THE ABDOMEN Chapter 16

THE ABDOMEN Abdominal injuries occur infrequently; however, they might be life-threatening Many times even serious injuries to the abdomen do not become apparent for days.

The abdominal cavity lies between Anatomy of the Abdomen The abdominal cavity lies between The lumbar spine posteriorly The diaphragm superiorly The abdominal musculature anteriorly The pelvis inferiorly

I. It is divided into four quadrants by an imaginary horizontal line through the navel and an imaginary vertical line running from the sternum, through the navel to the area between the legs.

1. located just below the ribs on person‘s right side 4 Quadrants A. Upper Right Quadrant 1. located just below the ribs on person‘s right side

2. Houses the: a. Bulk of liver b. Part of the pancreas c. Right kidney d. Gallbladder e. Small & large intestine

1. Lies just below the ribs on person‘s left side 4 Quadrants B. Upper Left Quadrant 1. Lies just below the ribs on person‘s left side

2. It contains the a. Stomach b. Part of the liver c. Portion of the pancreas d. Left kidney e. Spleen f. Small and large intestine

Just above the pelvis on the right side of the body 4 Quadrants C. Lower Right Quadrant Just above the pelvis on the right side of the body

2. Contains the a. Small and large intestine b. Appendix c. Part of the bladder d. Uterus and right ovary in females e. Prostate in males

1,500-3,000 sperm produced every second 4 Quadrants D. Lower Left Quadrant ~ Houses the a. Small and large intestine b. Portion of the bladder c. Uterus and left ovary in females d. Prostate in males Fun Fact: 1,500-3,000 sperm produced every second

II. Some of these organs are hollow and some are solid. Anatomy of the Abdomen II. Some of these organs are hollow and some are solid. A. Hollow organs are basically tubes that assist in transporting substances

Fun Fact: Small Int = 22 feet 1. Bladder, intestines, stomach, and appendix 2. Usually move to the side when hit, therefore injuries to these organs rarely causes rapid death Fun Fact: Small Int = 22 feet Large Int = 5 ft

Anatomy of the Abdomen B. Solid organs are composed of the liver, kidneys, pancreas, and spleen 1. Injuries to these organs present a medical emergency

2. Contain large amounts of blood which means that a person can bleed to death rapidly.

III. Abdominal organs can be divided into three categories A. Digestive organs Stomach, small and large intestine, appendix Liver, Pancreas, Gallbladder Dont actually touch the food produce enzymes to aid in digestive process

Kidneys, ureters, & bladder C. Reproductive Organs Fun Fact:Male sperm is the smallest cell in the body and the female egg is the largest. B. Urinary organs Kidneys, ureters, & bladder C. Reproductive Organs ~Males: prostate & seminal vessicles ~Females: ovaries & uterus

Fun Fact: Filter 3 pints of blood per minute Organs of the Abdomen Fun Fact: Filter 3 pints of blood per minute I. KIDNEYS: A. Located approximately in the center of the back.

B. They are BEAN SHAPED with the right kidney usually being slightly lower than the left because of the pressure of the liver. C. Function: Filter blood and remove waste products of metabolism

Anatomy of the Abdomen II. SPLEEN A. Located under the diaphragm on left side and behind ribs 9, 10, and 11.

B. Main functions of the spleen: Reservoir of blood Anatomy of the Abdomen B. Main functions of the spleen: Reservoir of blood 1. Regulate number of Red Blood Cells Production of new RBC Destruction of ineffective RBC 2. Production of antibodies

Fun Fact: Liver is thought to have 100 functions. III. LIVER A. Functions of the Liver 1. Detoxification of chemicals (eg.alcohol) 2. Storage of vitamins 3. Production of bile ~ Assistance w/food metabolism Fun Fact: Liver is thought to have 100 functions.

A. Functions of the Stomach Anatomy of the Abdomen IV. STOMACH A. Functions of the Stomach 1. Secretion of gastric jiuces to break down food before it enters the intestines

V. Gall Bladder A. Located at the liver Anatomy of the Abdomen 1. Storage tank for bile which is passed into small intestine to assist in digestion of fats

A. Produces insulin and enzymes important for digestion Anatomy of the Abdomen VI. Pancreas A. Produces insulin and enzymes important for digestion

VII. MUSCULATURE A. Although the liver & the spleen are protected in part by the inferior portion of the ribs, the abdominal musculature & fat provide most of the protection for the abdominal organs.

