Abdominal/Thorax Unit 1

ABDOMINAL CAVITY ANATOMY 2

Terminology Absorption: a process where digested food moves into the bloodstream to be used throughout the body Antibodies: a type of cell produced by the spleen to defend the body against foreign cells Bile: a substance produced by the liver that neutralizes the acid of the stomach and helps digest fat in the small intestine 3

Terminology Chyme: a semi-liquid substance formed when ingested food is mixed with digestive fluids from the stomach Detoxify: the process of breaking down harmful chemicals Diaphragm: a large muscle located between the chest and the abdomen that helps control breathing 4

Abdominal Cavity Borders Anterior – Abdominal musculature Posterior – Lumbar spine Superior – Diaphragm Inferior – Pelvis 5

The Abdominal Cavity Divided into 4 quadrants which intersect at the navel – Upper right – Upper left – Lower right – Lower left 6

The Abdominal Cavity Contains organs from 3 body systems – Digestive – Urinary – Reproductive 7

The Liver Secretes bile for digestion Detoxifies harmful chemicals 8

The Gall Bladder Stores bile from the liver used in digestion 9

The Pancreas Produces insulin & glucagon Secretes pancreatic juice for digestion 10

The Kidneys Filter blood from the rest of the body & excrete waste products in the form of urine 11

The Stomach Food mixes with secretions to form chyme 12

The Spleen Stores and regulates the number of red blood cells in the body Produces antibodies 13

Small Intestine The majority of digestion and absorption occurs here 14

Large Intestine Final digestion and absorption of food occurs Chyme is converted to feces to be expelled 15

Urinary Bladder Stores urine 16

Abdominal Organs Solid organs – Organs that contain a large blood supply – Injury to these organs is generally life-threatening – Examples: liver, kidneys, spleen & pancreas Hollow organs – Organs that are able to bend & move – Injury to these organs is less serious – Examples: stomach, intestines, appendix 17

THORACIC CAVITY ANATOMY 18

Terminology Atrium: upper chamber of the heart Intercostal: refers to the area between the ribs Thorax: the chest; the part of the body located between the neck and the abdomen Ventricle: lower chamber of the heart 19

Thoracic Cavity Borders Superior – Clavicle Inferior – Diaphragm Anterior – Sternum, ribs and intercostal muscles Posterior – Spine, ribs, scapulae & erector spinae muscle 20

The Rib Cage 21

The Rib Cage 12 pairs of ribs – True ribs (first 7 pairs): attach directly to the sternum by individual cartilage – False ribs (next 3 pairs): attach indirectly to the sternum by shared cartilage – Floating ribs (next 2 pairs): have no attachment to the sternum 22

Organs in the Thoracic Cavity Esophagus Trachea Lungs Heart 23

The Esophagus Location: – In the throat, behind the trachea Function: Structure for food to pass from the mouth to the stomach 24

The Trachea Location: – A cartilage structure in the throat, directly in front of the esophagus – The trachea divides into 2 branches (bronchi) which enter the lungs Function: – Allows air to pass into and out of the lungs 25

Divisions of the Respiratory System 26

The Lungs 27

The Lungs Location: On either side of the heart Functions: Exchange carbon dioxide for oxygen Help to remove heat from the body 28

The Heart Location: – Under the sternum (slightly to the left) and between the lungs Function: to pump blood throughout the body – Blood carries oxygen and nutrients to the cells – Blood carries carbon dioxide and waste products away from the cells 29

The Heart 30

The Heart Divided into 4 chambers – R and L atrium (upper chambers) – R and L ventricles (lower chambers) Heart valves separate each chamber and prevent a backflow of the blood – Tricuspid valve – Biscuspid (mitral) valve – Pulmonary valve – Aortic valve 31

ABDOMINAL INJURIES (EXTERNAL) 32

Terminology Hernia: a section of abdominal tissue comes through the abdominal wall Solar plexus: a group of nerves in the upper part of the abdomen that control breathing 33

Abdominal Injuries 1. Contusion / solar plexus injury 2. Abdominal strain 3. Hernia 4. Testicular pathology 34

