Chapter 31: Abdominal and Genitourinary Injuries

Objectives

• Understand management of abdominal and genitourinary trauma.
• Recognize life threats and need for immediate intervention.
• Cover anatomy, physiology, pathophysiology, complications, assessment, and management.
• Discuss specific injuries including blunt vs. penetrating mechanisms, eviscerations, impaled objects, and injuries to external genitalia.
• Learn emergency care skills for various abdominal injuries.

Abdominal Anatomy and Physiology

• Regions: Abdomen extends from diaphragm to pelvis.
• Quadrants: The abdomen is divided into four quadrants to help localize injuries.
  • Right Lower Quadrant: Common for swelling due to appendix.
• Organs:
  • Hollow Organs: Stomach, intestines, ureter, bladder.
    • Rupture leads to peritonitis, showing severe pain and muscle spasms.
  • Solid Organs: Liver, spleen, pancreas, kidneys.
    • Rich blood supply, severe hemorrhage risk.
• Retroperitoneal Space: Contains kidneys, ureters, bladder, pancreas.

Types of Abdominal Injuries

• Closed Injuries: Often from blunt trauma, e.g., car crashes, falls.
  • Signs may take hours to develop.
• Open Injuries: Result from penetration, require suspicion for internal damage.
  • Velocity Injuries:
    • Low velocity (knives)
    • Medium velocity (handguns)
    • High velocity (rifles)
  • Evisceration: Bowel protrusion that requires careful dressing.

Hollow vs. Solid Organ Injuries

• Hollow Organ: Delay in symptoms, risk of infection.
  • Blunt trauma may cause them to "pop."
• Solid Organ: May bleed significantly, hard to identify due to lack of pain.
  • Liver, spleen, pancreas, kidneys at risk.

Patient Assessment

• Scene Size-Up: Ensure safety, consider mechanism of injury.
• Primary Assessment: Focus on airway, breathing, circulation.
• History Taking: Use SAMPLE and OPQRST.
• Secondary Assessment: Physical exams, focusing on different body regions.
• Reassessment: Repeat vital signs, document thoroughly.

Emergency Care

• Closed Injuries: Monitor for shock, provide oxygen, maintain warmth.
• Open Injuries: Control external bleeding, stabilize impaled objects, cover eviscerations with moist dressings.

Genitourinary System Anatomy

• Components: Reproductive and waste discharge functions.
• Organs: Kidneys (solid), ureters, bladder, urethra (hollow).
• Male Genitalia: Mostly external.
• Female Genitalia: Mostly internal, except vulva, clitoris, labia.

Genitourinary Injuries

• Kidney Injuries: Associated with flank trauma.
• Urinary Bladder Injuries: Risk with blunt trauma, may rupture.
• External Genitalia Injuries: Painful but not usually life-threatening.
  • Use sterile dressings, manage bleeding.
• Female Genitalia: Protected but at risk during pregnancy.

Specific Care for Genitourinary Injuries

• Kidneys: Treat for shock, monitor vital signs.
• Urinary Bladder: Look for signs of trauma, transport if needed.
• Male Genitalia: Cover wounds, stabilize objects, manage bleeding.
• Female Genitalia: Maintain privacy, support and reassure the patient.

Sexual Assault Considerations

• Provide compassion, avoid examination unless necessary.
• Preserve evidence, avoid contamination.
• Ensure privacy and follow protocols.

Review Questions

• Peritonitis: Often from hollow organ leakage.
• Liver: Largest organ, high blood volume, risk of severe bleeding.
• Intra-abdominal Bleeding: Common after blunt trauma.
• Seatbelt Injuries: Occur at iliac crest.
• Emergency Care: Moist sterile dressing for eviscerations.

Conclusion

• Understanding and managing abdominal and genitourinary injuries is critical in emergency medical care. Proper assessment and intervention can prevent further complications and potentially save lives.