The Abdomen & Thorax

Abdominal Anatomy The Abdominal Cavity Lies between the diaphragm and the pelvis Bounded by the lower ribs, abdominal muscles, and vertebral column Contains the abdominal viscera (internal organs)

Abdominal Anatomy Solid Organs Hollow Organs ~ more often & easily injured ~ cause rapid death due to large blood supply which causes internal bleeding ~ spleen, liver, kidneys, pancreas Hollow Organs ~ injuries are rare because tubes are hollow ~ assist in transporting substances from one organ to another ~ stomach, gall bladder, sm & lg intestines, bladder

The Peritoneum A continuous sheath of tissue which covers the entire abdominal cavity and all visceral organs

The Abdominal Quadrants The abdomen is divided into 4 regions – or quadrants: RUQ (right upper quadrant), RLQ (right lower quadrant), LUQ (left upper quadrant), LLQ (left lower quadrant) This makes it easier to locate organs in the abdominal cavity

Right Upper Quadrant Right lobe of liver Gallbladder Right kidney Small Intestine Large Intestine

Right Lower Quadrant Small Intestine Large Intestine Appendix Right Ovary & Uterus (females) Prostate (males) Ureters

Left Upper Quadrant Small Intestine Stomach Spleen Left kidney Large Intestine Part of liver & pancreas

Left Lower Quadrant Small Intestine Portion of bladder Large Intestine Left Ovary & Uterus (females) Prostate (males)

Abdominal Anatomy Stomach Positioned between the esophagus & small intestines Holds and breaks down food for digestion Produces HCl (hydrochloric acid) to break down food into chyme.

Abdominal Anatomy Liver Located under the diaphragm Produces bile enzyme which is important for digesting fats Absorbs excess glucose from the bloodstream and stores it in the form of glycogen Helps to cleanse the body of poisons and waste (detox) Functions can be impaired by alcohol abuse – cirrhosis Hepatitis – inflammation caused by a viral infection..reduces liver efficiency

Abdominal Anatomy Found just beneath the liver Gallbladder Found just beneath the liver Accessory organ to the liver. Storage area for bile produced by the liver Gallstones - solid deposits of cholesterol or calcium salts - sometimes form in some individuals, leading to severe abdominal pain

Abdominal Anatomy Pancreas Found below the stomach surrounded by the intestine Secretes hormones used in the digestive process, particularly insulin and glucagon which lowers and elevates blood sugar levels.

Abdominal Anatomy Spleen Lies between the 9th -11th ribs on the left side Largest of the lymphoid organs Cleanses blood cells from bacteria, foreign matter, viruses, toxins from the blood Storing of excess blood cells for later use Produces red blood cells in the fetus Stores blood platlets Not necessary for survival and is often removed if injured or damaged because of the threat of bleeding from the organ

Abdominal anatomy Small Intestines Approx. 6 feet long Responsible for food digestion Where nutrient exchange takes place

Abdominal Anatomy Large Intestine or Colon Removes undigestable materials and excess water from the body

Abdominal Anatomy Appendix Located in the right lower quadrant of the abdomen near the right hip bone Appendage attached to the large intestine near the beginning of the large intestine Its purpose is unknown Sometimes becomes inflamed (appendicitis) leading to abdominal distress and infection Is usually removed surgically if this occurs

Abdominal Anatomy Kidneys Located at the rear of the abdominal cavity Cleanse blood of toxins and other waste material Produces urine Blood supply is inadequate, can cause hypertension from chemical constriction of body’s blood vessels Responsible for maintaining acid-base in body, which if changed causes body system to shut down eventually resulting in death

Abdominal Anatomy Ureters Bladder Carry urine to the bladder from the kidneys Bladder Stores urine for excretion

Abdominal Muscles Abdominal muscles provide protection for organs Rectus Abdominus Gives “washboard” affect Action – flex the vertebral column

Abdominal Muscles Internal Obliques Action – Laterally flex the vertebral column Rotate vertebral column to the same side

External Obliques Laterally flex the vertebal column to the same side Rotate vertebral column to the opposite side

Transverse Abdominis Holds internal organs in cavity

Anatomy - Thorax Located between the abdomen and the neck Boney structures include: 12 pairs of Ribs Costal cartilage Sternum (breast bone) Xiphoid process Thoracic vertebrae

