boney structures include:12 pairs of RibsCostal cartilageSternum (breast bone)Xiphoid processThoracic vertebrae
25Thorax Anatomy Internal Organs: Heart Lungs Major Arteries/Veins Pumps blood to the body tissuesLungsExchanges oxygen and carbon dioxide as blood passes though the lungsMajor Arteries/VeinsSuperior & Inferior AORTA (arter)Superior & Inferior VENA CAVA (vein_Pulmonary arteries and veins carry blood to/from the heart and lungs
26Thorax Anatomy Heart Size of your fist Pumps blood to all parts of the bodyDivided into 4 chambersUpper chambers – right and left atriumLower chambers – right and left ventriclesA muscular wall called the septum separates the right side from the left sideEach chambers have valves. The valves have different names.the tricuspid valve is at the exit of the right atriumthe mitral valve is for the left atriumthe pulmonary valve is at the exit of the right ventriclethe aortic valve is at the exit of the left ventricle.Their purpose is to allow blood to move forward through the heart and to prevent it flowing backwards into the previous chamber.
27Thorax Anatomy* The heart muscle contracts in two stages to squeeze blood out of the heart. This is known as systole.* In the first stage, the upper chambers (atria) contract at the same time, pushing blood down into the lower chambers (ventricles).* Blood is pumped from the right atrium down into the right ventricle and from the left atrium down into the left ventricle.* In the second stage, the lower chambers contract to push this blood out of the heart to either the body via your main artery (aorta) or to the lungs to pick up oxygen.* The heart then relaxes – known as diastole. Blood fills up the heart again, and the whole process, which takes a fraction of a second, is repeated.* The heart then relaxes – known as diastole. Blood fills up the heart again, and the whole process, which takes a fraction of a second, is repeated.* In the second stage, the lower chambers contract to push this blood out of the heart to either the body via your main artery (aorta) or to the lungs to pick up oxygen.* Blood is pumped from the right atrium down into the right ventricle and from the left atrium down into the left ventricle.* In the first stage, the upper chambers (atria) contract at the same time, pushing blood down into the lower chambers (ventricles).* The heart muscle contracts in two stages to squeeze blood out of the heart. This is known as systole.
28Thorax AnatomyOn the right side, the upper chamber fills with oxygen-depleted blood from your body and pushes it via the lower chamber and the pulmonary artery back to the lungs. Here blood picks up oxygen and releases carbon dioxide. On the left side, the upper chamber fills with oxygen-rich blood from the lungs. This is pumped via the lower chamber into the aorta and out to the body to provide cells with the crucial oxygen they need.
29Thorax Anatomy Lungs Right side has 3 lobes Left has 2 lobes Function To exchange O2 and CO2To dissipate heat from the body
30Thorax Anatomy Trachea divides into two bronchi Bronchi divide into bronchiolesBronchioles end in alveoliAlveoli are air containing cells of the lungsO2 and CO2 are exchanged hereCoughing & sneezing help keep trachea and bronchi clear and remove phlegm and allergy-causing agents from the lungsRespiration RateLung function and breathing rate controlled by CO2 receptorsIf there is too much CO2, inhalation occurs to bring in more O2Exercise increases cell metabolismCauses cells to need more O2 and eliminate more CO2With exercise lungs ability to exchange air more efficiently increasesBreaths become more deeper and more forcefulReturn to normal breathing quicker
31Thorax Anatomy Pleura Thin lubricated tissue Lines each half of thorax Folded back over the surface of the lung on same sideAllow for smooth movement of lungs as they encounter the wall of ribs during inhalation and exhalation
32Thorax anatomy The Diaphragm is a sheet of internal skeletal muscle that extends across the bottom of the rib cage.The diaphragm separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavityperforms an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.
33Thorax Anatomy Soft tissues include: Major muscles Pectoralis muscle Adducts and rotates the armRaises the ribs in forced inspirationUpper portion flexes the armIntercostal musclesElevate and depress ribsSerratus posteriorElevate ribs during inhalationDepress ribs during exhalation
35Abdominal Injuries General Considerations… The abdomen is particularly vulnerable to injury in all contact sportsBlows to the area may cause both superficial and/or deep injuriesStrong abdominal muscles provide good protection when they are tensed, but when relaxed they are easily injuredThe concept of “defense posturing”If someone is expecting to be hit in the abdomen, they will tense their muscles to protect themselves. Likewise, if they are having abdominal pain, they will often tense their abdominal muscles in an effort to relieve the discomfort. This is called DEFENSE POSTURING
36Abdominal Injuries General Considerations, continued… It is important to protect the abdomen and trunk from injury in collision and contact sportsConditioning is essential – strong abdominal muscles will help reduce the likelihood of injuryProper protective equipment should be worn when indicated or required by the rules of the game, such as in softball and baseball where chest protectors are requiredSafety rules should always be applied and enforced by officials, coaches, and ATCs.