Contusion / Solar Plexus Injury Mechanism – A blow to the area causes a contusion or temporary paralysis of the diaphragm muscle (“wind knocked out”) Signs & Symptoms – Pain – Temporary breathing difficulty - usually resolves quickly but may result in loss of consciousness with more serious injury Treatment – Reassure the athlete – Loosen any restrictive clothing / padding – Apply ice for contusion – Monitor athlete for possible complications including shock 35

Abdominal Strain Mechanism – Hyperextension or reaching over head (rectus abdominis) – Twisting / over-rotation, ie, baseball pitcher (obliques) Signs & Symptoms – Pain that increases during movement – Possible swelling / discoloration Treatment – Follow RICE – Gentle stretching / strengthening – Gradual pain-free return to activity 36

Hernia Mechanism – Increase in abdominal pressure, such as holding one’s breath during weightlifting Signs & Symptoms – Deformity – bulge in abdominal area – Pain (usually decreases while lying & increases while standing) – Increase in pain with activity Treatment – Temporary – strap to put pressure over the area – Surgery needed for repair, followed by extended recovery period – Untreated may lead to tissue strangulation and death 37

Testicular Pathology Explanation – Injury to reproductive organs are more common in males because the genitalia of males are exposed. Mechanism: – Direct blow to the area or twisting mechanism (cut to the side while foot is planted) Signs & Symptoms: – Acute testicular pain – Localized swelling – Nausea / vomiting possible Treatment: – Ice for contusion or area – Refer if pain doesn’t resolve or increases after 20 minutes – Need prompt medical attention to prevent atrophy/ other complications 38

ABDOMINAL INJURIES (INTERNAL) 39

Kehr’s sign: radiating pain in the left shoulder and arm, resulting from an injury to the spleen Referred pain: pain that begins in one area, but is felt in another area of the body 40 TERMINOLOGY

Internal Abdomen Injuries 1. Kidney contusion / laceration 2. Liver contusion 3. Spleen rupture 4. Pancreas injury 41

Kidney Contusion / Laceration Mechanism – Direct blow over area results in a contusion, laceration or rupture of the kidney Signs & Symptoms – Pain under – Pain with trunk extension + hip and knee flexion – Blood in urine – Monitor for shock – Nausea, vomiting Treatment – Call EMS – Treat for shock – Surgical repair required – Long-term complications may include tissue scarring, hypertension 42

Liver Contusion Mechanism – Blow to area (more vulnerable during hepatitis) Signs & Symptoms – Abdominal pain & referred pain in R shoulder – Rapid blood loss resulting in shock, weak pulse, ↓ blood pressure Treatment – Call EMS – Treat for shock – Surgical repair required 43

Spleen Rupture Mechanism – Fall or direct blow to upper left quadrant (more likely to rupture when enlarged or infected, i.e., mononucleosis) Signs & Symptoms – Abdominal pain – Pain in L shoulder (Kehr’s sign) – Shock, progressing to loss of consciousness (LOC) – ↑ heart rate, ↓ blood pressure – Nausea, abdominal spasms & cramping Treatment – Call EMS – Treat for shock – Generally requires surgical removal – Unable to participate in contact sports 44

Pancreas Injury Mechanism – Deceleration injury – Occurs when athlete is running and hits a wall, causing pancreas to change directions suddenly Signs & Symptoms – Pain in middle abdomen to back – Signs of shock – Vomiting / nausea Treatment – Call EMS – Treat for shock – Requires surgical repair 45

THORACIC INJURIES 46

Apnea: temporary stopping of breathing Asthma: condition in which the air passages constrict in response to a stimulus Dyspnea: difficulty breathing Hemothorax: blood in the thoracic cavity Pneumothorax: air in the thoracic cavity due to a collapsed lung TERMINOLOGY 47

Thoracic Injuries Rib contusion / fracture Exercise-induced asthma Pneumothorax Hemothorax Myocardial contusion Sudden death syndrome 48

Rib Contusion / Fracture Mechanism – Impact over area / compression Signs & Symptoms – Dyspnea – Pain is key to determine whether there is a contusion or a fracture Contusion? Pain remains constant during inhalation and exhalation Fracture? Pain ↑ during inhalation and ↓ during exhalation – Point tenderness – Possible deformity Treatment – Apply ice – Refer for x-ray 49

