kin 191 b – abdomen and thorax injuries
TRANSCRIPT
KIN 191B – Advanced Assessment of Upper
Extremity Injuries
Abdomen and Thorax Injuries
Pathologies Thoracic Injuries
Review bony injuries Pneumothorax Hemothorax Solar plexus contusions Heart contusion
Abdominal Injuries Liver Injury Splenic injury Kidney/urinary pathologies Appendix pathologies Hollow organ injury General medical issues Male/female reproductive system pathologies
Thoracic Injuries
Review Bony Injuries Rib fractures
Common fracture sites Why?
Flail chest Definition Classic presentation
Costochondral/chondrosternal injuries Types of injury Nature of articulation
Flail Chest
Pneumothorax Accumulation of air in pleural cavity that affects ability of lung to
expand Decreased oxygen, hypoxia, respiratory distress
Open vs. closed presentation Closed = spontaneous pneumothorax
Air leaks into cavity With/without trauma, post-op, poor breathing during strenuous exercise
Open pneumothorax Penetrating wound from rib fracture and/or foreign object “Sucking chest wound” – cover with nonporous material to prevent passage of
air
Pneumothorax
Pneumothorax
Tension pneumothorax If left untreated, spontaneous pneumo may
progress to tension pneumo = “collapsed lung” If tension pneumo untreated, pressure continues
to build ultimately affecting other lung, heart and great vessels
Tracheal shift and JVD
Tension Pneumothorax
Pneumothorax
Signs and symptoms Dyspnea, pain with respirations, guarding or
splinting of affected area, possible cyanosis If associated with trauma, pain at site of impact,
rib fracture or foreign object Decreased or absent breath sounds on
auscultation of affected lung Vitals – signs of shock
Heart rate, respirations Blood pressure
Hemothorax
Accumulation of blood in the pleural cavity Bleeding from lacerated lung and/or rupture of blood vessel
within thoracic cavity May be from penetrating injury
Often occurs simultaneously with pneumothorax
Essential signs and symptoms identical Also may present with coughing up of bloody sputum
Hemothorax
Solar Plexus Contusion Solar (celiac) plexus is large network of nerves associated with
abdomen/thorax
Blunt force trauma can cause contusion which causes transient paralysis of diaphragm leading to breathing difficulties
Condition is self-limiting and breathing will return – must minimize panic
Deep breaths, pant, loosen clothing
Must rule out other abdominal injury
Heart Contusion Uncommon due to anatomical location and bony protection
May be affected by forceful trauma to anterior chest/sternal region
Signs and symptoms Chest pain JVD Dyspnea Vitals – signs of shock
Can cause immediate death due to interruption of normal cardiac rhythm
Abdominal Injuries
Liver Injury
Typically associated with blunt force trauma to upper right quadrant – contusion vs. laceration
Risk is higher if liver is enlarged (hepatitis) from viral infection or alcohol consumption
Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury
Liver Injury
Signs and symptoms Pain at site of injury (upper right quadrant) Referred pain to right shoulder/scapula Nausea and/or vomiting (appearance) Significant bleeding may present with abdominal
rigidity and/or rebound tenderness Vitals – signs of shock
Heart rate/respirations Blood pressure Due to internal bleeding (hypovolemic)
Liver Laceration
Splenic Injury
Typically associated with blunt force trauma to upper left quadrant – may be atraumatic
Risk is higher if spleen enlarged due to systemic condition (mono, pneumonia, etc.)
Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury
Splenic Injury
Signs and symptoms Pain at site of injury (upper left quadrant) Referred pain to left shoulder (Kehr’s sign) Nausea and/or vomiting (appearance) Significant bleeding may present with abdominal
rigidity and/or rebound tenderness Vitals – signs of shock
Heart rate/respirations Blood pressure Due to internal bleeding (hypovolemic)
Splenic Injury
Kidney Contusion/Laceration
Well protected anatomically by rib cage, vertebrae and spinal musculature
Typically associated with blunt force trauma to “flank” region
Contusion generally isolated injury while laceration generally associated with rib fracture displacement
Kidney Contusion/Laceration
Signs and symptoms Pain to “flank” region at site of trauma Referred pain around thoracoabdominal region Associated symptoms of rib fracture Significant bleeding may present with abdominal
rigidity and/or rebound tenderness Hematuria
If significant - easily seen, but if minor – requires further analysis to rule out or verify
Vitals – signs of shock
Kidney Laceration
Kidney Stones
Result from collection of incomplete kidney filtration
Family history, stress, hypertension, high salt intake increase risk
Other foods may decrease risk Apple/grapefruit juice Coffee/tea/beer/wine Potassium rich foods (bananas, tomatoes)
Kidney Stones
Signs and symptoms Pain in affected side Pain on urination May feel larger stones move through ureter and
ultimately urethra (most pain) If on right side, must differentiate from appendix
pathology
Kidney Stones
Urinary Tract Infections (UTI)
Caused by bacterial infections of the bladder and/or urethra – may spread to ureter/kidney If urethritis, must consider STDs
Must differentiate from kidney stones
Signs and symptoms Dysuria – frequent need to urinate Abnormal appearance/odor of urine Other systemic symptoms (fever, etc.)