37Abdominal Injuries General Considerations, continued… ALWAYS remember… Any suspected internal injury to the abdomen should ALWAYS be referred to a physician or the hospital emergency room for further evaluationMake sure that the athlete and their parents understand the importance of doing what you advise when referring an athlete for a suspected abdominal injury – it could be the difference between life and and deathIf in doubt, activate the EMS system and have the athlete transported by an ambulance
38Abdominal Injuries Contusions Surprisingly, not particularly common in athleticsWhen they do occur, they are usually seen with sports like football, baseball, or hockeyRunningbacks, Catchers, and Goalies are most vulnerableBruising can occur superficially on the skin or deeper within the muscle tissue or even upon the internal organsThe extent of injury is often determined depending upon whether or not the force was blunt or penetrating oneUsually larger objects tend to produce blunt forces, whereas smaller objects produce penetrating forces (ie, body to body contact in football vs. ball to body contact in baseball or softball
39Abdominal Injuries Contusions, continued… A contusion to the rectus abdominus can be very disablingMay lead to the formation of a hematoma under the fascial tissue surrounding the muscleCauses extreme pain and muscle tightness to the area
40Abdominal Injuries Contusions, continued… Care and treatment by the ATC should include…Ice and compression to the area of the contusionEvaluation and examination for internal injuriesReferral to a physician (if internal injury may be suspected)
41Abdominal muscle strains Usually caused by a sudden twisting of the trunk or from reaching overhead for somethingCan be very incapacitating with severe pain and hematoma formationCare and treatment by the ATC is generally conservative and includes…Ice with a pressure wrap (as tolerated)Gradual return to exercise within pain free limits with an emphasis on flexibility and muscle strengtheningSimple rest is essential for recovery from these injuries
42HerniasA protrusion of the abdominal viscera through a portion of the abdominal wallThere are 2 types of herniasCongenital – developed before birth (birth defect)Acquired – developed as a result of muscle weakness in the abdomen or as the result of an injury to the abdomen
43Hernias, continued… Structures of a hernia include… Mouth Neck Body Also known as the hernial ring, it is the opening from the abdominal cavityNeckPortion that joins the mouth and body of the herniaUsually the area that becomes strangledBodyPortion of the sac that protrudes outside the abdominal wall
44Hernias, continued…Acquired hernias usually exhibit the following signs and symptoms…Previous history of a blow or strain to the groin area that has produced pain and prolonged discomfortSuperficial protrusion in the groin area that is becomes larger when coughingReported feeling of weakness and a pulling sensation in the groin area
45Hernias, continued…Hernias may become a problem in athletics due to falls or blows to the lower abdominal areaA strangulated hernia may resultThis occurs when the hernial ring closes tightly over the neck of the hernia cutting of blood supply to the tissues in the body of the hernia leading to tissue death and painHernias in the groin area are most common in athletics and known as INGUINAL HERNIASThese are seen most often in males (75%)
46Hernias, continued… Care and treatment by the ATC Surgical repair is usually the most appropriate long term care for a hernia that is causing discomfort for an athleteThere are medical prosthesis that can be worn in lieu of surgical repair, but they are not always functional in athletics due to the friction and irritation they produce while wearing themAthletes with a suspected hernia should be referred to a physician for further evaluation and care
47“Stitch in the Side”An idiopathic (of unknown cause) condition that occurs in some athletesBest described as a cramp-like pain that develops in the right or lower left side of the lower abdomen during physical activity, especially runningCauses of this condition are obscure, but some explanations include…ConstipationIntestinal gasDiaphragmatic spasm due to poor conditioningIschemia, or lack of blood flow, to the diaphragm and/or intercostal muscles
48Stitch in the Side”, continued… Care and treatment by the ATC includes the following…Having the athlete discontinue their activityRelaxation of the spasm by stretching the arm on the affected side over the athlete’s headHaving athlete flex their trunk, resting on the thighsThis last method is usually not very effective because it actually reduces oxygen flow to the affected areaWhy is this?Athletes with recurrent problems may need medical study of their eating habits, bathroom habits, or types of training regimens they are following in order to help identify the cause of their problem
49Blow to the Solar Plexus The CELIAC PLEXUS (SOLAR PLEXUS) is a bundle of nerves that controls involuntary movement of the diaphragm and allows us to breathA blow to this structure causes transitory paralysis of the diaphragmThis is often referred to as “getting the wind knocked out”
50Blow to the Solar Plexus, continued… When this occurs, it causes a loss or respiration leading to anoxia, or a lack of oxygen and can cause the athlete to become quite frightened because of their inability to breathCare and treatment by the ATC includes…Immediately reassure the athlete by speaking to them in a calm but confident manner, helping them to remain calm themselvesLoosen the athletes belt or clothing around the abdomen and have them bend there kneesEncourage the athlete to relax by initiating short inspirations through their nose and long expirations through their mouth
51Appendicitis – Signs/symptoms Inflamation of the appendix Progressively worsening painCoughing or sneezing is painfulNauseaVomitingFeverInability to pass gasConstipationLoss of appetite.