Exercise-Induced Asthma Mechanism – Physical activity and/or environmental conditions trigger a stimulus – The stimulus causes airway to constrict and/or ↑ mucous production Signs & Symptoms – Coughing – Wheezing – Dyspnea – Chest pain / tightness – Anxiety Treatment – Treat with inhaler (medication used to dilate bronchi) – Reassure and calm athlete – Call EMS if condition worsens – Gradual increase of activity in athletes with EIA 50

Hemothorax Mechanism – Internal injury: ruptured blood vessel or ruptured lung – External injury: penetrating wound Signs & Symptoms – Dyspnea – Bluish skin tone – Rapid, weak pulse – No breath sounds from injured side – Loss of consciousness Treatment – Call EMS – Control bleeding – Perform CPR if necessary 51

Pneumothorax Mechanism – Spontaneous (non-traumatic): lung tissue weakness – Tension (traumatic): laceration or rib fracture punctures lung Signs & Symptoms – Dyspnea / gasping for air – Chest pain – Bluish tint to skin Treatment – Call EMS – Place athlete on side with injured lung closest to the ground – Treat for shock 52

Myocardial Contusion Mechanism – Compression force (i.e., baseball player hit by pitch, barbell dropped on chest) Signs & Symptoms – Immediate, severe pain in chest – Rapid onset of shock – Possible complications of myocardial contusion Fluid buildup around the heart Failure of electrical activity of heart Fluid backup in lungs (congestive heart failure) Damage to heart valves or muscle Treatment – Call EMS – Treat athlete for shock; administer CPR if needed 53

Sudden Death Syndrome Mechanism – Non-traumatic - caused by a pre-existing heart condition such as: Thickening of heart muscle (hypertrophic cardiomyopathy) Weakness of connective tissue (Marfan’s syndrome) Congenital heart disease Signs & Symptoms – Chest pain during exercise – Irregular heart beat / racing of the heart – Shortness of breath – Excessive sweating – LOC due to lack of oxygen to the brain Treatment – Call EMS – Perform CPR with AED 54

REHAB/EVALUATION 55

HOPS Injury Evaluation History—a series of questions asked to determine nature and location of injury Observation—A visual examination of the injury P alpation—A hands-on approach where examiner feels for deformity or other abnormal findings S tress tests— A series of tests to check range of motion and degree of function of tissues at a joint 56

SOAP NOTES Subjective—detailed information about the history of injury and athlete; chief complaints, sign, and symptoms Objective—information that is record of test measurements; data gained from inspection Assessment---Identification of problem; determine injury; severity of injury Plan of Action--Treatment 57

Subjective - Questioning Prompts What happened? When did it happen? Was there a previous injury? What did you feel then? How do you feel now? Describe the type of pain. Where does it hurt? Did it make a sound? Have you had difficulty breathing? Are certain positions more comfortable than others? Do you feel faint, light-headed or nauseous? How long has it been since you last ate? What did you eat? Do you have a personal or family history of any heart problems or abdominal problems? * Ask for a witness if the person is incapable of answering 58

Objective: Inspection Prompts Observe for the following: Apnea Dyspnea Breathing patterns Lack of deep breathing Chest symmetry during breathing Body posture/position including leaning to the side or splinting/protecting with opposite hand Deformity or protrusions Discoloration Swelling Gait / Walk Facial expressions Bleeding Skin color Scars 59

Completing the S & O Subjective: History (Symptoms) Objective: Observation & Palpation (Signs) 60

Abdomen & Thorax Palpation Bones – R & L chest walls – Movement of chest during inspiration & expiration – Rib(s) and intercostal space specific to injury Musculature – Rectus abdominis – Transverse abdominis – Obliques 61

Abdomen & Thorax Palpation Palpate kidneys with athlete: – Lying prone or standing Palpate the rest of the organs in each of the abdominal quadrants with athlete: – Lying supine – Arms at side – Hips and knees flexed 62

Abdomen & Thorax Palpation When palpating, begin with upper right quadrant and move clockwise. Palpate for the following indications of abdominal injury or internal bleeding: – Muscle guarding or involuntary muscle contraction – Areas of rigidity or tightness – Areas of abdominal pain – Rebound tenderness – Referred pain 63

Abdomen & Thorax – Special Tests Trunk movements – perform active ROM, followed by resistive – Forward flexion or bending – Twisting – Side bending – Extension 64