1. Abdominal of Trauma

2. 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

3. Anatomy and Physiology

4. 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

5. Peritoneal Signs Significant abdominal tenderness on palpation
Involuntary guarding
Percussion tenderness
Diminished or absent bowel sounds

6. Causes of Abdominal Injuries
BLUNT TRAUMA
Motor vehicle accidents
Auto vs. pedestrian
Falls
Blast injuries
PENETRATING TRAUMA
Gunshot wounds
Stab wounds
Shrapnel wounds
Impalements

7. Diagnostic Procedures
Diagnostic Peritoneal Lavage (DPL)
Ultrasound (FAST)
CT Scan
Laparoscopy

8. 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.

9. 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

10. Blunt Abdominal Trauma
Flank ecchymosis from internal bleeding

11. Penetrating Abdominal Trauma
Visible wounds may not reflect severity of underlying injury
Significant internal bleeding likely
Bowel injury likely
Patient may be in shock

12. Impalement Injury

13. 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

14. Evisceration
Extrusion of abdominal contents secondary to penetrating abdominal trauma

15. 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

16. 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

17. 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

18. 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

19. 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 hematuria—the absence of hematuria does not rule out renal injury

20. 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