1. Abdomen and Thorax Injuries
Chapter 12-13
Abdomen and Thorax Injuries

2. Anatomy of the Abdomen Where is the abdominal cavity?
4 quadrants (according to athlete’s right and left)
Boundaries – Lumbar spine posteriorly, diaphragm superiorly, abdominal musculature anteriorly, and pelvis inferiorly.
4 quadrants –
Upper right – contains liver, portion of the pancreas, right kidney, gall
bladder, portion of the large and small intestine.
Upper left – contains stomach, portion of the liver, portion of the pancreas, left kidney, spleen, and portions of the large and small intestine.
Lower right – contains small intestine, appendix, a portion of the bladder, uterus and right ovary (in females), prostate (in males).
Lower left – contains large and small intestine, a portion of the bladder, uterus and left ovary (in females), and prostate (in males).

3. Anatomy of the Thorax What separates the thorax from the abdomen?
What two vital organs are in the thorax?
Bones of the Thorax: Scapula, Clavicle, Ribs, Sternum
Ribs – 12 pairs
Costal Cartilage – attaches ribs to sternum
Sternum – 3 parts: manubrium, body, xiphoid process

4. Hollow vs. Solid Organs Hollow organs: Solid Organs:
Injuries rarely result in rapid death.
Tendency to move out of the way when hit.
Are basically tubes used to transport substances from one organ to another.
Solid Organs:
Aid in body chemistry
Can cause rapid death because of large blood supply
Hollow organs – bladder, intestines, stomach, appendix
Solid Organs – liver, kidney, spleen

5. Digestive Organs Liver Gallbladder Pancreas Stomach Small Intestine
Large Intestine
Liver – The largest internal organ of the body. Located in the upper right quadrant against the inferior surface of the diaphragm. Weighs approx. 3 lbs. Consists of two major lobes (right and left). Performs digestive and excretory functions, absorbs and stores excessive glucose, processes nutrients, and detoxifies harmful chemicals. It secretes bile, which is essential in neutralizing and diluting stomach acid and for digesting fat in the small intestine during the digestive process.
Gallbladder – pear-shaped, saclike structure located on the inferior surface of the liver. Serves as a storage site for bile. Shortly after a meal, the gallbladder secretes bile into the small intestine. Gallstones are a result of large amounts of cholesterol in the diet. Gall stones can block release of bile. They will need to be removed surgically.
Pancreas – Located between the small intestine and the spleen. Secretes pancreatic juice, which is critical in the digestion of fats, CHOs, and PROs. Produces insulin and glucagon, hormones that control the amount of glucose and amino acids in the blood.
Stomach – Primarily found in the upper left quadrant. Sits between the esophagus (superior end of stomach) and the small intestine (inferior end of stomach). Main function is for food storage and a mixing chamber. Some digestion and absorption occurs in the stomach. Gastric secretions assist in the partial digestion of proteins and the absorption of alcohol and caffeine. Ingested food is mixed w/secretions from the stomach to forma semifluid mixture called chyme, which passes from the stomach to the small intestine.
Small Intestine - Connected to the inferior portion of the stomach. Has three parts: duodenum, jejunum, and the ileum. It is approx 20 ft. long. Secretions from the liver and pancreas mix with secretions form the small intestine to help break down chyme into smaller nutrients that can be absorbed. Chyme is move through the small intestine through a series of peristaltic (wave-like) contractions. Chyme can stay in the small intestine for 3-5 hours. Most of the digestion and absorption of nutrients occurs in the small intestine.
Large Intestine – The large intestine is approximately 6 ½ feet long. It has three divisions: Cecum, Colon, rectum. The appendix extends from the cecum. Water absorption occurs in the large intestine.

6. Urinary Organs Kidneys Ureters Bladder
Kidneys – located on either side of the spine, approximately in the center of the back. Bean shaped and are approx 4.5 inches long, 2 inches wide, and 1 inch thick. The right kidney is usually slightly lower than the left (b/c of liver). Responsible for maintaining acid-base balance of the blood/body. If unable to due this due to injury or illness, body systems will start shutting down and death will occur. If either kidney has inadequate blood supply, it can also cause hypertension (high BP) Also responsible for removing waste products from the body in liquid form.
Ureters – Tubes that extend from the kidney to the bladder.
Bladder – Hollow container that lies posterior to the pubic symphysis. Function is to store urine.

