Abdominal Trauma: Etiology and Pathophysiology

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Questions and Answers

What mechanism causes blunt trauma to abdominal organs due to seat belts?

  • The seat belt causes the organs to rupture.
  • The seat belt causes the organs to swell.
  • The seat belt presses the organs into the spinal column. (correct)
  • The seat belt cuts through the organs.

Which of the following is a classic manifestation of peritonitis following abdominal trauma?

  • Guarding and splinting of the abdominal wall. (correct)
  • Bradycardia.
  • Increased bowel sounds.
  • Soft and pliable abdomen.

What does a hard, distended abdomen typically indicate in a patient with abdominal trauma?

  • Intestinal obstruction.
  • Liver laceration.
  • Intraabdominal bleeding. (correct)
  • Dehydration.

What does bruising around the umbilicus (Cullen sign) or flanks (Grey Turner sign) suggest?

<p>Retroperitoneal hemorrhage. (B)</p> Signup and view all the answers

What might the presence of bowel sounds in the chest indicate?

<p>Diaphragmatic rupture. (B)</p> Signup and view all the answers

Which assessment finding is most suggestive of arterial damage in the abdomen?

<p>Auscultation of bruits. (B)</p> Signup and view all the answers

What is the immediate intervention for an unresponsive patient with suspected abdominal trauma?

<p>Assess circulation, airway and breathing. (C)</p> Signup and view all the answers

Why should impaled objects not be removed at the scene of an abdominal injury?

<p>Because they may be tamponading bleeding. (C)</p> Signup and view all the answers

Why might a patient with abdominal trauma have normal hemoglobin and hematocrit levels initially, despite bleeding?

<p>Fluid loss occurs at the same rate as red blood cell loss. (A)</p> Signup and view all the answers

What is the primary reason for performing a type and crossmatch in a patient with abdominal trauma?

<p>To determine if the patient is likely to need a blood transfusion. (D)</p> Signup and view all the answers

Which diagnostic method is considered the most common for abdominal trauma, but requires patient stabilization?

<p>Abdominal CT scan. (B)</p> Signup and view all the answers

What is the purpose of inserting a nasogastric (NG) tube with low suction in a patient with abdominal trauma?

<p>To decompress the stomach and prevent aspiration. (A)</p> Signup and view all the answers

Why should an impaled object be left in place until skilled care is available?

<p>To prevent any further damage and bleeding that removal might cause. (C)</p> Signup and view all the answers

What are the common characteristics of chronic abdominal pain, as described in the provided text?

<p>Dull, aching, or diffuse (B)</p> Signup and view all the answers

When assessing a patient with chronic abdominal pain, what factor is particularly important to evaluate to help determine the cause?

<p>Specific pain characteristics including severity, location, duration, and onset. (A)</p> Signup and view all the answers

Which of the following diagnostic tests may be used to investigate the underlying cause of chronic abdominal pain?

<p>Endoscopy, CT scan, MRI, laparoscopy, and barium studies. (C)</p> Signup and view all the answers

Which type of injury is most commonly associated with a rapid deceleration event, such as a car crash?

<p>Shearing Injury (B)</p> Signup and view all the answers

Which of the following is a primary risk associated with a ruptured hollow organ in the abdomen?

<p>Peritonitis (C)</p> Signup and view all the answers

What is a significant physiological consequence of increased intra-abdominal pressure in abdominal compartment syndrome?

<p>Respiratory Failure (B)</p> Signup and view all the answers

A patient presents with a contusion across their lower abdomen following a motor vehicle accident. What should this finding raise suspicion for?

<p>Internal organ trauma (A)</p> Signup and view all the answers

Which of the following is NOT typically a direct result of blunt abdominal trauma?

<p>Gunshot wound (A)</p> Signup and view all the answers

Hypovolemic shock is most likely to occur as a result of damage to which type of abdominal organs?

<p>Solid organs like the liver or spleen (B)</p> Signup and view all the answers

What is a key factor contributing to the development of abdominal compartment syndrome?

<p>Excessive pressure from increased fluid or organ size (C)</p> Signup and view all the answers

Which condition is a possible consequence of decreased blood perfusion to the kidneys due to abdominal compartment syndrome?

<p>Renal Failure (B)</p> Signup and view all the answers

Flashcards

Blunt Abdominal Trauma

Injury to the abdomen caused by a force that does not penetrate the skin, like a car crash or a fall.

Penetrating Abdominal Trauma

Injury to the abdomen caused by an object piercing the skin, such as a gunshot or stabbing.

Abdominal Compartment Syndrome

A condition caused by high pressure within the abdominal cavity. This pressure can compromise breathing, blood flow, and organ function.

Solid Organ Injury

Damage to the liver, spleen, pancreas, kidneys, or intestines, often caused by blunt or penetrating trauma.

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Hollow Organ Injury

Damage to the stomach, bladder, or intestines, often caused by penetrating trauma.

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Hypovolemic Shock

A life-threatening condition where blood loss from an internal injury leads to decreased blood volume.

