The abdominal cavity contains the major organs of which body systems? (3)
-digestive
-urinary
-endocrine
What surrounds the abdomen superiorly, inferiorly, anteriorly, and posteriorly?
superiorly: diaphragm
Inferiorly: The heavy bony pelvic ring
Anteriorly: Tough, thick, flat muscles form the bulk of the border along with the lower portion of the rib cage
Posteriorly: the spinal column and strong muscles provide protection
What are the layers of the abdomen? (2)
Inner: visceral peritoneum (supports the organs)
outer: parietal peritoneum (adheres to the walls of the abdomen)
*between the two layers is a small amount of fluids that serves as a lubricant to reduce friction
What is the potential space between the visceral and parietal peritonea called?
peritoneal space
Some organs in the posterior abdominal cavity lie partially or completely behind the peritoneum, they are said to be retroperitoneal or located in the retroperitoneal cavity. List the organs located in the retroperitoneal cavity? (6)
-duodenum
-pancreas
-inferior vena cava
-aorta
-kidneys
-ureters
What are the different types of abdominal organs are structures found? (3)
-vascular
-hollow
-solid
What are the hallow organs found in the abdominal cavity? (8)
-Stomach
-Gallbladder
-Urinary bladder
-Ureters
-Internal urethra
-Fallopian tubes
-Small intestine
-Large intestine
True or false. hallow organs leak substances such as blood?
False. they do not bleed very much but it is true that spill their contents into the abdominal cavity, commonly leading to peritonitis.
*leaking substances ex: gastric juices from the stomatch, highly acidic and partially digested food from upper small intestine, bacteria from large intestine, or urine from bladder
*Leakage of acidic substance leads to pain but this is not found in leakage of bacteria because it is not acidic but leakage of bacteria can cause infection of the peritoneal lining; hence leading to a complaint of pain. delay of pain could be hours.
What is peritonitis?
irritation and inflammation of the peritoneal lining
What are solid organs found within the abdominal cavity? (4)
-Liver
-Spleen
-Pancreas
-Kidneys
What is the major complication associated with laceration or tearing of a solid organ?
major hemmorhage and severe shock. solid organs are vascular and bleed into the capsule that surrounds it until rupture; hence allowing blood to leak into abdominal cavity
What is Kehr sign?
refered pain to the shoulder found in solid organ injury. the blood ruptures the capsule and leaks into the abdominal cavity. since blood ins not irritating to the peritoneal lining, it may not cause severe abdominal pain, however, the blood might irritate the diaphragm and cause refered pain to the shoulder.
What are vascular structures that lie parially within the abdominal cavity? (2)
-abdominal aoarta and its braches
-inferior vena cava
In addition to the abdominal aorta and inferior vena cava, many large arteries and veins supply the abdominal organs. These organs are primarily stationary, large, and very vascular. If injuried, it will cause great hemmoraghe and lead to shock and death. S/S associated with major abdominal vascular injury are those of hemmorhage shock. This patient can deteriorate quickly. true or false.
true
What is the diaphragm?
A muscle that separates the thoracic and abdominal cavities. The diaphragm forms the upper border of the abdominal cavity and lower border of the thoracic cavity.
Location of the diaphragm during inhalation and Exhalation?
Exhalation: approx level of 4th or 5th intercostal space (nipple line)
Inhalation: moves lower as much as 3 inches or two rib spaces
How responsible is the diaphragm for breathing percentage wise? range
60-70%
*diaphragm injuries will likely cause respiratory distress and if severe, the abdominal contents can enter the thoraic cavity. In this case, breath sounds would be decreased on the side of the injuried diaphragm, bowel sounds may be heard in the chest, and the abdominal contents within the thorax may further compromise breathing
What is an abdominal evisceration?
Occurs when an open wound through the abdominal wall allows abdominal contents, usually the small intestines, to protrude and be exposed.
*most commonly associated with penetrating injury
*To treat, protect exposed organs from further injury or contamination AND do not attempt to replace organs
science size up
- look for MOI gun or kife and estimate charteristics (cabilar/length of bullet/knife)
-abdominal wounds are not obvious, expose them
-Motor vehicle collision most common blunt trauma cause
*alcohol intoxication and drugs can reduce a patient pain sensitivity
When a motor vehicle collision is involved, what should you attempt to determine?
-type of vehicle
-speed
-type of collision/point of impact
-patient role (driver, pedestrian, etc)
-where and position patient was found in
-where the patient was thrown
-impact marks to objects (windshield, steering wheel, dashboard, airbag deployment)
-if seat belt was used and if used propelry
primary
-normally, patient is found with abdominal injury lying extremely still with knees flexed up toward chest (decreases tension on abdomen muscle and reduces pain)
-do SMR if spinal injury is suspected
-do MARCH
-radial pulse may be weak/absent due to bleeding
-HR is normally increased bradycardia
-skin pale, cool, moist, maybe
secondary
-no tunnel vision, do rapid secondary and search for other possible injuries that may not be obvious (could be done en route to hospital in critial patient)
-look for contusions, lacerations, abrasions, and punctures in the abdomen
-it takes 1-2 liters of blood to expand abdominal girth by 1 inch (blood lost in abdomen)
-abdominal guarding
-palpate at point furthes from pain, don’t lose childerns trust
-abdominal aortic injury can make pulse of lower extremitiy weaker than upper extremity
-check popliteal pulse or femoral pulse if no pedopulse can be found
-check for PMS
-log roll and inspect back
-shock= low BP, high HR
-abdominal injuries lead to faster breathing and shallow
-OPQRST
S/S of those with abdominal injury
-contusions, abrasions, lacerations, puntures, or other signs of blunt/penetrating trauma
-worseing pain that may have started mildly
-tenderness on palpation to other areas besides sit of injury
-rigid abdomen
-lying with legs drawn up to chest
-distended abdomen
-discoloration around umbilicus or to the flank (LATE FINDING)
-rapid shallow breathing
-signs of hemmoraghic shock
-nausea and vomiting, possible blood
-abdominal cramping
-pain radiating to shoulder, both or one (kehr sign) due to irritation of diaphragm
-weakness
Treatment for a abdominal evisceration? 5 steps
- expose the wound (cut away clothing. Do not touch or attempt to replace organs)
2.position the patient (on his back and flex the legs toward the chest if spinal injury is not suspected) - Prepare a clean, sterile dressing (by soaking it with saline or sterile water. apply it over organs. DO NOT USE ABSORBENT COTTON OR ANY OTHER MATERIAL THAT MIGHT CLING TO ORGANS WHEN WET LIKE PAPER TOWELS OR TP)
- Cover the moist dressing with an occlusive dressing (to retain moisture and warmth, plastic wrap will do. avoid aluminium foil if possible. It can lacerate the organs. secure dressing in place with tape, cravars, or a bandage
5.Administer O2. >95%