52TreatmentAthletic trainer will have the athlete seek medical attentionMonitor vital signs
53Ruptured Spleen Most often injured internal organ with blunt trauma The spleen is a sponge-like organ consisting of lymphatic tissue and enclosed by a dense capsule. It stores blood and filters bacteria and other waste matterInjuries to the spleen are usually the result of a fall that jars or a direct blow to the left upper quadrant of the abdomenMononucleosis and other blood born diseases and infections often enlarge the spleen and predispose and athlete to a spleen injuryAthletes with a recent history of these conditions should not participate in contact or collision sports unless cleared by a physician
54Ruptured Spleen, continued It is extremely important that ATCs know the signs and symptoms of a spleen injuryFailure to recognize these signs could lead to death if the athlete does not receive timely medical careSigns and symptoms include…History of severe blow to the abdomen, particularly in the upper left quadrantPossible shockAbdominal rigidity and/or guardingNausea and/or vomitingReflex pain occurring approximately 30 minutes after the initial injury. This is called Kehr’s Sign and is indicated by pain which radiates from the LUQ to the left shoulder and sometimes 1/3 the length of the left arm
55Ruptured Spleen, continued It is also important to understand and recognize that the spleen as the ability to “splint” itselfThis involves producing a blood clot that may delay hemorrhageAny slight strain or jarring movement, however, may disrupt this “splint” leading to massive internal bleeding and possible deathCare and treatment by the ATC includes…Immediate referral to the hospital emergency room via ambulance transport if a spleen injury is suspected
56Kidney ContusionsThe kidney’s sit at the back of the abdominal cavity, with one on each side of the spineContusions are usually caused by a severe outside blow or force to the areaSigns and symptoms of a kidney contusion include…Possible shock (in severe cases)Nausea and/or vomitingRigidity of back musclesBlood in the urine (hematuria)Possible referred pain high in the back or into the anterior abdominal region
57Kidney Contusions, continued… Care and treatment by the ATC includes…Instructing the athlete to urinate 2-3 times and to look for blood in the urineIf blood is present, referral to a physician for evaluationApplication of ice to the area for treatment of superficial pain
58Rib Contusions Usually caused by a blow to the rib area Usually involves the intercostal muscles and/or the bony structure of the ribsSince intercostal muscles are essential to breathing, injury to them will cause pain and discomfort with breathingCharacteristically, the pain is sharp in nature with inspiration and there will also be point tenderness present over the injured area
59Rib Contusions, continued… Care and treatment by the ATC includes…Ice, compression, and restReferral to a physician for x-rays and evaluationAnti-inflammatory medications per physician orders and local protocolFitting the athlete for rib protectors when appropriate and/or necessary
60Rib Fractures Not uncommon in sports Seen most often in contact/collision sports like wrestling and footballCan be caused a direct blow or indirect traumaViolent muscle contractionViolent coughingVomiting, etc
61Rib Fractures, cont’d… Direct fractures are the most dangerous With this type of fracture, the rib bones fracture and displace inwardThe jagged edges of the bone can then lacerate internal tissues and organs such as the lungs, liver, spleen, heart, etc.
