Chapter 8Abdominal Injuries

Objectives

• Understand the anatomy of the abdomen.

• Understand the implications of illness or injury related to a specific organ.

• Understand how to prevent injuries of the abdomen.

• Describe the care necessary to treat an injury within the abdomen.

Anatomy of the Abdomen•4 Quadrants

–Upper-right (just below ribs on athlete’s right side)

•Liver•Portion of pancreas•Right kidney •Gall bladder•Large intestine•Small intestine

Anatomy of the Abdomen (cont)•Upper-left quadrant

–Stomach–Portion of liver–Portion of pancreas–Left kidney–Spleen–Large intestine–Small intestine

Anatomy of the Abdomen (cont)•Lower-right quadrant

–Large intestine–Small intestine–Appendix–Portion of bladder–Uterus and right ovary (females)–Prostate (males)

Anatomy of the Abdomen (cont)•Lower-left quadrant

–Large intestine–Small intestine–Portion of the bladder–Uterus and left ovary (female)–Prostate (male)

Abdominal anatomy (continued)• Solid and hollow organs

– Solid-can cause rapid death if injured due to having a large blood supply

• Liver• Kidneys• Spleen

– Hollow-injury to these rarely cause rapid death and tend to move away if athlete is hit in abdomen

• Bladder• Intestines• Stomach• appendix

Abdominal anatomy (continued)• 3 categories of abdominal organs

– Digestive• Stomach• Liver• Pancreas• Large and small intestines• Appendix• Spleen • Gall bladder

– Urinary• Kidneys• Ureters• bladder

– Reproductive• Ovaries and uterus (female)• Prostate and seminal vesicles (male)

Digestive Organs•Stomach

–Secretes gastric juices that assist in food breakdown

•Liver–Detoxifies chemicals–Stores vitamins–Produces bile–Assists with metabolism

•Gall Bladder–Stores bile

Digestive organs• Pancreas

– Produces insulin and enzymes for digestion• Small intestine

– Completes digestive food breakdown– Products of digestion are absorbed into circulatory

system• Large intestine

– Water is absorbed• Appendix

– No known function• Spleen

– Produces and destroys red blood cells– Assists in destruction of harmful microorganisms– Stores blood

Urinary Organs•Kidneys

–Maintain acid-base balance of the body–Filter blood–Remove waste products of metabolism

•Ureters–Transport urine to bladder

•Bladder–Holds urine until excreted

Reproductive organs•Female

–Ovary•Produces eggs

–Uterus•Where fertilized egg develops•Lining is released if fertilized egg not present (mestrual period)

•Male–Seminal vesicles–Prostate gland

•Both add fluid and nutrients to seminal fluid

More anatomy (bones)•The pelvis

–Provides protection for some lower abdominal organs

Anatomy (muscles)•Abdominals

–Provide most of the protection for the abdominal organs (along with fat)–Rectus abdominis

•Washboard•Attaches at hipbones and extends to lower ribs and sternum•Responsible for forward flexion

–Obliques•Attach on lateral aspects of the lower ribs and run diagonally to the hip bones•Help compress the abdomen

Injuries•Prevention is key•Abdominal injury can quickly cause death•Protective equipment a must•Prevent bladder ruptures by emptying before competing

Ruptured Spleen• Causes

– Direct blow– More susceptible to injury if spleen is

enlarged from infection (mononucleosis) • Signs/symptoms

– Abdominal pain– Possible left shoulder pain (Kehr’s sign)– Kehr’s sign caused by bleeding that puts

pressure on the diaphragm, which presses on nerve causing referred pain to the shoulder

– Nausea, cramps, feeling of weakness– May lose consciousness

Ruptured spleen

• More S/S– May have abdominal spasms,

vomiting, rapid heart rate, decreased blood pressure and shock

– Transport by EMS immediately• Minor spleen injuries can be

hospitalized and treated• Ruptures will cause spleen

removal• Athlete can fully recover and

compete again

Pancreas injury

• Injury can be caused by deceleration… pancreas shifting once body has stopped, causes tearing

• Pain in middle of abdomen and into back

• Nausea, vomiting, signs of shock• Refer for additional exam• Ruptures must be surgically

repaired

Kidney Injury• Direct blow can cause contusion,

laceration, or rupture• S/S

– Pain under posterior ribs– Pain may radiate to bladder– Pain increases with trunk extension and

ease with knee or hip flexion– Nausea, vomiting– Urine may contain blood– Blood loss can cause athlete to go into

shock– Transport by EMS immediately– Kidney injuries often require several weeks

rest before athlete can return to activity

Hernias•Lump of tissue that bulges through an weakness in the abdominal wall•Can be a result of increased abdominal pressure caused by holding breath while weight lifting or while going to the bathroom

Hernias

• Lump may appear with abdominal pressure and disappear when pressure is released

• May or may not cause pain• In males intestine may go through

inguinal canal and stay in scrotal sac

• Must be surgically repaired• Can cause many complications if

not repaired

Liver contusions

• Caused by a direct blow• Pain over liver and possible

referred pain to right shoulder• Blood loss will likely cause shock,

rapid weak pulse, and drop in blood pressure

• Refer by EMS immediately

Bladder Injuries

• Rupture– Causes urine to leak into

surrounding areas– Painful urination, contusion, or blood

in urine– Severe cases can cause shock, rapid

pulse, decreased blood pressure, anxiety, and sweating

– Refer immediately

Side stitch• Pain in upper abdomen just below ribs• Various theories to cause of pain

– Lack of oxygen to abdominal muscles– Improper breathing– Eating before exercise– Air trapped in abdominal organs– Muscle spasms

• Generally occur to less fit individuals– Treat by pressing directly over area or

raising arm of affected side and leaning away from pain

• Unresolved pain needs to be referred