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Abdominal Injury

Injury of Abdomen


Presentation

  • The mode of injury may cause other injuries that can distract attention from more serious problems that are undiagnosed at presentation.[patient.info]
  • Acute duodenal perforation needs to be a diagnostic consideration at initial presentation It can be detected by presence of free air.[rch.org.au]
  • No patient was found to have delayed presentation of a missed injury.[reliasmedia.com]
  • Presentation Abdominal trauma patients can present in multiple ways ranging from frank shock to hemodynamic instability to completely stable vitals to polytrauma.[saem.org]
  • Patients who presented with peritonism were six times more likely to have therapeutic laparotomy (Table 3 ).[cureus.com]
Hunting
  • The velocity of military firearms and hunting rifles is much higher than that of civilian handguns and therefore has a much higher energy transfer.[patient.info]
  • […] assessment as part of a trauma exam Discuss prehospital management Identify emergency department care transfer and ED assessment tools On a cold November afternoon in northern Wisconsin, Medic 4 is dispatched for a male patient who fell from his deer hunting[emsworld.com]
  • Low-velocity ( 600 m/s) injuries typically are caused by handguns while high-velocity ( 600 m/s) injuries tend to be caused by military or hunting weapons.[reliasmedia.com]
Collapse
  • (Though some reports suggest 6 weeks may be sufficient) The most important issue is to brief the parents fully on the risks of late rupture, and the need to return to hospital urgently if symptoms of pain or collapse occur.[rch.org.au]
Decreased Breath Sounds
  • breath sounds • Abdominal peristalsis heard in thorax • Acute chest pain and shortness of breath may indicate diaphragmatic tear • May be hard to diagnose because of multisystem trauma or the liver may "plug" the defect and mask it 11.[slideshare.net]
  • breath sounds No vomiting The abdominal exam is useful![emdocs.net]
Pleural Effusion
  • The use of US also has been found to be reliable for the detection of traumatic pleural effusions and hemothoraces. 19,25,26 Ma et al demonstrated that intercostal oblique views were 96% sensitive, 100% specific, and 99% accurate in diagnosing free pleural[reliasmedia.com]
Abnormal Breathing
  • Additionally, the PPV of physical exam for the detection of abnormal breath sounds in penetrating chest trauma does not require radiographic confirmation prior to treatment. Chest Radiographs.[reliasmedia.com]
Abdominal Pain
  • A sensible protocol is strict bed-rest until the abdominal pain subsides, followed by restricted activity for 3 months, followed by return to full activity.[rch.org.au]
  • pain as a symptom does not confirm (LR 1.6; 95% CI, 1.3-2.0) or rule out an injury (LR 0.52; 95% CI, 0.34-0.79). 2 The most useful signs, laboratory results, and imaging result are shown in Table 88-1.[jamaevidence.mhmedical.com]
  • Abdominal pain, redness, and swelling Bruises or scratches on the abdomen How is a blunt abdominal injury diagnosed? Your healthcare provider will ask questions about your injury. He or she will feel and press on your abdomen.[drugs.com]
  • Common complaints include abdominal pain/tenderness, shoulder pain, nausea and vomiting, and anemia. CT scan is 98% sensitive in identifying the injury.[mdedge.com]
  • Patient 2 A 12-year-old boy presented with abdominal pain 16 hours after being hit from behind by a large wave while attempting to ride it to shore.[mja.com.au]
Nausea
  • […] deceleration; injury from steering wheel • Often associated (40%) with other organ damage (liver, spleen, vessels) CLINICAL MANIFESTATIONS • Pain over pancreas • Paralytic ileus • Symptoms may occur late (after 24 hr); epigastric pain radiating to back; nausea[slideshare.net]
  • Symptoms and signs – Not all may be present history of injury to the abdominal area bleeding wound or other obvious injury, possibly with visible intestines severe pain and possible muscle spasm across the abdominal wall nausea or vomiting bruising of[stjohn.org.nz]
  • At the time of discharge, patients should be given written information describing signs of undiagnosed injury; increased abdominal pain or distention, nausea and/or vomiting, weakness, light-headedness, fainting or new bleeding in urine or faeces should[patient.info]