7. Heart – Parts and Circulation
Divided into 4 sections
Valves of the Heart
About the size of your clenched fist
4 parts of the heart:
Right Atrium, Right Ventricle, Left Atrium, Left Ventricle
Valves: Tricuspid, Pulmonary, Mitral, Aortic
1.Right ventricle
2. Pulmonary trunk (to pulmonary arteries)
3. Lungs
4. Left Atrium
5. Left Ventricle
6. Aorta
7. Head and neck
8. Lower body
9. Superior Vena cava
10. Inferior Vena cava
11. Right atrium

8. Lungs Pathway into the lung Lobes of the lung
Pathway – air enters nose/mouth and travels through the trachea (windpipe) to the right and left bronchi. The bronchi continue dividing into smaller and smaller divisions until they end in clusters of air sacs called alveoli. Alveoli facilitate the exchange of O2 and CO2 with the capillaries. The lungs are elastic and spongy. The expand and contract in response to contraction of the diaphragm muscle.
Lobes of the Lung – Right side – 3 lobes (upper, middle, lower)
Left side – 2 lobes (upper, lower)
Lobes divided by fissures – right side - 2 fissures (horizontal, oblique)
left side – 1 fissure (oblique)

9. Thoracic Muscles External Intercostals Origin Insertion Function
Internal Intercostals
Diaphragm
External Intercostals – Origin – Inferior border of the ribs and the costal cartilage.
Insertion – Superior border of the rib below the rib of origin.
Function – Elevates ribs, aiding in inhalation
Internal intercostals – Origin – Inner surface of the ribs and costal cartilages.
Function – Draws ribs together, aiding expiration.
Diaphragm – Origin – Inferior border of the rib cage, the xiphoid process, the costal
cartilages, and the lumbar vertebrae.
Insertion – Central tendon of the diaphragm
Function – Pulls central tendon downward, increasing the size of the
thoracic cavity, therefore causing inhalation.

10. Abdominal Muscles External Obliques Origin Insertion Function
Origin – External surface of the lower 8 ribs
Insertion – Linea alba and the anterior half of the iliac crest
Function – Compresses the abdominal cavity, assists in flexing and rotating the vertebral column.
Most superficial layer of abdominal muscle.

11. Abdominal Muscles Internal Obliques Origin Insertion Function
Origin – Inguinal ligament, the iliac crest, and the lumbodorsal fascia.
Insertion – Linea alba, the pubic crest, and the lower 4 ribs.
Function – Compresses the abdominal cavity, assists in flexing and rotating the vertebral column.
Intermediate layer of abdominal muscle under the external obliques. Muscle fibers travel in opposite direction of external oblique muscle fibers.

12. Abdominal Muscles Transverse Abdominis Origin Insertion Function
Origin – Inguinal ligament, the iliac crest, the lumbodorsal fascia, and the costal cartilages of the last six ribs.
Insertion – Linea alba and the pubic crest.
Function – Compresses the abdominal cavity.
Muscle fiber travel horizontally across the abdomen. Deep under the external and internal obliques.

13. Abdominal Muscles Rectus Abdominis Origin Insertion Function
Origin – Pubic Crest
Insertion – Xiphoid process and the costal cartilages of the 5th through 7th ribs.
Function – Compresses the abdominal cavity, flexes the vertebral column.
“Six Pack Muscles” superficial layer of muscle.

14. Abdominal Muscles Quadratus Lumborum Origin Insertion Function
Origin – Iliac crest and the iliolumbar ligament.
Insertion – Lower border of the 12th rib and the transverse processes of the first 4 lumbar vertebrae.
Function – Pulls the thoracic cage towards the pelvis, abducts the vertebral column toward the side being contracted.

15. Referred Pain Pain that is felt somewhere other than it’s origin.
These are some common areas where “referred pain” show up and what organ might be involved with the pain.

16. Thoracic & Abdominal Injuries
Splenomegaly
Pancreatitis
Kidney Contusion
Hernias
Liver Contusion
“Side Stitch”
Appendicitis
Rib Fracture
Sternum Fracture
Pneumothorax
Flail Chest
Hemothorax
Sucking Chest Wound
Hyperventilation

17. Splenomegaly Etiology Signs and Symptoms Complications Management
Etiology – Uncommon. Usually due to a fall or direct blow to the left upper quadrant when some existing medical condition has caused splenomegaly (enlargement of the spleen). Infectious mononucleosis is the most likely cause. Athletes should not engage in activity for 3 weeks b/c approximately 50% of people w/mono have enlarged spleens which is hard to diagnose clinically.
Signs and symptoms – History of severe blow to upper left quadrant, signs of shock, abdominal rigidity, nausea, and vomiting. May also exhibit Kehr’s sign. May c/o pain in left shoulder and left arm approx 30 minutes after injury.
Complications – The danger w/ruptured spleen lies in its ability to splint itself and then produce a delayed hemorrhage. Splinting occurs when loose hematoma formation and surrounding structures provide pressure to prevent hemorrhage. Any slight strain may disrupt this splinting effect, causing the athlete to die of internal bleeding days or weeks later.
Management – When tx mono, athlete may be given antibiotics to help fight infection and will usually be required to stay out of activity for 3 weeks. If surgery is required to repair a ruptured spleen, the athlete may need a minimum of 3 months to recover. If the spleen is removed recovery time is approximately 6 months.

