Abdominal Trauma Past Paper PDF

*ABDOMINAL TRAUMA* *Etiology and Pathophysiology* *Injuries to the abdominal area usually are a result of blunt* *trauma or penetrating injuries. Common injuries of the abdomen* *include lacerated liver, ruptured spleen, mesenteric artery* *tears, diaphragm rupture, urinary bladder rupture, gre...

*ABDOMINAL TRAUMA* *Etiology and Pathophysiology* *Injuries to the abdominal area usually are a result of blunt* *trauma or penetrating injuries. Common injuries of the abdomen* *include lacerated liver, ruptured spleen, mesenteric artery* *tears, diaphragm rupture, urinary bladder rupture, great vessel* *tears, renal or pancreas injury, and stomach or intestine* *rupture.* *Blunt trauma often occurs with motor vehicle accidents,* *direct blows, and falls. It may not be obvious because it does* *not leave an open wound. Both compression injuries (e.g.,* *direct blow to the abdomen) and shearing injuries (e.g., rapid* *deceleration in a motor vehicle crash allowing some tissue* *to move forward while other tissues stay stationary) occur* *with blunt trauma. Penetrating injuries occur when a gunshot* *or stabbing produces an obvious, open wound into the* *abdomen.* *When solid organs (liver, spleen) are injured, bleeding can be* *profuse, resulting in hypovolemic shock. When contents from* *hollow organs (e.g., bladder, stomach, intestines) spill into the* *peritoneal cavity, the patient is at risk for peritonitis. In addition,* *abdominal compartment syndrome can develop.* *Abdominal compartment syndrome, or abdominal hypertension,* *is excessively high pressure in the abdomen. Anything* *that increases the volume in the abdominal cavity (e.g., edematous* *organs, bleeding) increases abdominal pressure. This high* *pressure restricts ventilation, potentially leading to respiratory* *failure. The high pressure decreases cardiac output, venous* *return, and arterial perfusion of organs. Decreased perfusion to* *the kidneys can lead to renal failure.* *Clinical Manifestations* *Careful assessment provides important clues to the type and* *severity of injury. Intraabdominal injuries are often associated* *with rib fractures, fractured pelvis, spinal injury, and thoracic* *injury. If the patient was in an automobile accident, a contusion* *or abrasion across the lower abdomen may indicate internal* *organ trauma from the seat belt. Seat belts can produce blunt* *trauma to abdominal organs by pressing the intestine and pancreas* *into the spinal column.* *Classic manifestations of abdominal trauma are (1) guarding* *and splinting of the abdominal wall (indicating peritonitis);* *(2) a hard, distended abdomen (occurs with intraabdominal* *bleeding); (3) decreased or absent bowel sounds; (4) abrasions* *or bruising over the abdomen; (5) abdominal pain; (6) hematemesis* *or hematuria; and (7) signs of hypovolemic shock (Table* *47.13). Bruising around the umbilicus (Cullen sign) or flanks* *(Grey Turner sign) may mean retroperitoneal hemorrhage.* *Loss of bowel sounds occurs with peritonitis. If the diaphragm* *ruptures, you may hear bowel sounds (if present) in the chest.* *Auscultation of bruits indicates arterial damage.* *Abdominal Trauma* *Etiology Assessment Findings Interventions* *Blunt* * Assault with a blunt object* * Crush injury* * Explosions* * Falls* * Motor vehicle collisions* * Pedestrian event* *Penetrating* * Gunshot wounds* * Impalement* * Knife* * Other missiles* *Abdominal and GI Findings* * Abdominal distention* * Abdominal pain with palpation* * Abdominal rigidity* * Absent or ↓ bowel sounds* * Hematemesis* * Hematuria* * Nausea and vomiting* * Rebound tenderness* *Hypovolemic Shock* * ↓ BP* * ↑ HR* * ↓ Level of consciousness* * Tachypnea* *Surface Findings* * Abrasions, bruising on abdominal* *wall, flank, or peritoneum* * Impaled object* * Open wounds: lacerations, eviscerations,* *puncture wounds, gunshot wounds* *Initial* * If unresponsive, assess circulation, airway, and breathing.* * If responsive, monitor airway, breathing, and circulation.* * Apply appropriate O2 therapy.* * Control external bleeding with direct pressure or sterile pressure dressing.* * Establish IV access with 2 large-bore catheters and infuse normal saline or* *lactated Ringer's solution.* * Obtain blood for type and crossmatch and CBC.* * Remove clothing.* * Stabilize impaled objects with bulky dressing---do not remove.* * Cover protruding organs or tissue with sterile saline dressing.* * Insert indwelling urinary catheter if there is no blood at the meatus, pelvic* *fracture, or boggy prostate.* * Obtain urine for urinalysis.* * Insert NG tube if no evidence of facial trauma.* * Anticipate diagnostic peritoneal lavage.* *Ongoing Monitoring* * Monitor vital signs, level of consciousness, O2 saturation, and urine output.* * Maintain patient warmth using blankets, warm IV fluids, or warm humidified O2.* *Diagnostic Studies* *Laboratory tests include a baseline CBC and urinalysis. Even* *when bleeding, the patient will have normal hemoglobin and* *hematocrit because fluids are lost at the same rate as the red* *blood cells. Deficiencies are evident after fluid resuscitation* *begins. Blood in the urine may be a sign of kidney or bladder* *damage. Other laboratory work includes arterial blood gases,* *prothrombin time, electrolytes, BUN and creatinine, and type* *and crossmatch (in anticipation of possible blood transfusions).* *An abdominal CT scan and focused abdominal ultrasound are* *the most common diagnostic methods, but the patient must* *be stable before going for CT. Diagnostic peritoneal lavage can* *detect blood, bile, intestinal contents, and urine in the peritoneal* *cavity.* *Interprofessional and Nursing Care* *Emergency management of abdominal trauma is outlined in* *Table 47.13. Volume expanders or blood are given if the patient* *is hypotensive. An NG tube with low suction will decompress the* *stomach and prevent aspiration. Frequent, ongoing assessment* *is needed to monitor fluid status, detect deterioration in condition,* *and determine the need for surgery. The decision about* *whether to do surgery depends on clinical findings, diagnostic* *test results, and the patient's response to conservative management.* *Do not remove an impaled object until skilled care is* *available. Removal may cause further injury and bleeding.* *CHRONIC ABDOMINAL PAIN* *Chronic abdominal pain may originate from abdominal structures* *or be referred from a site with the same or a similar nerve* *supply. The pain is often described as dull, aching, or diffuse.* *Common causes include irritable bowel syndrome (IBS), peptic* *ulcer disease, chronic pancreatitis, hepatitis, pelvic inflammatory* *disease, adhesions, and vascular insufficiency.* *Diagnosing the cause of chronic abdominal pain begins* *with a thorough history and description of specific pain characteristics,* *including severity, location, duration, and onset.* *Assess pain frequency and factors that increase or decrease* *the pain, such as eating, defecation, and activities. Endoscopy,* *CT scan, MRI, laparoscopy, and barium studies may be done.* *Treatment for chronic abdominal pain depends on the underlying* *cause.*