Thorax Anatomy Internal Organs: Heart Lungs Major Arteries/Veins Pumps blood to the body tissues Lungs Exchanges oxygen and carbon dioxide as blood passes though the lungs Major Arteries/Veins Superior & Inferior AORTA (arter) Superior & Inferior VENA CAVA (vein_ Pulmonary arteries and veins carry blood to/from the heart and lungs

Thorax Anatomy Heart Size of your fist Pumps blood to all parts of the body Divided into 4 chambers Upper chambers – right and left atrium Lower chambers – right and left ventricles A muscular wall called the septum separates the right side from the left side Each chambers have valves. The valves have different names. the tricuspid valve is at the exit of the right atrium the mitral valve is for the left atrium the pulmonary valve is at the exit of the right ventricle the aortic valve is at the exit of the left ventricle. Their purpose is to allow blood to move forward through the heart and to prevent it flowing backwards into the previous chamber.

Thorax Anatomy * The heart muscle contracts in two stages to squeeze blood out of the heart. This is known as systole. * In the first stage, the upper chambers (atria) contract at the same time, pushing blood down into the lower chambers (ventricles). * Blood is pumped from the right atrium down into the right ventricle and from the left atrium down into the left ventricle. * In the second stage, the lower chambers contract to push this blood out of the heart to either the body via your main artery (aorta) or to the lungs to pick up oxygen. * The heart then relaxes – known as diastole. Blood fills up the heart again, and the whole process, which takes a fraction of a second, is repeated. * The heart then relaxes – known as diastole. Blood fills up the heart again, and the whole process, which takes a fraction of a second, is repeated. * In the second stage, the lower chambers contract to push this blood out of the heart to either the body via your main artery (aorta) or to the lungs to pick up oxygen. * Blood is pumped from the right atrium down into the right ventricle and from the left atrium down into the left ventricle. * In the first stage, the upper chambers (atria) contract at the same time, pushing blood down into the lower chambers (ventricles). * The heart muscle contracts in two stages to squeeze blood out of the heart. This is known as systole.

Thorax Anatomy On the right side, the upper chamber fills with oxygen-depleted blood from your body and pushes it via the lower chamber and the pulmonary artery back to the lungs. Here blood picks up oxygen and releases carbon dioxide. On the left side, the upper chamber fills with oxygen-rich blood from the lungs. This is pumped via the lower chamber into the aorta and out to the body to provide cells with the crucial oxygen they need.

Thorax Anatomy Lungs Right side has 3 lobes Left has 2 lobes Function To exchange O2 and CO2 To dissipate heat from the body

Thorax Anatomy Trachea divides into two bronchi Bronchi divide into bronchioles Bronchioles end in alveoli Alveoli are air containing cells of the lungs O2 and CO2 are exchanged here Coughing & sneezing help keep trachea and bronchi clear and remove phlegm and allergy-causing agents from the lungs Respiration Rate Lung function and breathing rate controlled by CO2 receptors If there is too much CO2, inhalation occurs to bring in more O2 Exercise increases cell metabolism Causes cells to need more O2 and eliminate more CO2 With exercise lungs ability to exchange air more efficiently increases Breaths become more deeper and more forceful Return to normal breathing quicker

Thorax Anatomy Pleura Thin lubricated tissue Lines each half of thorax Folded back over the surface of the lung on same side Allow for smooth movement of lungs as they encounter the wall of ribs during inhalation and exhalation

Thorax anatomy The Diaphragm is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavity performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.

Thorax Anatomy Soft tissues include: Major muscles Pectoralis muscle Adducts and rotates the arm Raises the ribs in forced inspiration Upper portion flexes the arm Intercostal muscles Elevate and depress ribs Serratus posterior Elevate ribs during inhalation Depress ribs during exhalation

Abdominal Injuries General Considerations… The abdomen is particularly vulnerable to injury in all contact sports Blows to the area may cause both superficial and/or deep injuries Strong abdominal muscles provide good protection when they are tensed, but when relaxed they are easily injured The concept of “defense posturing” If someone is expecting to be hit in the abdomen, they will tense their muscles to protect themselves. Likewise, if they are having abdominal pain, they will often tense their abdominal muscles in an effort to relieve the discomfort. This is called DEFENSE POSTURING

Abdominal Injuries General Considerations, continued… It is important to protect the abdomen and trunk from injury in collision and contact sports Conditioning is essential – strong abdominal muscles will help reduce the likelihood of injury Proper protective equipment should be worn when indicated or required by the rules of the game, such as in softball and baseball where chest protectors are required Safety rules should always be applied and enforced by officials, coaches, and ATCs.

