ABDOMINAL TRAUMA
INTRODUCTION
• It an injury to the abdomen. It is one of the leading causes of
death and disability.
• Identification of serious intraabdominal injuries is often
challenging. Many injuries may nor manifest during the initial
assessment and treatment period.
ANATOMY OF THE ABDOMEN
• The abdomen is the body space between the thorax and the pelvis. It
consists of the anterior abdomen, the flank and the posterior abdomen.
• The abdomen contains all the digestive organs. It also houses the kidneys
and spleen. These organs are at risk of injury because they have few bony
structures to protect them.
• Many important vessels travel through the abdomen. They include the
abdominal aorta, the inferior vena cava and their branches.
ANATOMY OF THE ABDOMEN
The abdomen is divided into four or nine quadrants as shown below;
TYPES OF ABDOMINAL TRAUMA
According to type of structure injured
i. Abdominal wall
ii. Solid organ (liver, pancreas, kidney)
iii. Hollow viscus (stomach, small intestines, colon, uterus and bladder)
iv. Vasculature
TYPES OF ABDOMINAL TRAUMA
CONT’
According to mechanism of injury
i) Blunt trauma (no break in the skin)
• Attributed to collisions between the injured person and the
external environment. May involve;
A direct blow e.g. Kick
Impact with an object e.g. Fall on an object
Deceleration forces e.g. Sudden stop of a car
Fall from height
TYPES OF ABDOMINAL TRAUMA
CONT’
According to mechanism of injury Cont’
ii) Penetrating trauma
• Occurs when a foreign object pierces skin
• May or may not penetrate the peritoneum
• May be a gunshot wound or a stab wound
• The spine may also be injured
CAUSES
• RTA; accounts to 50-75% of causes
• Falls and sports
• Stab wounds
• Gunshots
• Recreational accidents
PATHOPHYSIOLOGY
• Blunt or penetrating trauma may lacerate or rupture intra-abdominal
structures.
• It may also cause a hematoma in a solid organ or the wall of a hollow
viscus.
• Internal hemorrhage may occur; it may be intraperitoneal or
retroperitoneal. Organs in the retroperitoneal space can bleed profusely,
blood accumulation in the space may lead to hypovolemic shock.
PATHOPHYSIOLOGY CONT’
• Solid organs such as the liver and kidneys, bleed profusely when
cut or torn. The same case is seen in the major blood vessels.
• Hollow organs such as the stomach may not likely to bleed but
may result to serious infection if not treated, due to spillage of
content into the abdominal cavity leading to sepsis.
• Gastrointestinal organs such as large intestines may also spill their
contents in the abdominal cavity and lead to a systematic injury;
peritonitis.
SIGNS AND SYMPTOMS
• Abdominal pain is typically present but mild and mostly obscured by other
more painful injuries e.g. fractures or by altered sensorium due to head
injury
• Nausea and vomiting
• Haematuria
• Fever
• Abdominal tenderness and distension
• Leakage of bile
SIGNS AND SYMPTOMS CONT’
• Diminished or absent bowel sounds
• Rigidity to touch
• Pneumoperitoneum. Air or gas in the abdominal cavity; may indicate
rupture of a hollow organ
• Evisceration. Protrusion of internal organs out of a wound; in a protruding
wound.
• Seatbelt sign. Occurs in RTA victims; ecchymosis and or abraded skin in
the distribution of a seat belt.
DIAGNOSIS
1. Health history
2. Physical examination
a) Inspection
• Penetrating injuries
• Ecchymosis e.g. seatbelt sign or the Cullen sign
• Abdominal distension
DIAGNOSIS CONT’
2. Physical Exam Cont’
b) Auscultation
• Auscultate for bowel sounds. Absence may indicate underlying
injury. If they are heard in the chest cavity, this indicates tear in
the diaphragm.
c)Palpation
• Abdominal tenderness
DIAGNOSIS CONT’
3 Imaging
a) Ultrasonography; The focused assessment with sonography in
trauma (FAST). Done during initial assessment without moving
the patient.
The primary aim is to find abnormal pericardial fluid or
intraperitoneal free fluid.it is directed in 4 regions;
i. Right upper quadrant to view liver, kidney and diaphragm
ii. Left upper quadrant to view diaphragm, spleen and kidney
iii. Subxiphoid to view fluid in pericardial cavity
iv. Suprapubic to view bladder
DIAGNOSIS CONT’
3. Imaging Cont’
b) Chest x-ray. To look air under the diaphragm indicating perforation of a
hollow viscus
c) Pelvic x-ray
d) Abdominal CT scan
DIAGNOSIS CONT’
4. Laboratory tests
a) Urinalysis to detect hematuria
b) Complete blood count to identify the hematocrit levels
5. Exploratory laparotomy done for gunshot wounds that are serious i.e.
hemodynamic instability.
6. Laparoscopy may also be done. These are diagnostic as well as
therapeutic interventions.
7. Diagnostic peritoneal lavage: Used to detect hemoperitoneum and help
determine need for laparotomy following abdominal trauma
MANAGEMENT
• Assessment of abdominal trauma requires the identification of immediate
life-threatening injuries on primary survey, and delayed life threats on
secondary survey (head to toe assessment).
• ABCDE approach (primary survey)
• IV fluid resuscitation; alternating with RL- to avoid hypovolemia
• Monitor blood pressure and heart rate
• Ensure hemodynamic stabilization
MANAGEMENT CONT’
• Keep patient nil per oral in the initial past resuscitation
• Pain management; administer opioids and analgesics
• Tetanus immunization especially in penetrating wounds
• Frequent assessment
Management if object is still in
• Hold wound edges together; do not try to remove the object.
• If organs are eviscerated; do not try to replace them instead cover
with wet sterile gauze and cotton wool dipped in warm saline.
• Used normal saline to clean abdomen; avoid sticking objects e.g.
fingers, cotton swabs
NURSING MANAGEMENT
1. Fluid volume deficit: Monitor vital signs (BP/HR). Assess for internal or
external bleeding. Give IV fluids as prescribed. Blood transfusion, if
indicated. Monitor input and output.
2. Risk for infection: Monitor vital signs (temp), observe aseptic techniques
and administration of antibiotics as prescribed
3. Pre- and post-operative nursing management
4. Ineffective tissue perfusion
COMPLICATIONS
• Hematoma rupture
• Intraabdominal abscess; mainly occur after surgery, trauma or infection
due to bowel obstruction or ileus
• Biliary leakage
• Abdominal compartment syndrome