18. Pancreas Injury Etiology Signs and Symptoms Management
Etiology – May be acute or chronic and is often related to an obstruction of the pancreatic duct. Usually from a gall stone. Acute inflammation can lead to necrosis (Death of cells or tissues through injury or disease, especially in a localized area of the body), suppuaration (The formation or discharge of pus), gangrene (the localized death of living cells (as from infection or the interruption of blood supply)), and hemorrhage (heavy bleeding). Chronic inflammation may result in scar tissue formation that may cause malfunction of the pancreas; usually caused from chronic alcoholism.
Signs and Symptoms – Acute: epigastric pain, vomiting, belching, constipation, and potentially shock. May also be tenderness and rigidity to palpation. Chronic: jaundice, diarrhea, mild to moderate pain that radiates to the back.
Management – Acute: rehydration, pain reduction, treatment of shock, reduction of pancreatic secretions using medications, and prevention of secondary infection. Surgery would be indicated only if the pancreatic duct is blocked. Chronic: Difficult and requires large doses of analgesics, the administration of pancreatic enzymes, and a low fat diet.

19. Kidney Injuries Etiology Signs and Symptoms Management
Etiology – An external force, usually applied to the back of the athlete, will cause abnormal extension of an engorged kidney, resulting in injury.
Signs and Symptoms – May display signs of shock, nausea, vomiting, rigidity of the back muscles, and blood in the urine. May cause referred pain (located posteriorly from bottom or ribs to PSIS and anteriorly along the waist. May have contusion, edema, ecchymosis present as well. Athlete should be instructed to urinated 2-3 times and to look for blood in the urine.
Management – If blood is present, 24 hour observation at a medical care facility is necessary. If the hemorrhage fails to stop, surgery may be necessary. Controllable contusions may require up to 2 weeks of bed rest and close surveillance after activity is resumed. If possible, area should be padded if playing a contact or collision sport.

20. Hernia Definition Etiology Signs and Symptoms Management
Definition – refers to the protrusion of abdominal viscera through a portion of the abdominal wall. Types – inguinal (groin of athlete; 75% of the athletes are males), femoral (groin of athlete; most often occurring in females); strangulated hernia – wall of abdomen encloses around protrusion, cutting off blood flow = gangrene and death if not treated immediately.
Etiology – abdominal viscera (organs; usually intestine) push through the abdominal wall due to some weakness or trauma to the abdomen that may cause an opening to occur.
Signs and symptoms – previous history of a blow or strain to the groin area, superficial protrusion in the groin area that is increased by coughing, or reported feeling of weakness and pulling sensation in the groin area.
Management – Surgery is most preferred option to repair damage to abdominal wall to prevent further hernias from happening.

21. Liver Contusion Etiology Signs and Symptoms Management
Etiology – In sports this injury is infrequent. Result from a hard blow to the right side of the ribcage. Especially vulnerable to injury if liver is inflamed due to disease or hepatitis. Hepatitis is an inflammation of the liver caused by either viral infection or alcohol consumption.
Signs and symptoms – A liver injury can cause hemorrhage and shock, requiring immediate surgical attention. Usually produces a referred pain that is just below the right scapula, right shoulder, and substernal area and, on occasion, a referred pain located in the anterior left side of the chest.
Management – A liver contusion requires immediate referral to a physician for diagnosis and treatment.

22. “Side Stitch” Etiology Signs and Symptoms Management
Etiology – The cause is obscure. Has been theorized that it could be from constipation, intestinal gas, overeating, diaphragmatic spasm, lack of visceral support from weak abdominal wall muscles, distended spleen, breathing techniques that lead to lack of oxygen in the diaphragm, ischemia of either the diaphragm or the intercostal muscles, and a fluid-engorged gut that tugs on visceral ligaments.
Signs and symptoms – cramp-like pain that develops on either the left or right side of the inferior portion of the rib cage during hard physical activity. Usually encountered in sports that involve running.
Management – Immediate care requires relaxation of the spasm. Athlete is usually instructed to reach high above the head with arm on affected side, or both arm, and to lean back and away from affected side to stretch out spasm. Recurrent abdominal spasms require special study. Look for poor eating habits, poor elimination habits (bathroom time), or poor training regimen.