Abdominal Injuries General Considerations, continued… ALWAYS remember… Any suspected internal injury to the abdomen should ALWAYS be referred to a physician or the hospital emergency room for further evaluation Make sure that the athlete and their parents understand the importance of doing what you advise when referring an athlete for a suspected abdominal injury – it could be the difference between life and and death If in doubt, activate the EMS system and have the athlete transported by an ambulance

Abdominal Injuries Contusions Surprisingly, not particularly common in athletics When they do occur, they are usually seen with sports like football, baseball, or hockey Runningbacks, Catchers, and Goalies are most vulnerable Bruising can occur superficially on the skin or deeper within the muscle tissue or even upon the internal organs The extent of injury is often determined depending upon whether or not the force was blunt or penetrating one Usually larger objects tend to produce blunt forces, whereas smaller objects produce penetrating forces (ie, body to body contact in football vs. ball to body contact in baseball or softball

Abdominal Injuries Contusions, continued… A contusion to the rectus abdominus can be very disabling May lead to the formation of a hematoma under the fascial tissue surrounding the muscle Causes extreme pain and muscle tightness to the area

Abdominal Injuries Contusions, continued… Care and treatment by the ATC should include… Ice and compression to the area of the contusion Evaluation and examination for internal injuries Referral to a physician (if internal injury may be suspected)

Abdominal muscle strains Usually caused by a sudden twisting of the trunk or from reaching overhead for something Can be very incapacitating with severe pain and hematoma formation Care and treatment by the ATC is generally conservative and includes… Ice with a pressure wrap (as tolerated) Gradual return to exercise within pain free limits with an emphasis on flexibility and muscle strengthening Simple rest is essential for recovery from these injuries

Hernias A protrusion of the abdominal viscera through a portion of the abdominal wall There are 2 types of hernias Congenital – developed before birth (birth defect) Acquired – developed as a result of muscle weakness in the abdomen or as the result of an injury to the abdomen

Hernias, continued… Structures of a hernia include… Mouth Neck Body Also known as the hernial ring, it is the opening from the abdominal cavity Neck Portion that joins the mouth and body of the hernia Usually the area that becomes strangled Body Portion of the sac that protrudes outside the abdominal wall

Hernias, continued… Acquired hernias usually exhibit the following signs and symptoms… Previous history of a blow or strain to the groin area that has produced pain and prolonged discomfort Superficial protrusion in the groin area that is becomes larger when coughing Reported feeling of weakness and a pulling sensation in the groin area

Hernias, continued… Hernias may become a problem in athletics due to falls or blows to the lower abdominal area A strangulated hernia may result This occurs when the hernial ring closes tightly over the neck of the hernia cutting of blood supply to the tissues in the body of the hernia leading to tissue death and pain Hernias in the groin area are most common in athletics and known as INGUINAL HERNIAS These are seen most often in males (75%)

Hernias, continued… Care and treatment by the ATC Surgical repair is usually the most appropriate long term care for a hernia that is causing discomfort for an athlete There are medical prosthesis that can be worn in lieu of surgical repair, but they are not always functional in athletics due to the friction and irritation they produce while wearing them Athletes with a suspected hernia should be referred to a physician for further evaluation and care

“Stitch in the Side” An idiopathic (of unknown cause) condition that occurs in some athletes Best described as a cramp-like pain that develops in the right or lower left side of the lower abdomen during physical activity, especially running Causes of this condition are obscure, but some explanations include… Constipation Intestinal gas Diaphragmatic spasm due to poor conditioning Ischemia, or lack of blood flow, to the diaphragm and/or intercostal muscles

Stitch in the Side”, continued… Care and treatment by the ATC includes the following… Having the athlete discontinue their activity Relaxation of the spasm by stretching the arm on the affected side over the athlete’s head Having athlete flex their trunk, resting on the thighs This last method is usually not very effective because it actually reduces oxygen flow to the affected area Why is this? Athletes with recurrent problems may need medical study of their eating habits, bathroom habits, or types of training regimens they are following in order to help identify the cause of their problem

Blow to the Solar Plexus The CELIAC PLEXUS (SOLAR PLEXUS) is a bundle of nerves that controls involuntary movement of the diaphragm and allows us to breath A blow to this structure causes transitory paralysis of the diaphragm This is often referred to as “getting the wind knocked out”