Appendix Pathologies
Appendicitis Initial general systemic symptoms Initial tenderness in lower right quadrant (McBurney’s
point) – rebound tenderness May have referred pain to right chest, upper trap
and/or umbilicus
Appendix rupture May be more risk with blunt force trauma to lower right
quadrant if appendix is inflamed
Appendicitis
Hollow Organ Rupture
Uncommon due to ability to deform when impacted and absorb forces
Signs and symptoms Abdominal pain at site of injury (trauma) Nausea/vomiting Abdominal rigidity and/or rebound tenderness Absence of bowel sounds on auscultation Blood in stool Vitals –signs of shock
Stomach Rupture
General Medical Conditions Gastritis
Inflammation of lining of stomach NSAIDs, alcohol, bile
Heartburn/indigestion
Ulcer Irritation of duodenum (proximal small intestine) Most are bacterial but may be due to long term use of some meds
Gastroenteritis Inflammation of the small intestine Nausea/vomiting/diarrhea Often attributable to “food poisoning”
Peptic Ulcer
General Medical Conditions Colitis
Inflammation of the large intestine Frequent diarrhea, blood if ulcerative colitis
Regional enteritis (Crohn’s disease) Primarily affects ileum Cramping, incontinence, constipation Requires diet modification
Irritable bowel syndrome (IBS) Altered motility of large intestine Diarrhea/constipation, gas, nausea/vomiting, abdominal pain Requires stress reduction and diet modification
Colitis
Male Reproductive System Pathologies
More common than in women due to external location of male genitalia
Pathologies Testicular contusion Testicular torsion Testicular dysfunction Testicular cancer
Testicular Contusion
Etiology is direct trauma
Calm injured person
Signs and symptoms Localized pain, often severe Nausea/vomiting
Must inspect for abnormalities (self-exam unless unable) once symptoms minimize Swelling, abnormal tissue density
Testicular Torsion
Twisting of spermatic cord within scrotum
Higher risk if undescended testicle and lower risk if athletic supporter worn
Signs and symptoms Intense pain Nausea/vomiting Swelling and/or mass in scrotum from occlusion of vascular
structures
Testicular Torsion
Testicular Dysfunction Hydrocele
Fluid filled “sac” into testicle
Multiple causes – often associated with inguinal hernia
Varicocele Varicose veins within scrotum – alters blood flow “Bag of worms” on palpation
Epididymitis Typically associated with UTIs/STDs Inflammation of epididymis Pain with urination/ejaculation/bowel movements
Varicocele and Hydrocele
Testicular Cancer
If detected early by self-exam, often respond well to treatment
Definitive diagnosis via advanced studies and/or biopsy
Hardening and/or enlarging of affected testicle is most common symptom
May present with referred pain to low back or inguinal area in addition to localized pain
Female Reproductive System Pathologies
Less common due to protection afforded by abdomen/anatomical location
Pathologies Amenorrhea Dysmenorrhea Female athlete triad Vaginitis Pelvic inflammatory disease
Amenorrhea Primary vs. secondary
Primary – absence of onset of menstruation by age 16 Secondary – cessation of menstruation for 6+ months
Contributing factors Exercise, weight loss, stress, anxiety Body image, societal pressures
Contributing component of female athlete triad
Dysmenorrhea
Pain and/or cramping in lower abdomen and pelvis prior to menstruation
Signs and symptoms Nausea/vomiting Diarrhea or constipation Bloating
May be related to other conditions (PID, endometriosis, etc.)
Female Athlete Triad
Comprised of three elements Amenorrhea, disordered eating, osteoporosis
Presence of one component requires screening for the others In combination, can be life threatening
Best treatment is prevention (screening) and education Team approach to clinical treatment – physiological and
psychological
Vaginitis Bacterial vaginosis
Bacterial imbalance in vagina
Trichomoniasis Most commonly affects vagina but also may involve urethra
Vulvovaginal candidiasis (“yeast infection”) Overgrowth of normally present yeast cells
Signs and symptoms Abnormal odor and/or discharge Pain with urination and/or intercourse
Pelvic Inflammatory Disease (PID)
Inflammation or infection of the uterus, ovaries or fallopian tubes
Often related to STDs
Signs and symptoms Vaginal discharge Menstrual irregularities Low back/abdominal pain Dysuria/frequent urination Fever
Pelvic Inflammatory Disease