B. Main muscles include: 1. Rectus Abdominis 2. Obliques (internal and external)

1. Rectus Abdominis MUSCULATURE a. Extends from the sternum and lower ribs to the pelvis b. Action = trunk flexion c. When well developed appears in form of a washboard or 6-pack

MUSCULATURE 2. Obliques a. Run from the side of the ribs to the anterior pelvis b. Perform rotation and lateral flexion of the trunk, and assist in trunk flexion c. Internal are deeper than external

INJURIES TO THE ABDOMEN Contusions can occur through direct blows Strains can follow sudden twisting of the trunk or reaching overhead. Both these injuries can be very disabling

INJURIES TO THE ABDOMEN Injuries w/in the abdominal cavity, especially to the hollow organs, are rare The solid organs can be injured, resulting in internal bleeding and a possibly life-threatening condition

Signs and Symptoms of serious abdominal injury are: Abdominal pain, signs of shock, muscle rigidity (spasms), or blood in urine

INJURIES TO THE ABDOMEN I. Spleen Injuries A. A blow to the abdomen can cause the spleen to rupture

B. Signs and Symptoms Abdominal pain; pain in left shoulder (referred pain) called KEHR‘S SIGN; possibly nausea, vomiting, cramping and weakness; abdominal rigidity; signs of shock

C. Treatment Call 911 Athlete may bleed severly internally,causing rapid blood loss and a drop in blood pressure, which can lead to death

INJURIES TO THE ABDOMEN II. Pancreas Injury A. The pancreas is prone to tearing during deceleration, eg. an athlete hitting a wall The body stops suddenly but the internal organs are still shifting forward (like whiplash)

B. Signs and Symptoms Pain in middle of abdomen to the back, nausea and vomiting, signs of shock C. Treatment ~ Call 911 ~ Ruptured pancreas must be surgically repaired

INJURIES TO THE ABDOMEN III. Kidney Injury A. A direct blow to the area of the kidneys can cause contusion, laceration, or rupture

B. Signs and Symptoms Pain just under the posterior ribs to the side of the spine, which may radiate to the bladder

Pain will increase with trunk extension and decrease with knee and hip flexion Possibly nausea, vomiting , or blood in urine C. Treatment ~ Call 911

INJURIES TO THE ABDOMEN IV. Hernias A. A lump of tissue, usually in the intestine, that bulges through a weakness in the abdominal wall.

B. Caused by increased pressure (holding your breath while weight-lifting or going to the bathroom)

INJURIES TO THE ABDOMEN C. If untreated, the hernia can get stuck which may lead to strangulation Cuts off blood supply, therefore the tissue will eventually die

D. If the intestine is involved a bowel obstruction can result Obstruction prevents waste material from passing through the body, causing pain and illness

INJURIES TO THE ABDOMEN E. Signs and Symptoms Possibly pain Possibly a lump in the groin area, which may disappear when lying down and re-appear when standing up

When untreated, gangerine and possible death may occur

INJURIES TO THE ABDOMEN Treatment Surgical Repair Temporarily a truss can be worn to apply external pressure to keep the bulge inside the abdomen Pictures are next!

INJURIES TO THE ABDOMEN V. Liver Injuries A. A blow to the right upper quadrant can lead to a liver contusion or rupture Fun Fact: liver weighs 3-5 pounds

B. Signs and Symptoms Pain in right upper quadrant which might radiate into right shoulder, signs of shock C. Treatment Call 911

INJURIES TO THE ABDOMEN VI. Side Stich A. Pain in upper abdominal region, just below the ribs

1. a lack of O2 to abdominal muscles B. Typically caused by: 1. a lack of O2 to abdominal muscles 2. improper breathing technique 3. eating just before exercising 4. trapped air in abdominal organs, or 5. muscle spasms 6. Dehydration

C. Usually occurs more frequently in unfit indviduals D. May be resolved by stopping exercise and applying direct pressure over the area and controlled breathing

Chapter 16 Special Tests

Appendicitis Test PT: laying supine EX: standing at the right side of pt. Find ASIS and move 1 inch towards belly button. (McBurney’s Point) Push straight down and hold 1-2 seconds Release quickly Positive – Pain on release

Abdominal Palpation PT – lying supine with knees bent Positive rigidity of muscles Muscle guarding, accumulation of blood pain rebound tenderness EX: appendicitis tissue density Accumulation of blood (internal bleeding) Specific organ issue

Vital Signs Heart Rate Blood pressure Breathing Rate Facial Color Temperature

Rib Compression PT: standing, lying, or sitting with good posture EX: standing next to patient 1. Hands on front and back right then left 2. Hands on sides Positive: excess movement and/or pain