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Peritonitis

Inflammation of the peritoneum, the lining of the abdominal cavity, often caused by spilled contents from a hollow organ injury.

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Abdominal Trauma Assessment

The evaluation of a patient's condition to assess the type and severity of abdominal trauma.

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Distended Abdomen

A hard, rigid, or tightly stretched abdomen, which may be a sign of internal bleeding.

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Rebound Tenderness

Severe pain felt when pressure is released from the abdomen, suggesting irritation of the peritoneum.

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Cullen's Sign

Bruising around the belly button, suggesting bleeding in the retroperitoneal space (behind the abdominal cavity).

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Grey Turner's Sign

Bruising on the flanks (sides of the body), also indicating bleeding in the retroperitoneal space.

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Absent Bowel Sounds

Loss of bowel sounds during auscultation, often a sign of peritonitis.

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Diagnostic Peritoneal Lavage (DPL)

A medical procedure that involves inserting a needle into the abdominal cavity to draw fluid for analysis. This can detect blood, bile, intestinal contents, and urine, helpful in diagnosing abdominal injuries.

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Nasogastric (NG) Tube

A procedure where a thin, flexible tube is inserted into the stomach through the nose or mouth. It's used to drain the stomach and prevent aspiration.

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Internal Bleeding

A term describing internal bleeding. It is a common complication of abdominal trauma. Hematocrit levels may be normal initially due to fluid loss, but become abnormal after resuscitation.

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Focused Abdominal Ultrasound (FAST)

An imaging technique that uses sound waves to create images of internal organs. It can be used to diagnose injuries to the abdominal organs, especially after a blunt trauma event.

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Irritable bowel syndrome (IBS)

A chronic condition characterized by abdominal pain, bloating, and changes in bowel habits. It is common and often diagnosed based on symptoms.

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Study Notes

Abdominal Trauma: Etiology and Pathophysiology

  • Injuries to the abdomen result from blunt or penetrating trauma.
  • Common injuries include lacerated liver, ruptured spleen, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal injury, and stomach/intestinal rupture.
  • Blunt trauma often occurs in motor vehicle accidents, direct blows, or falls, with possible internal injuries without external wounds.
  • Shearing injuries and compression injuries may occur during blunt trauma.
  • Penetrating injuries involve gunshot or stabbing wounds, resulting in an outward opening.
  • Bleeding from solid organs (liver, spleen) can cause hypovolemic shock.
  • Damage to hollow organs (bladder, stomach, intestines) can spill contents leading to peritonitis.
  • Abdominal compartment syndrome, arising from excessive abdominal pressure, may develop due to internal factors.
  • Increased pressure can hinder ventilation, cardiac output, and overall organ perfusion, potentially leading to kidney failure.

Clinical Manifestations

  • Careful assessment is vital for determining injury type/severity.
  • Associated injuries like rib or pelvis fractures, spinal or thoracic injuries are common.
  • Seatbelt injuries may indicate internal trauma to abdominal organs.
  • Manifestations include abdominal pain, guarding/splinting, a hard/distended abdomen, decreased/absent bowel sounds, abrasions/bruising, and hematemesis/hematuria.
  • Hypovolemic shock signs are also common indicators.
  • Bruising around the umbilicus (Cullen sign) or flanks (Grey Turner sign) may indicate retroperitoneal hemorrhage.
  • Loss of bowel sounds implies peritonitis, and bowel sounds in the chest can signal a ruptured diaphragm.
  • Arterial damage can be indicated through auscultation of bruits.

Diagnostic Studies

  • Baseline CBC and urinalysis are common initial tests.
  • Hemoglobin/hematocrit, despite bleeding, may seem normal initially due to fluid loss at the same rate as blood loss.
  • Blood in the urine can indicate kidney/bladder damage.
  • Additional tests may include arterial blood gases, prothrombin time, electrolytes, BUN, and creatinine, and type and crossmatch.
  • CT scan and focused abdominal ultrasound are common diagnostic methods.
  • Diagnostic peritoneal lavage can detect blood, bile, and other internal substances.

Interprofessional and Nursing Care

  • Emergency management involves volume expansion, blood transfusion if necessary, NG tube placement for stomach decompression, and frequent assessment.
  • Determining whether surgery is required depends on clinical findings, diagnostic tests and patient response to conservative management.
  • Impaled objects should not be removed.

Chronic Abdominal Pain

  • Chronic abdominal pain's origins can stem from abdominal organs or refer from a different site with similar nerve supply.
  • Descriptions of pain may be dull, aching, or diffuse.
  • Possible causes include IBS, peptic ulcer disease, chronic pancreatitis, hepatitis, pelvic inflammatory disease, adhesions, and vascular insufficiency.
  • Diagnosing requires careful pain history with specifics on location, duration, severity, and factors affecting frequency.
  • Diagnostic tools (endoscopy, CT scan, MRI, laparoscopy, barium studies) may be used.
  • Treatment will depend on the underlying cause.

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