  • Muscle guarding, back and flank pain, nausea, vomiting, and even shock are possible with significant trauma to the kidneys. With enough force transferred to the abdominal area, intestinal damage and even bowel perforation can occur.[ncbi.nlm.nih.gov]
Epigastric Tenderness
  • tenderness • Signs of peritonitis • Bloody gastric drainage 13.[slideshare.net]
  • Duodenum Acute duodenal injuries Should be suspected on a history of bruising in the epigastrium, severe epigastric tenderness or bilious vomiting Are often associated with pancreatic injuries Are particularly associated with bicycle handlebar and seat[rch.org.au]
Left Upper Quadrant Pain
  • upper quadrant pain • Fixed dullness to percussion in left flank; dullness to percussion in right flank that disappears with change of position 15.[slideshare.net]
Epigastric Pain
  • pain radiating to back; nausea, vomiting • Tenderness to deep palpation 16.[slideshare.net]
Jaundice
  • […] spleen injury • When small bowel ruptures from blunt injury, rupture occurs most often at proximal jejunum and CLINICAL MANIFESTATIONS • Testicular pain • Referred pain to shoulders, chest, back • Mild abdominal pain • Peritoneal irritation • Fever, jaundice[slideshare.net]
  • On physical examination, jaundice was present and the abdomen was distended predominantly on the right side with no tenderness on palpation.[scielo.isciii.es]
Hypertension
  • Abdominal compartment syndrome, characterized by intra-abdominal hypertension and resultant remote organ dysfunction, is a risk in patients undergoing high-volume fluid resuscitation.[oxfordmedicine.com]
  • Patients with persistent renal damage are at risk of hypertension, and should be followed up for at least 1 year. References Blunt renal trauma in children: experience with conservative management at a paediatric trauma centre. Margenthaler JA.[rch.org.au]
  • Diagnosis requires measuring intra-abdominal pressure, typically with a pressure transducer connected to the bladder catheter; values 20 mm Hg are diagnostic of intra-abdominal hypertension and are concerning.[msdmanuals.com]
Vascular Disease
  • Auscultation Abdominal bruit may indicate underlying vascular disease or traumatic arteriovenous fistula. During auscultation, gently palpate the abdomen while noting the patient's reactions.[patient.info]
  • disease or traumatic arteriovenous fistula Local or generalized tenderness, guarding, rigidity, or rebound tenderness: Suggests peritoneal injury Fullness and doughy consistency on palpation: May indicate intra-abdominal hemorrhage Crepitation or instability[emedicine.medscape.com]
Agitation
  • Grade I Grade II Grade III Grade IV Blood loss 7501500ml 15002000ml 2000ml Pulse normal tachy tachy weak Blood pressure normal raised diastolic lowered systolic very low Mental state normal agitated confused obtunded Urine output 30ml/h 2030ml/h 515ml[rcemlearning.co.uk]
  • Portable, Fast, Serial exams Can detect small amounts of hemoperitoneum with good specificity Non-invasive, safe Can find thoracic injuries Accuracy Variation Doesn’t image solid parenchymal damage, retroperitoneal, diaphragm injuries Limited in the obese, agitated[canadiem.org]
Forgetful
  • Injury Don’t forget other sources of shock![canadiem.org]
  • Clinicians often focus on the most obvious injury and forget to examine other areas, specifically the axilla and groin regions. Peripheral pulses should be evaluated to exclude major vascular injury.[reliasmedia.com]
Lethargy
  • They may include the following: Signs of intra-abdominal bleeding (bleeding in the belly) such as: Looking pale Lethargy (hard to keep awake) Blood in urine, stools (bowel movement) or vomitus (throw up) Fever (temperature greater than 101 degrees Fahrenheit[aftertheinjury.org]
Testicular Pain
  • pain • Referred pain to shoulders, chest, back • Mild abdominal pain • Peritoneal irritation • Fever, jaundice, intestinal obstruction 17.[slideshare.net]
Microscopic Hematuria
  • Urinalysis for blood: Microscopic hematuria in the presence of shock is an indication for genitourinary evaluation. ABG: Base deficit may suggest hypovolemic shock and help guide the resuscitation. Imaging See “ Essential Workup .”[emergency.unboundmedicine.com]

