Blunt abdominal trauma. Damage to the abdominal organs. Emergency
Table of contents:
A Closed (blunt) abdominal trauma - injury, not involving the violation of the integrity of the abdominal wall. These injuries are also called "non-penetrating". However, the absence of visual abnormalities is not evidence of preservation of internal organs. Closed traumas of the abdomen are accompanied by damage to the pancreas, spleen, liver, intestinal tract, bladder and kidney, which affects the health of the patient and can lead to death.
Etiology
A punch in the stomach is considered to be the main reason that causes damage to internal organs. Most patients affected in this way, was relaxed at the time of injury. Muscles are at rest, which causes the penetration force of the blow deep into the tissues. This mechanism of damage is characterized in the following situations:
- Criminal incidents (blow in the stomach with fists or feet);
- Drop;
- Automobile accidents;
- Sports injuries
- Uncontrollable cough reflex, followed by a sharp contraction of the abdominal muscles;
- Industrial disaster;
- Natural or military disasters.
At the time of exposure to detrimental factors causing the bruising of the abdominal wall, the presence of obesity and, conversely, exhaustion or weakness of the muscular system increase the risk of internal injuries.
Frequent clinical cases are complex injuries that connects blunt abdominal wounds, with fractures of extremities, pelvis, ribs, spine, traumatic brain injury. This mechanism causes the development of massive blood loss, weight the patient and accelerates the emergence of traumatic shock.
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If any minor injury should go to the nearest emergency room. Working around the clock, staff will provide first aid, deciding the question of further hospitalization, and there is internal damage. Please note! In the case of severe condition of the victim or when there is any suspicion of a rupture of an internal organ independent movement of the patient is contraindicated. Be sure to call an ambulance.
Classification
Blunt abdominal trauma are split according to the following principles:
- Without damage of the abdominal cavity (contusions, ruptures of muscle groups and fascia).
- With the presence of damage of the internal organs located in the peritoneal space (ruptures of the liver, spleen, sections of the intestinal tract, bladder).
- With damage located retroperitoneal organs (rupture of the pancreas, kidneys).
- Pathology with intra-abdominal bleeding.
- Damage, accompanied by the risk of peritonitis (trauma hollow organs).
- The Combined damage of parenchymatous and hollow organs.
Pain syndrome
Closed abdominal trauma is characterized by first and main complaint by the victim - the presence of pain in the abdomen. It is important to remember that erectile phase of shock may be accompanied by inhibition of the pain syndrome, which makes diagnosis of pathology. In the case of combined injuries the pain from the broken ribs or bones of the limbs, pelvis can push aside the symptoms, which is caused by blunt abdominal trauma, secondary.
Torpid phase of shock depresses the brightness painful conditions due to the fact that the patient is disoriented or unconscious.
The Nature of pain, its intensity, and the radiation of sensations depend on the localization of damage and organ involved in the process. For example, injury of the liver, accompanied by dull aching pain, radiating into the right forearm. A ruptured spleen is manifested by radiating pain in the left forearm. Damage to the pancreas typical girdle pain, caused in the field of both clavicles, waist, left shoulder.
Rupture of the spleen, the consequences of which are difficult for the patient due to excessive blood loss, accompanied by a third of all closed injuries of the abdomen. Frequent cases be damage to the spleen and left kidney. Often the doctor has to re-operate a patient if he had not seen the clinical picture is one of several injured bodies.
Trauma to the upper part of the intestinal tract, accompanied by rupture of the walls, appears sharp knife-like pain arising due to penetration of intestinal contents into the abdominal cavity. The brightness of the pain syndrome patients may lose consciousness. Damage colon less aggressive in forms, since content does not have a strong acidic environment.
Other clinical features
Blunt trauma to the abdomen reflexes vomiting. In cases of rupture of the walls of the small intestine or stomach vomit will contain blood clots, or have the color of coffee grounds. Like discharge with faeces indicate trauma to the colon. Injury of the rectum accompanied by red blood or clots.
Intra-Abdominal bleeding is accompanied by the following symptoms:
- The weakness and drowsiness;
- Dizziness;
- The appearance of spots before eyes;
- Skin and mucous membranes acquire a bluish hue;
- Lowered blood pressure;
- Weak and rapid pulse;
- Frequent shallow breathing;
- The emergence of cold sweat.
Damage to hollow organs cause the development of peritonitis. In such a pathology the victim's body responds with a rise in body temperature (in cases of severe blood loss - hypothermia), uncontrollable vomiting, cardiac peristalsis of the intestinal tract. The nature of pain is constantly changing, alternating severe pain with her temporary disappearance.
Trauma to the urinary system is accompanied by an absence or a violation of the separation of urine, gross hematuria and pain in the lumbar region. Later develops swelling in the crotch area.
Damage without injuring the internal organs
Injury of the anterior abdominal wall is manifested by local visual modifications:
- Swelling;
- Flushing;
- The pain;
- The presence of bruises and abrasions;
- Bruises.
The Pain accompanying the injury, aggravated by every change of position, sneezing, coughing, defecation.
Blunt abdominal trauma may be accompanied by tearing of the fascia. The patient complains of pronounced pain, sensation of bloating. Appears dynamic paresis of the intestinal tract, respectively, and the dynamic nature of the obstruction. Rupture of the muscle groups accompanied by local manifestations in the form of punctate hemorrhages or large hematomas that can be localized not only at the site of trauma, but also far beyond its borders.
The Final diagnosis was "injury of the anterior abdominal wall" is put in case of confirmation of the lack of internal pathologies.
Diagnostic measures
Differential diagnosis of the condition of the patient begins with the medical history and travaganza. Further, the determination of the condition of the victim includes the following survey methods:
- A General analysis of peripheral blood shows all the signs of acute blood loss: decrease in red blood cells and hemoglobin, hematocrit, leukocytosis with the presence of the development of the inflammatory process.
- Urinalysis determines gross hematuria, and if the damage to the pancreas - the presence of amylase in the urine.
- Instrumental methods of examination used bladder catheterization and the introduction of a tube into the stomach.
- Ultrasound.
- Computed tomography with intravenous contrast injection.
- Radiography.
- Other tests if necessary (cystography, rheovasography, ERCP).
Differentiation pathology
Examination of the abdominal cavity and its organs must be multilateral, as the associated trauma may suppress the symptoms of injuries, bringing to the fore the clinic injury to the other.
| On | Clinical signs | Differential tests |
| Anterior abdominal wall | Pain and muscle tension palpation, when determining the volume of education should check for a hematoma. | To Distinguish a hematoma from neoplasm by using the test: the patient lies on the back and strains the muscles. The hematoma will be felt in the tense and relaxed state. |
| Liver | Pain in the projection of the body, often in conjunction with fractures of the lower ribs on this side. The increase in the volume of stomach hypovolemia. | KT: gap body with the presence of bleeding. The UAC determines anemia, low hematocrit. Ultrasound - abdominal hematoma. Retrograde cholangiography indicates damage to the bile ducts. DPL - blood in stock. |
| Spleen | Tenderness in the projection, combined with broken ribs. The pain radiates to the left shoulder. | CT scan: ruptured spleen, active bleeding. Oak decline in hematocrit and hemoglobin. DPL detects blood. Ultrasound picture abdominal or...
Article in other languages: TR: https://www.tostpost.com/tr/sa-l-k/7279-k-nt-kar-n-travmas-zarar-kar-n-organlar-acil-yard-m.html
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