Overview
This lecture covers assessment and management of abdominal injuries in trauma patients, including common affected organs, signs, and initial interventions.
Abdominal Quadrants & Common Injuries
- The abdomen is divided into four quadrants: left upper, right upper, left lower, right lower.
- Left upper quadrant trauma often injures the spleen (penetrating/blunt) or stomach (blast).
- Right upper quadrant trauma commonly affects the liver, gallbladder, or duodenum.
- Left lower quadrant injuries may impact the colon, arteries, or any hollow organ (esp. with blast).
- Right lower quadrant trauma can involve arteries, intestines, appendix, or hollow organs.
- Injuries to either lower quadrant may also damage the bladder or pelvis.
Types of Abdominal Trauma & Initial Actions
- Penetrating injuries (e.g., gunshots, stabbings): do not remove embedded objects; stabilize with gauze.
- Solid (e.g., liver) and hollow (e.g., bowel) organs may be involved; liver is most frequently injured.
- Blunt trauma (e.g., vehicle accidents, falls): often internal, harder to detect, with potential for massive blood loss.
- Always assess for hemorrhage after intraabdominal injury.
Assessment and Signs
- Perform a full abdominal and hemodynamic assessment including vital signs.
- Common signs of peritoneal irritation: absent bowel sounds, distension, guarding, tenderness, rigidity.
- Signs of shock: hypotension, tachycardia, hypoxemia, sense of impending doom.
- Labs: order CBC (hemoglobin, hematocrit, WBC), lactate, ABGs, clotting times like INR.
- Pain location may indicate injury type; referred shoulder pain (Kehr's sign) links to spleen (left) or liver (right) injuries.
- Inspect front, back, and flanks for injury.
Imaging & Clinical Tests
- Use CT, bedside FAST exam, and X-ray to detect internal bleeding.
- Cullen's sign (bruising at the belly button) and Grey Turner's sign (flank bruising) indicate internal hemorrhage.
Treatment and Interventions
- Follow ABCs (Airway, Breathing, Circulation); stop hemorrhage to prevent the "lethal triad."
- Blood transfusions may be needed; always prepare for emergency surgery.
- Blunt injuries: immobilize spine until injury is ruled out.
- Penetrating injuries with protruding viscera: cover organs with moist, sterile saline gauze.
- Never remove impaled objects; stabilize and await surgery.
- Give tetanus booster and prophylactic antibiotics.
Pelvic and Genitourinary Trauma
- Pelvic trauma: suspect pelvic instability, limb shortening with external rotation, crepitus.
- Genitourinary trauma: look for hematuria, scrotal/perineal ecchymosis, and inability to urinate.
- Use pelvic binder for unstable patients.
- Foley catheter is contraindicated until imaging rules out genitourinary injury.
- Prepare patient for surgery, assess pulses, and perform occult stool test.
Key Terms & Definitions
- Quadrant — One of four regions of the abdomen used for localization.
- Peritoneal cavity — Abdominal space that can hold large blood volume.
- Kehr’s sign — Shoulder pain referred from abdominal injury (left: spleen, right: liver).
- Cullen’s sign — Periumbilical bruising indicating internal bleeding.
- Grey Turner’s sign — Flank bruising signaling retroperitoneal bleeding.
- FAST exam — Focused abdominal sonography for trauma.
Action Items / Next Steps
- Review anatomy of abdominal quadrants and organ locations.
- Practice identifying and interpreting clinical signs of abdominal injury.
- Complete assigned readings on abdominal trauma assessment and intervention.