Workup

  • Imaging See “ Essential Workup .” Diagnostic Procedures/Other See “ Essential Workup ” Lower thoracic injury may cause abdominal pain. Treatment Titrate fluid resuscitation to clinical response.[emergency.unboundmedicine.com]
  • An adequate diagnostic workup must be completed in time and the priority of the treatment sequence determined.[mysurgery.de]
  • The workup and coexisting diseases reviewed here will primarily focus on concomitant traumatic injuries of organ systems, as opposed to chronic medical diseases.[clinicalpainadvisor.com]
  • Many institutions have protocolized the workup of trauma to include full body scans and, as such, many injuries that previously were not seen now are being diagnosed.[reliasmedia.com]
  • See Workup for more detail. Management Treatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patient’s arrival at the ED or trauma center.[emedicine.medscape.com]
Bowel Distention
  • Pain and bowel distention , related to diagnosis. 44. Risk for imbalanced body temperature related to infection 45. Risk for impaired skin integrity related to bed rest, hemiparesis, hemiplegia, immobility, or restlessness 46.[slideshare.net]
  • Many believe that bowel distention with oral and rectal contrast is paramount when evaluating for these injuries.[reliasmedia.com]
Pleural Effusion
  • The use of US also has been found to be reliable for the detection of traumatic pleural effusions and hemothoraces. 19,25,26 Ma et al demonstrated that intercostal oblique views were 96% sensitive, 100% specific, and 99% accurate in diagnosing free pleural[reliasmedia.com]

Treatment

  • Rationale for inclusion: This was one of the first papers to describe a systematic approach to the non-operative treatment of splenic injury. The authors describe a large 35 year experience.[east.org]
  • Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only.[drugs.com]
  • Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions .[patient.info]
  • OTHER TREATMENT Nutritional supplementation: TPN Enteral feeding Antibiotics Intravenous fluid infusion Blood components transfusion 39. NURSING MANAGEMENT 40.[slideshare.net]
  • If you have specific questions or concerns about your child's injury or treatment, please make sure to talk with your healthcare provider.[aftertheinjury.org]

Prognosis

  • ., chest pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension ) Diagnostics Initial test: chest x-ray Mediastinal widening Tracheal deviation Hemothorax Further tests Treatment Prognosis : 80% of patients die before[amboss.com]
  • The goal of every trauma management is to determine the extent and prognosis of the injuries. An adequate diagnostic workup must be completed in time and the priority of the treatment sequence determined.[mysurgery.de]
  • Prognosis Overall prognosis for patients who sustain blunt abdominal trauma is favorable.[emedicine.medscape.com]
  • In general, the prognosis of patients with blunt abdominal trauma is good. [11] [12] [13] Complications Inadequate resusc i tation Missed abdominal injuries Delays in diagnosis and treatment Intraabdominal sepsis Delayed splenic rupture Consultations[ncbi.nlm.nih.gov]
  • Patient prognosis is dependent on early detection and the time interval between the time of injury and the time of therapeutic intervention.[oatext.com]

