Abdominal Trauma
Athens Technical College
EMS Program
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The Abdomen


Everything between diaphragm and
pelvis
Injury, illness very difficult to assess
because of large variety of structures
2
Abdominal Anatomy


Abdomen divided into four quadrants by
body mid-line, horizontal plane through
umbilicus
Organs can be located by quadrant
3
Abdominal Anatomy

Right Upper Quadrant
– Liver
– Gall Bladder
– Right Kidney
– Ascending Colon
– Transverse Colon
4
Abdominal Anatomy

Left Upper Quadrant
– Spleen
– Stomach
– Pancreas
– Left Kidney
– Transverse Colon
– Descending Colon
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Abdominal Anatomy

Right Lower Quadrant
– Ascending Colon
– Appendix
– Right Ovary (female)
– Right Fallopian Tube (female)
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Abdominal Anatomy

Left Lower Quadrant
– Descending Colon
– Sigmoid colon
– Left Ovary (female)
– Left Fallopian Tube (female)
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Abdominal Anatomy

Periumbilical area
– Located around (peri) the navel (umbilicus)
– Small bowel lies in all quadrants in
periumbilical area

Suprapubic area
– Located just above pubic bone
– Urinary bladder, uterus lie in this area
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Abdominal Cavity


Peritoneum = abdominal cavity lining
Divides abdomen into two spaces
– Peritoneal cavity
– Retroperitoneal space
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Abdominal Anatomy

Peritoneal
–
–
–
–
–
Spleen
Liver
Stomach
Gall bladder
Bowel

Retroperitoneal
–
–
–
–
–
–
–
Pancreas
Kidney
Ureter
Inferior vena cava
Abdominal aorta
Urinary bladder
Reproductive organs
Disease, injury of retroperitoneal organs
often causes back pain
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Abdominal Anatomy

Organs can be classified as:
– Hollow
– Solid
– Major vascular
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Solid Organs




Liver
Spleen
Kidney
Pancreas
When solid organs are
injured, they bleed heavily
and cause shock
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Solid Organs

Liver
– Largest abdominal
organ
– Most frequently
injured
– Fractures of ribs 812 on right side
– Bleeding can be
either:
• Slow, contained
under capsule
• Free into peritoneal
cavity
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Solid Organs

Spleen
– Frequently injured
with trauma ribs 9-11
on left side
– Bleeds easily
– Capsule around
spleen tends to slow
development of
shock
– Rapid shock onset
when capsule
ruptures
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Solid Organs

Pancreas
– Lies across lumbar spine
– Sudden deceleration produces straddle
injury
– Very little hemorrhage
– Leakage of enzymes digests structures in
retroperitoneal space, causes volume loss,
shock
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Hollow Organs




Stomach
Gall bladder
Large, small intestines
Ureters, urinary bladder
Rupture causes content
spillage, inflammation of
peritoneum
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Hollow Organs

Stomach
– Acid, enzymes
– Immediate peritonitis
– Pain, tenderness, guarding, rigidity
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Hollow Organs

Colon
– Spillage of bacteria
– May take 6 hrs to develop peritonitis

Small Bowel
– Fewer bacteria
– May take 24-48 hours to develop peritonitis
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Major Vascular Structures



Aorta
Inferior vena cava
Major branches
Injury can cause severe
blood loss ; exsanguination
(bleeding out)
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Abdominal Trauma



Blunt or penetrating trauma
Most survive to reach hospital
Most common factors leading to death
– Failure to adequately evaluate
– Delayed resuscitation
– Inadequate volume
– Inadequate diagnosis
– Delayed surgery
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High Index of Suspicion





Mechanism
Trauma to lower chest, back, flank,
buttocks, and perineum
Hypovolemic shock with no readily
identifiable cause
Diffusely tender abdomen
Pain in uninjured shoulder
21
Mechanism

Look for signs of injury
– Bruises
– Tire marks
– Obvious open injuries


Assume any abdominal injury is serious
until proven otherwise!
Injury above umbilicus also involves
chest until proven otherwise
22
Unexplained Shock



Assess vital signs; skin color,
temperature; capillary refill
Tachycardia; restlessness; cool, moist
skin
In trauma, signs of shock suggest
abdominal injury if no other obvious
causes present
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Signs of Injured Abdomen


Diffuse tenderness
Pain
– Pain referred to shoulder = Organ under
diaphragm involved (?spleen)
– Pain referred to back = Retroperitoneal
organ involved (?kidney)
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Abdominal Rigidity



NOT reliable
Bleeding may not cause rigidity if free
hemoglobin absent
Bleeding in retroperitoneal space may
not cause rigidity
25
Abdominal Trauma Management



Less important to diagnose exact injury
Treat clinical findings
Management same regardless of
specific organ(s) injured
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Abdominal Trauma Management





Airway
C-Spine if mechanism indicates
High flow O2
Assist ventilations if needed
Give nothing by mouth
27
Impaled Object

Leave in place
– Shorten if necessary for transport
– Leave part of object exposed
28
Evisceration


With large laceration
abdominal contents
may spill out
Do NOT try to
replace
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Evisceration



Cover exposed
organs with saline
moistened multitrauma dressing
Do NOT use 4 x 4s
Cover first dressing
with second DRY
dressing or
aluminum foil
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