Chapter 31: Abdominal and Genitourinary Injuries

Overview

• Focus on management of patients with abdominal and genitourinary trauma.
• Emphasis on recognizing life threats and necessity for immediate intervention.
• Includes anatomy, physiology, pathophysiology, assessment, and management.

Anatomy and Physiology

Abdominal Quadrants

• Abdomen divided into four quadrants for diagnosing potential organ involvement.
• Right lower quadrant often involved in appendicitis.

Organs

• Hollow Organs: Stomach, intestines, ureter, bladder.
  • Rupture leads to peritonitis.
• Solid Organs: Liver, spleen, pancreas, kidneys.
  • Rich blood supply; significant hemorrhage can occur.

Retroperitoneal Space

• Includes kidneys, ureters, urinary bladder, pancreas.

Types of Abdominal Injuries

Closed Injuries

• Result from blunt trauma (e.g., MVCs, falls).
• Signs: Abrasions, hematomas, seatbelt injuries.

Open Injuries

• Result from penetrating trauma (e.g., knives, firearms).
• Types: Low, medium, high velocity injuries.

Evisceration

• Bowel protrusion from the peritoneum.
• Require careful visual assessment.

Pathophysiology

• Hollow Organ Injuries: Delayed signs, infection risk.
• Solid Organ Injuries: Severe hemorrhage, often not immediately painful.

Assessment

Initial Assessment

• Scene safety, spinal precautions.
• Quick general impression, check for life threats.
• Consider trauma center transport.

History Taking

• Use SAMPLE and OPQRST for detailed history.
• Identify referred pain, tenderness, or guarding.

Examination

• Visual and physical examination, including D-CAP BTLS.
• Check vital signs regularly, treat for shock if necessary.

Emergency Care

Closed Abdominal Injuries

• Monitor for shock, use suction if needed.
• Administer oxygen, keep patient warm.

Open Abdominal Injuries

• Inspect for unseen internal damage.
• Apply sterile dressings, stabilize impaled objects.
• Techniques for treating evisceration.

Genitourinary System

Anatomy

• Organs: Kidneys (solid), ureters, bladder, urethra (hollow).
• Male Genitalia: External, except prostate and seminal vesicles.
• Female Genitalia: Internal except external vulva, clitoris, labia.

Genitourinary Injuries

Kidney Injuries

• Often part of multi-system trauma.
• Signs: Flank bruising, tenderness.

Bladder Injuries

• Often ruptured by blunt trauma.

External Genital Injuries

• Painful, significant bleeding can occur.

Female Genital Injuries

• Internal genitalia usually protected, but risk increases during pregnancy.

Assessment and Treatment

General Assessment

• Be professional, respect privacy.
• Look for signs of trauma, assess vital signs.

Specific Injury Care

• Kidney: Treat for shock, monitor vitals.
• Bladder: Treat for shock, monitor vitals.
• External Genitalia: Use sterile compresses, control bleeding.
• Female Genitalia: Use compresses, avoid internal penetration.

Sexual Assault

• Provide support and privacy.
• Advise against washing or altering evidence.
• Follow protocol for evidence handling.

Review Questions

• Tests understanding of peritonitis, organ bleeding, injury mechanisms, and treatment protocols.