23. Appendicitis Etiology Signs and Symptoms Management
Etiology – Caused by a variety of conditions such as: fecal obstruction, lymph swelling, or even carcinoid tumor. Highest incident is in males ages Can be commonly mistaken for gastric complaints. In early stages it becomes red and swollen. Later it may become gangrenous, rupturing into the bowels or peritoneal cavity causing peritonitis. Bacterial infection is a complication of a ruptured or inflamed appendix.
Signs and symptoms – Mild to severe pain in lower abdomen, nausea, vomiting, low-grade fever, later cramps may localized into a pain in the right side. Palpation may reveal abdominial rigidity and point tenderness between ASIS and the umbilicus (McBurney’s Point). A strain of the psoas muscle can sometimes be mistaken for appendicitis.
Management – Surgical removal of the appendix is often necessary. If the bowel is not obstructed there is no need to rush the surgery, but an obstructed bowel with an acute rupture is a life-threatening emergency.

24. Rib Fracture Etiology Signs and Symptoms Management
Etiology – Usually result from a direct blow. Have been cases though where a rib has broken due to a sneeze.
Signs and Symptoms – Usually easy to detect. History from athlete will usually explain how it could be a fx. Pain on inspiration and pt. tenderness.
Management – Send to physician for x-rays. Usually managed with support and rest. May heal in 3-4 weeks.

25. Sternum Fracture Etiology Signs and Symptoms Management
Etiology – Results from a high impact blow to the chest. More likely in automobile accident than in athletics.
Signs and symptoms – Pt. tenderness over sternum. Painful inspiration and expiration. Signs of weak, rapid pulse may also indicate more severe internal injury.
Management – Sent for x-rays and closely monitored for signs of trauma to the heart.

26. Pneumothorax Etiology Signs and Symptoms Management
Etiology – a condition in which the pleural cavity fills with air that has entered the chest through an opening. As the negatively pressured cavity fills with air, the lung on that side collapses.
Signs and Symptoms – Pain, difficulty breathing, anoxia (Lack of Oxygen). Also some sort of wound to the chest would be present.
Management – Activate EMS and get athlete to hospital ASAP. Air needs to be removed from the pleural cavity via a chest tube.

27. Flail Chest Etiology Signs and Symptoms Management
Etiology – Fracture of three or more ribs on the same side, each in two or more places, usually caused by a direct blow to the chest.
Signs and Symptoms – Injured section will move in and out with inspiration/expiration, however it will be moving in the opposite direction. On inspiration, the loose section will move into the body and on expiration, the loose piece will move out. Extremely painful and difficult to breath with.
Management – Treatment is to try and stabilize loose piece to prevent movement as much as possible. Athlete should also be treated for shock and EMS should be activated and the athlete should be transported to the hospital for further care.

28. Hemothorax Etiology Signs and Symptoms Management
Etiology – Results from tearing or puncturing of the lung or pleural tissue. Blood accumulates in the pleural space collapsing the lung on the affected side. Breathing becomes painful.
Signs and symptoms – severe pain while breathing, dyspnea (difficulty breathing), coughing up frothy blood, and signs of shock.
Management – Athlete should be treated for shock, EMS should be activated, and a physician will most likely use a chest tube to remove the fluid from the lung at the hospital.

29. Sucking Chest Wound Etiology Signs and Symptoms Management
Etiology – The wall of the chest is punctured by some object. The lung may or may not be punctured as well.
Signs and symptoms – difficulty breathing, circulation may become impaired, cyanotic skin color, breathing will cause a noise from the wound as air is drawn into the wound.
Management – The athlete should be treated by controlling the bleeding and sealing the wound with a cellophane wrap, piece of plastic bag, or vaseline gauze. EMS should be activated immediately and the athlete should be transported to the hospital for further evaluation.

30. Hyperventilation Etiology Signs and Symptoms Management
Etiology – An athlete who has excessively rapid rate of ventilation usually due to anxiety-induced stress or asthma gradually develops a decrease amount of CO2 in the blood (hypocapnia).
Signs and symptoms – Difficulty breathing, struggling to get air, panic state, gasping or wheezing. While it appears that the athlete is not getting enough O2, in reality it is the level of CO2 that is too low.
Management – Immediate treatment should be to reduce the amount of CO2 loss. Have athlete start to slow down respirations by concentrating on breathing in through the nose and out through the mouth. Also having the athlete breath in a paper bag will help. This keeps the CO2 that is expired in the bag which the athlete will then breath in again, eventually raising the CO2 levels. Typically the athlete will return to a normal breathing rate within 1-2 minutes. After normal breathing is returned it is important to determine the underlying cause and take appropriate treatment measures.

31. The End For your quiz You should be able to:
Name the three parts of the small intestine
Name the three parts of the large intestine
List the two main functions of the liver
Name the three parts of the sternum
Label the abdominal organs on an illustration.