Etiology

  • References: [1] [2] [3] [4] Blunt chest trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly:[amboss.com]
  • […] pelvis, spine, ribs) Extra-abdominal structures (skin/soft tissue, muscle) Epidemiology True current incidence of blunt abdominal trauma unknown although most believed to involve motor vehicles in United States (crashes, pedestrian hit by vehicle) Other etiologies[dynamed.com]
  • Introduction Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. [1] [2] Etiology The chief cause of blunt abdominal trauma in the United States is motor vehicle accidents.[ncbi.nlm.nih.gov]
  • Etiology Vehicular trauma is by far the leading cause of blunt abdominal trauma in the civilian population. Auto-to-auto and auto-to-pedestrian collisions have been cited as causes in 50-75% of cases.[emedicine.medscape.com]
  • The goal of this study was to evaluate the epidemiological reports and clinical data that aim to illustrate the mechanisms of injury, etiology, warning signs, sequelae, and frequency of deaths resulting from pure abdominal injuries that underwent laparotomy[azmj.eg.net]

Epidemiology

  • Keywords: abdominal injuries, emergency laparotomy, epidemiology How to cite this article: Saleem AEA, Abdul Raheem OA, Abdallah HA, Yousef A M.[azmj.eg.net]
  • Epidemiology of sepsis in patients with traumatic injury. Crit Care Med 2004;32:2234-40. 32. Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, et al.[onlinejets.org]
  • Epidemiology of trauma deaths: A reassessment. J Trauma 1995; 38:185-193. 3. MacKenzie EJ, Fowler CJ. Epidemiology. In: Mattox KL, et al, eds. Trauma. 4th. New York: McGraw-Hill; 2000: 21-40. 4. Shackford SR, et al.[reliasmedia.com]
  • Ileocecal junction Mesenteric vessel injuries Retroperitoneal organs: duodenum, pancreas, kidneys/urogenital, aorta Diaphragm Minimal bleeding so may produce few symptoms Bones (pelvis, spine, ribs) Extra-abdominal structures (skin/soft tissue, muscle) Epidemiology[dynamed.com]
  • OBJECTIVES Discuss the incidence and epidemiology of abdominal trauma Review abdominal anatomy Discuss the mechanisms of injury for abdominal trauma Explain an abdominal assessment as part of a trauma exam Discuss prehospital management Identify emergency[emsworld.com]
Sex distribution
Age distribution

Pathophysiology

  • PATHOPHYSIOLOGY OF ABDOMINAL INJURY DECELERATION • Rapid decelaration causes differential movement among adjacent structures.[slideshare.net]
  • Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg. 2007 May;31(5):1055-64 OpenInNew Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient.[dynamed.com]
  • Pathophysiology Intra-abdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the person’s internal organs.[emedicine.medscape.com]
  • Each year thousands of patients with blunt abdominal injury are seen in emergency departments, and this substantially increases the cost of healthcare. [5] [6] Pathophysiology Blunt abdominal trauma can cause damage to the internal organs, resulting in[ncbi.nlm.nih.gov]
  • Medical Center Department of Emergency Medicine 780 Prior Hall, 376 West 10th Ave, Columbus, OH 43210 Objectives Upon completion of this module, you should be able to: Diagnose, resuscitate, stabilize and manage abdominal trauma patients; Identify common pathophysiologic[saem.org]

Prevention

  • Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your skin. Place it on your injured area for 15 to 20 minutes every hour or as directed.[drugs.com]
  • The epidemic number of automobile crash injuries and deaths, despite great efforts to prevent accidents, has stimulated supplementary methods to reduce injuries under crash conditions. The simplest form of crashproofing is the lap or safety belt.[jamanetwork.com]
  • Recover » Injury and pain care Find Ways to Help Your Child Recover Abdominal Trauma This section of the website offers some general information about common injuries and tips for home management, as well as helpful hints for pain management and injury prevention[aftertheinjury.org]
  • MANGEMENT BASED ON ORGANS • DIAPHRAGMATIC TEARS :  repaired surgically to prevent visceral herniation in later years. • ESOPHAGEAL INJURY:  gastric decompression with a nasogastric tube, antibiotic therapy  surgical repair of the esophageal tear. •[slideshare.net]
  • Many traumatic injuries can be prevented, beginning with awareness and education. Blunt abdominal trauma is in the top three categories of preventable injuries. These include older adults falls and preventable motor vehicle accidents in teens.[ncbi.nlm.nih.gov]

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