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18.abdominal Injury
18.abdominal Injury
Compression:
Organs trapped between other structures
Shear:
Parts of an organ is able to move while another parts is fixed.
PENETRATING TRAUMA
Energy transmitted to surrounding tissue
Results in-
Uncontrolled hemorrhage
Organ damage
Spillage of hollow organ contents
Irritation & Inflammation of abdominal lining
Liver most commonly affected organ
Common causes -Shotgun Trauma, stab wound, cuts & tears
Produces least visible signs of injury
ESOPHAGEAL INJURY : • Penetrating injury is more common than blunt injury • May be
caused by knives, bullets, foreign body obstruction • May be caused by iatrogenic(related to
illness cause by medical examination or treatment) perforation
• May be associated with cervical spine injury.
CLINICAL MANIFESTATIONS • Pain at site of perforation • Fever • Difficulty swallowing
• Cervical tenderness • Peritoneal irritation
STOMACH INJURY : • Penetrating injury is more common than blunt injury; in one-third of
patients, both the anterior and the posterior walls are penetrated • May occur as a complication
from cardiopulmonary resuscitation or from gastric dilation.
CLINICAL MANIFESTATIONS • Epigastric pain • Epigastric tenderness • Signs of
peritonitis • Bloody gastric drainage
LIVER INJURY DESCRIPTIONS • Most commonly injured organ; blunt injuries (70% of
total) usually occur from motor vehicle crashes and steering wheel trauma • Highest mortality
from blunt injury and gunshot wound • Hemorrhage is most common cause of death from liver
injury; overall mortality 10%–15%.
CLINICAL MANIFESTATIONS • Persistent hypotension despite adequate fluid resuscitation
• Guarding over right upper or lower quadrant; rebound abdominal tenderness • Dullness to
percussion • Abdominal distention and peritoneal irritation • Persistent thoracic bleed
SPLEEN INJURY DESCRIPTIONS • Most commonly injured organ with blunt abdominal
trauma • Injured in penetrating trauma of the left upper quadrant
CLINICAL MANIFESTATIONS • Hypotension, tachycardia, shortness of breath • Peritoneal
irritation • Abdominal wall tenderness • Left upper quadrant pain • Fixed dullness to percussion
in left flank; dullness to percussion in right flank that disappears with change of position.
PANCREAS INJURY : • Most often penetrating injury (gunshot wounds at close range) • Blunt
injury from 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, vomiting • Tenderness to deep
palpation
SMALL INTESTINES INJURY: • Duodenum, ileum, and jejunum; hollow viscous structure
most often injured by penetrating trauma • Gunshot wounds account for 70% of cases • Incidence
of injury is third only to liver and spleen injury • When small bowel ruptures from blunt injury,
rupture occurs most often at proximal jejunum
CLINICAL MANIFESTATIONS • Testicular pain • Referred pain to shoulders, chest, back
• Mild abdominal pain • Peritoneal irritation • Fever, jaundice, intestinal obstruction
LARGE INTESTINES INJURY: • One of the more lethal injuries because of fecal
contamination; occurs in 5% of abdominal injuries • More than 90% of incidences are
penetrating injuries • Blunt injuries are often from safety restraints in motor vehicle crashes.
CLINICAL MANIFESTATIONS • Pain, muscle rigidity • Guarding, rebound tenderness •
Blood on rectal examination • Fever
CRUSHING • Intra abdominal contents are crushed between the anterior abdominal wall & the
vertebral column or posterior thoracic cage. This produces a crushing effect, to which solid
viscera (eg. spleen, liver, kidneys) are especially vulnerable.
SYMPTOMS • Pain or tenderness • A rapid heart rate • Rapid breathing • Sweating • Cold,
clammy, pale or bluish skin • Confusion or low level of alertness • Blunt trauma may cause
bruising. • Cullen’s sign • Grey turner’s sign • Kehr’s sign(occurrence of acute pain in the tip of
the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person
is lying down and the legs are elevated)
DIAGNOSTIC STUDIES
HISTORY TAKING AMPLE History • A: Allergy • M: Medications • P: Past medical history
• L: Last meal • E: Event - What happened
PHYSICAL EXAMINATION
Palpation : For tenderness, guarding and/or rigidity, rebound tenderness – hemoperitoneum
Percussion : Dullness/ shifting dullness Intraabdominal collection
Auscultation : Where to auscultate & What to listen for??? All four quadrants for the +/- of
bowel sounds
The classical ‘seatbelt’ sign. The bruising on the left breast is from the shoulder belt and the low
bruising to the abdominal wall is from the lap belt.
COLLABORATIVE MANAGEMENT
Initial Assessment and Resuscitation
Primary survey
Identification & treatment of life threatening conditions
Airway , with cervical spine precautions
Breathing
Circulation
Disability
Exposure
EMERGENCY CARE
• I V fluids • Control external bleeding • Dressing of wounds • Protect eviscerated organs with a
sterile dressing • Stabilize an impaled object in place • Give high flow oxygen • Immobilize the
patient with a fractured pelvis • Keep the patient warm • Analgesics
• GASTRIC INJURY: Partial gastrectomy may be needed if extensive injury has occurred.
• SPLEEN INJURY • Splenectomy is the treatment of choice when the patient is markedly
hemodynamically unstable, or when the spleen is totally macerated.
• PANCREATIC INJURY :Depends on the degree of pancreatic damage, but drainage of the
area is usually necessary to prevent pancreatic fistula formation and surrounding tissue damage
from pancreatic enzymes.
NURSING MANAGEMENT
Increased risk of hypovolemia and shock related to abdominal trauma and internal bleeding.
Increased risk of sepsis related to acute inflammatory process and peritonitis.
Increased risk of severe fluid, electrolyte, and metabolic imbalances related to injury or
inflammation.
Risk for imbalanced body temperature related to infection
Risk for impaired skin integrity related to bed rest, hemiparesis, hemiplegia, immobility, or
restlessness
Impaired elimination due to abdominal & retroperitoneal injury , nerve injury
Body image disturbance related to presence of colostomy bag, wound.
Deficient knowledge about abdominal injury, recovery, and the rehabilitation process
Anxiety related to the symptoms of disease and fear of death.