62Indirect Rib Fractures Usually occur outwardProduces an oblique and/or transverse fissure in the skin, that can be observed or palpatedSigns and symptoms of rib fractures include…Discoloration and bruising in the chest areaSevere pain on inspirationPoint tenderness over the injured areaPossible crepitis on palpationDifficulty breathing (in some cases)
63Care and treatment for rib fractures and related injuries by the ATC should include… Application of iceApplication of a splint to the rib cage to immobilizeReferral to a physician for x-rays and further evaluationDecreased or stopped activity until ribs have healedGenerally 3-4 weeks for simple fracturesIF A PNEUMOTHORAX, HEMOTHORAX, OR FLAIL CHEST IS SUSPECTED EMS SHOULD BE ACTIVATED AND THE ATHLETE SHOULD BE TRANSPORTED TO THE HOSPITAL AS SOON AS POSSIBLE
64Complications of Rib Fractures include… HemothoraxInvolves blood filling the chest cavity, creating pressure on the heart and lungs, eventually causing the lung to collapseUsually occurs as the result of blunt trauma, such as is seen with a rib fracture
65Complications of Rib Fractures include… PneumothoraxResults when air enters the chest cavity but does not enter the lungThe pressure of the air in the chest cavity presses against the lung, causing it to collapseAir can enter the chest cavity two waysFrom an open wound in the chestFrom a laceration in the lung
66Complications of Rib Fractures include… Tension PneumothoraxUsually occurs after a pneumothoraxWhen the lung has collapsed as much as it possibly can, the pressure continues to build in the cavity causing the collapsed lung to press against the heart and the other lungThis causes the remaining lung to start collapsing and the extremely high pressures also prevent the return of blood to the heart from the veinsThis is true life threatening emergency
67Complications of Rib Fractures include… Flail ChestResults when the chest wall becomes unstable due to fractures of the sternum, ribs, or cartilageUsually only occurs when there are fractures to 3 or more ribs next to each otherWith a flail chest, the athlete will exhibit paradoxical breathingWhen they inhale, the injured area will not expand like the rest of the chestWhen they exhale, the injured area will protrude while the rest of the chest retracts
69Sternal fractures Very rarely seen in athletics Result from a direct blow to the sternum, with a violent compressive force applied posteriorly, or from hyperflexion of the trunkSigns and symptoms include…Sharp chest pain occurring on inhalation and localized over the sternumThe head and shoulders will be drooped forwardMild swelling and displaced bone fragments may be evident with physical examination
70Sternal fractures, continued… Care and treatment by the ATC should include…Application of ice to the injured areaReferral for x-rays and evaluation by a physicianAfter return to activity, a posterior figure-8 wrap may be applied to help maintain the shoulders in an erect positionThe use of protective padding may also be appropriate to reduce the likelihood of reinjuryThe athlete with this condition will most likely be confined to bed rest for 2-3 weeks with immobilization
71Costochondral Separation and Dislocation A separation of the cartilagenous connections between the ribs and the sternumHas a higher incidence than fractures in sportsCan be caused by a direct blow, a sudden twisting motion, or by falling on an object
72Costochondral Separation and Dislocation Signs and symptoms include…Similar to those seen with rib fracturesThe major difference being that pain is localized at the junction of the rib bone and rib cartilage or at the junction between the rib cartilage and the sternumCare and treatment by the ATC includes…Application of iceReferral to a physician for x-rays and evaluation in severe casesThe use of anti-inflammatory medications per physician direction and/or local protocolReduced or stopped activityRest and immobilizationHealing usually takes 6-8 weeks with no sports activity
73Muscle InjuriesUsually occur in the form of muscle contusions or muscles strainsCan range in severity from very minor to very significantTypical care and treatment by the ATC involves…Application of ice and compression to the injured areaReduction of activity until pain as subsidedProtective padding and/or support for the injured areaIn severe cases, referral to a physician for further evaluation and care
74Traumatic AsphyxiaOccurs as the result of a violent blow to, or a compression of, the rib cageCauses cessation of breathing and also forces blood back into the veinsSigns and symptomsCyanosisBright red conjuctiva in eyesCare and treatment…Immediate activation of EMSBegin CPR immediately
75Heart ContusionOccurs when the heart is compressed between the sternum and the spineOften seen in baseball and weight liftingInjury produces shock and severe chest painCare and treatment includes…Immediate activation of EMSMonitoring vital signsTreating for shockPossible CPR
76Myocardial Infarction (Heart Attack) and other Sudden Cardiac Events More commonly seen in athletic activities than one may thinkThere have been numerous high profile cases in recent years where athletes have died from sudden cardiac arrest or heart attacksAthletes complaining of severe chest pain with no other logical explanation or causation should be suspected of suffering from some type of cardiological disorderThese athletes should be immediately referred to their family physician or the hospital emergency room for further evaluation and treatment