Blow to the Solar Plexus, continued… When this occurs, it causes a loss or respiration leading to anoxia, or a lack of oxygen and can cause the athlete to become quite frightened because of their inability to breath Care and treatment by the ATC includes… Immediately reassure the athlete by speaking to them in a calm but confident manner, helping them to remain calm themselves Loosen the athletes belt or clothing around the abdomen and have them bend there knees Encourage the athlete to relax by initiating short inspirations through their nose and long expirations through their mouth

Appendicitis – Signs/symptoms Inflamation of the appendix Progressively worsening pain Coughing or sneezing is painful Nausea Vomiting Fever Inability to pass gas Constipation Loss of appetite.

Treatment Athletic trainer will have the athlete seek medical attention Monitor vital signs

Ruptured Spleen Most often injured internal organ with blunt trauma The spleen is a sponge-like organ consisting of lymphatic tissue and enclosed by a dense capsule. It stores blood and filters bacteria and other waste matter Injuries to the spleen are usually the result of a fall that jars or a direct blow to the left upper quadrant of the abdomen Mononucleosis and other blood born diseases and infections often enlarge the spleen and predispose and athlete to a spleen injury Athletes with a recent history of these conditions should not participate in contact or collision sports unless cleared by a physician

Ruptured Spleen, continued It is extremely important that ATCs know the signs and symptoms of a spleen injury Failure to recognize these signs could lead to death if the athlete does not receive timely medical care Signs and symptoms include… History of severe blow to the abdomen, particularly in the upper left quadrant Possible shock Abdominal rigidity and/or guarding Nausea and/or vomiting Reflex pain occurring approximately 30 minutes after the initial injury. This is called Kehr’s Sign and is indicated by pain which radiates from the LUQ to the left shoulder and sometimes 1/3 the length of the left arm

Ruptured Spleen, continued It is also important to understand and recognize that the spleen as the ability to “splint” itself This involves producing a blood clot that may delay hemorrhage Any slight strain or jarring movement, however, may disrupt this “splint” leading to massive internal bleeding and possible death Care and treatment by the ATC includes… Immediate referral to the hospital emergency room via ambulance transport if a spleen injury is suspected

Kidney Contusions The kidney’s sit at the back of the abdominal cavity, with one on each side of the spine Contusions are usually caused by a severe outside blow or force to the area Signs and symptoms of a kidney contusion include… Possible shock (in severe cases) Nausea and/or vomiting Rigidity of back muscles Blood in the urine (hematuria) Possible referred pain high in the back or into the anterior abdominal region

Kidney Contusions, continued… Care and treatment by the ATC includes… Instructing the athlete to urinate 2-3 times and to look for blood in the urine If blood is present, referral to a physician for evaluation Application of ice to the area for treatment of superficial pain

Rib Contusions Usually caused by a blow to the rib area Usually involves the intercostal muscles and/or the bony structure of the ribs Since intercostal muscles are essential to breathing, injury to them will cause pain and discomfort with breathing Characteristically, the pain is sharp in nature with inspiration and there will also be point tenderness present over the injured area

Rib Contusions, continued… Care and treatment by the ATC includes… Ice, compression, and rest Referral to a physician for x-rays and evaluation Anti-inflammatory medications per physician orders and local protocol Fitting the athlete for rib protectors when appropriate and/or necessary

Rib Fractures Not uncommon in sports Seen most often in contact/collision sports like wrestling and football Can be caused a direct blow or indirect trauma Violent muscle contraction Violent coughing Vomiting, etc

Rib Fractures, cont’d… Direct fractures are the most dangerous With this type of fracture, the rib bones fracture and displace inward The jagged edges of the bone can then lacerate internal tissues and organs such as the lungs, liver, spleen, heart, etc.

