Chapter 8

1. Chapter 8 Abdominal Injuries

2. 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.

3. 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

4. Anatomy of the Abdomen (cont) • Upper-left quadrant • Stomach • Portion of liver • Portion of pancreas • Left kidney • Spleen • Large intestine • Small intestine

5. Anatomy of the Abdomen (cont) • Lower-right quadrant • Large intestine • Small intestine • Appendix • Portion of bladder • Uterus and right ovary (females) • Prostate (males)

6. Anatomy of the Abdomen (cont) • Lower-left quadrant • Large intestine • Small intestine • Portion of the bladder • Uterus and left ovary (female) • Prostate (male)

7. 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

8. 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)

9. 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

10. 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

11. 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

12. 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

13. More anatomy (bones) • The pelvis • Provides protection for some lower abdominal organs

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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