Indirect Rib Fractures Usually occur outward Produces an oblique and/or transverse fissure in the skin, that can be observed or palpated Signs and symptoms of rib fractures include… Discoloration and bruising in the chest area Severe pain on inspiration Point tenderness over the injured area Possible crepitis on palpation Difficulty breathing (in some cases)

Care and treatment for rib fractures and related injuries by the ATC should include… Application of ice Application of a splint to the rib cage to immobilize Referral to a physician for x-rays and further evaluation Decreased or stopped activity until ribs have healed Generally 3-4 weeks for simple fractures IF A PNEUMOTHORAX, HEMOTHORAX, OR FLAIL CHEST IS SUSPECTED EMS SHOULD BE ACTIVATED AND THE ATHLETE SHOULD BE TRANSPORTED TO THE HOSPITAL AS SOON AS POSSIBLE

Complications of Rib Fractures include… Hemothorax Involves blood filling the chest cavity, creating pressure on the heart and lungs, eventually causing the lung to collapse Usually occurs as the result of blunt trauma, such as is seen with a rib fracture

Complications of Rib Fractures include… Pneumothorax Results when air enters the chest cavity but does not enter the lung The pressure of the air in the chest cavity presses against the lung, causing it to collapse Air can enter the chest cavity two ways From an open wound in the chest From a laceration in the lung

Complications of Rib Fractures include… Tension Pneumothorax Usually occurs after a pneumothorax When the lung has collapsed as much as it possibly can, the pressure continues to build in the cavity causing the collapsed lung to press against the heart and the other lung This causes the remaining lung to start collapsing and the extremely high pressures also prevent the return of blood to the heart from the veins This is true life threatening emergency

Complications of Rib Fractures include… Flail Chest Results when the chest wall becomes unstable due to fractures of the sternum, ribs, or cartilage Usually only occurs when there are fractures to 3 or more ribs next to each other With a flail chest, the athlete will exhibit paradoxical breathing When they inhale, the injured area will not expand like the rest of the chest When they exhale, the injured area will protrude while the rest of the chest retracts

Sternal fractures Very rarely seen in athletics Result from a direct blow to the sternum, with a violent compressive force applied posteriorly, or from hyperflexion of the trunk Signs and symptoms include… Sharp chest pain occurring on inhalation and localized over the sternum The head and shoulders will be drooped forward Mild swelling and displaced bone fragments may be evident with physical examination

Sternal fractures, continued… Care and treatment by the ATC should include… Application of ice to the injured area Referral for x-rays and evaluation by a physician After return to activity, a posterior figure-8 wrap may be applied to help maintain the shoulders in an erect position The use of protective padding may also be appropriate to reduce the likelihood of reinjury The athlete with this condition will most likely be confined to bed rest for 2-3 weeks with immobilization

Costochondral Separation and Dislocation A separation of the cartilagenous connections between the ribs and the sternum Has a higher incidence than fractures in sports Can be caused by a direct blow, a sudden twisting motion, or by falling on an object

Costochondral Separation and Dislocation Signs and symptoms include… Similar to those seen with rib fractures The major difference being that pain is localized at the junction of the rib bone and rib cartilage or at the junction between the rib cartilage and the sternum Care and treatment by the ATC includes… Application of ice Referral to a physician for x-rays and evaluation in severe cases The use of anti-inflammatory medications per physician direction and/or local protocol Reduced or stopped activity Rest and immobilization Healing usually takes 6-8 weeks with no sports activity

Muscle Injuries Usually occur in the form of muscle contusions or muscles strains Can range in severity from very minor to very significant Typical care and treatment by the ATC involves… Application of ice and compression to the injured area Reduction of activity until pain as subsided Protective padding and/or support for the injured area In severe cases, referral to a physician for further evaluation and care

Traumatic Asphyxia Occurs as the result of a violent blow to, or a compression of, the rib cage Causes cessation of breathing and also forces blood back into the veins Signs and symptoms Cyanosis Bright red conjuctiva in eyes Care and treatment… Immediate activation of EMS Begin CPR immediately

Heart Contusion Occurs when the heart is compressed between the sternum and the spine Often seen in baseball and weight lifting Injury produces shock and severe chest pain Care and treatment includes… Immediate activation of EMS Monitoring vital signs Treating for shock Possible CPR

Myocardial Infarction (Heart Attack) and other Sudden Cardiac Events More commonly seen in athletic activities than one may think There have been numerous high profile cases in recent years where athletes have died from sudden cardiac arrest or heart attacks Athletes complaining of severe chest pain with no other logical explanation or causation should be suspected of suffering from some type of cardiological disorder These athletes should be immediately referred to their family physician or the hospital emergency room for further evaluation and treatment

Thorax injuries Hypertrophic Cardiomyopathy Causes Signs/Symptoms Congenital Abnormalities Abnormal coronary arteries Marfan Syndrome Signs/Symptoms Chest pain, syncope (fainting), dizziness, palpitations, fatigue, shortness of breath Treatment Evaluation by physician

ALL DONE ????