Transcript The Thorax and Abdomen

The Thorax and Abdomen
Chapter 26
Anatomy of Thorax
 Thoracic Cavity
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– Contains lungs, heart and
thymus
Ribs (12), Costal Cartilage, and
Sternum
Thoracic Muscles
– External intercostals-elevate
diaphragm
– Internal intercostals-depress rib
cage
Lungs
– - trachea, R & L primary
bronchi… aveoli (O2 – CO2
exchange)
Respiratory Muscles
– Diaphragm; contractionincreases thorax volume =
inspiration
 Blood Supply
– Pulmonary artery (CO2) & vein (O2)
 Heart – 4 chambers
– blood supply – de O2 blood to R atrium-tricuspid-R
ventricle-pulmonary valve-pulmonary artery-lungs-O2
blood returns via pulmonary vein-L atrium-mitral
valve-L ventricle – ejected thru aortic valve
– Heartbeat = contraction of atrium followed by
ventricles (systole) and relaxation (diastole)
 Thymus
– Produce lymphocytes – respond to foreign substances
 Abdominal Muscles
– rectus abdominis, external oblique, internal oblique, transverse
abdominis
Abdominal Viscera
 Urinary System
– Kidneys-filter wastes
– Adrenal glands- secrete
hormones (epi, norepi,
cortosol, estrogen, aldosterone,
androgen)
– Ureters / urinary bladder
 Digestive System
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Liver-digestive & excretory
Gallbladder- bile storage
Pancreas -digestion
Stomach-storage &mixing
food
– Small intestines-digestion and
absorption
– Large intestines – waste
 Lymphatic System
– Spleen –reservoir of RBCs, destroy ineffective RBCs,
produces antibodies = immunity; produces lymphocytes
 Reproductive System
– Female
• Uterus& vagina (main supporting ligament – broad lig.),
ovaries, tubes
• Internal and protected by pelvis
– Male
• Prostate (internal behind pubic symphysis)
• More external : testes, series of ducts, penis (both urine and
semen exit thru urethra)
Prevention of Injury
 Protective equipment
 Core muscle strength
 Ensure hollow organs are empty when
participating (stomach and bladder)
Assessing Injuries to Thorax and
Abdomen
 History
 Observation
 Palpation
– Abdomen - ausculation and percussion (solid organ
= dull sound; hollow organ = resonant sound)
• Palpation
 Special Tests
– Anterior-posterior compression – fx
– Transverse compression – costochondral defect
Recognition and Management of
Specific Injuries
 Rib Contusion
– Etiology- direct blow
– Symptoms and Signs- pain with breathing, point tender
– Management-RICE, NSAIDs, self limiting
 Rib Fracture
– Etiology-direct blow; forced cough/sneeze
– Symptoms and Signs-sharp pain, crepitus, point tender
– Management-referred; brace
 Costochondral Separation and Dislocations
– Etiology-direct blow, fall on object
– Symptoms and Signs- pain local to junction, difficulty
breathing, crepitus
– Management-refer for X-ray and monitor
 Sternum Fracture
– Etiology- high impact blow to chest
– Symptoms and Signs-point tender, pain with breathing,
LOOK FOR SIGNS OF SHOCK!!!
– Management-refer for X-ray and monitor
 Muscle Injuries
– Etiology- direct blow or sudden torsion
– Symptoms and Signs-pain with active motion, laugh,
cough, etc
– Management-pressure and cold; possible
immobilization
 Breast Injury
– Etiology-violent up and down and lateral motions =
bruise or strain (Cooper’s ligament)
– Symptoms and Signs - pain
– Management – proper support
 Injuries to the Lungs
– Pneumothorax (pleural cavity fills with air; lung
collapses) Hemothorax ( blood in pleural cavity),
Traumatic Asphyxias(violent blow to chest causes
breathing to stop), Tension pnemothorax (pleural sac
fills with air and lung displaces)
– Etiology
– Symptoms and Signs
– Management – medical emergency =TRANSPORT
 Heart Contusion
– Etiology-direct force
– Symptoms and Signs-severe shock and heart pain;
arrhythmias
– Management – be prepared for CPR and transport
Sudden Death Syndrome
 Three prevalent conditions
– Others (CAD, R ventricular dysplasis (enlarged R
ventricle, cardiac conducton problems, aortic
stenosis, Wolff-Parkinson-White syndrome
(abnormality = ventricular tachycardia),
myocarditis
– Marfan’s Syndrome
• Weakened aorta and cardiac valves
– HCM (hypertrophic cardiomyopathy)
• Thicken cardiac muscle, no enlarged chamber, myocardial
scarring
– Prevention
• Counseling, screening, early ID of disorders
– Etiology
• Congenital, Non-cariad (alcohol, drug abuse,
vascular event, obstrutcive respiratory disease
– Symptoms and Signs
• Cardiac causes: chest pain, heart
palpatations,syncope, profuse sweating, SOB,
general malaise, fever, etc
– Management
• Of death? Survivors…
 Abdominal Injuries
– Kidney Contusions
• Etiology – back blows
• Symptoms and Signs- signs of shock, nausea,
vomitting, rigidity of back muscles, hematuria
• Management
– Kidney Stones
• Unknown cause
• Management – must be passed
 Contusion of Ureters, Bladder, and Urethera
– Prevention – empty bladder
– Etiology – direct blow
– Symptoms and Signs – pain lower ab, rigidity, nausea, vomitting,
shocky, passing blood (if bladder is ruptured, cannot urinate)
– Management – referral and manage
 Cystitis
– Etiology- inflammation caused by urinary tract infection
– Symptoms and Signs- frequent urination, pain, chills, fever,
– Management - antibiotics
 Hernia
– Etiology- congentital or acqurired (blow or strain)
– Symptoms and Signs- history, protrusion increased by coughing,
weakness or pulling sensation in groin area
– Management- referral
 Urinary Tract Infection
– Etiology – staph bacteria; more common in females
– Symptoms and Signs –frequent, urination
– Management
 Urethritis
– Etiology- STD (gonorrhea) or nongonococcal
organisms
– Symptoms and Signs – painfull urination, urethral
discharge
– Management- antibiotics
 Contusion of Abdominal Wall
– Etiology – severe blow to region
– Symptoms and Signs – pain, nausea, rigidity, etc
– Management- r/o severe internal injury & monitor
Recognition and Management of
Specific Injuries of the Abdomen
 Gastrointestinal Bleeding
– Etiology-gastritis, iron deficient anemia, ingestion of asprin or
NSAIDs, stress, bowel irritation, colitis
– Symptoms and Signs- bloody stool; discomfort
– Management - refer
 Liver Contusion
– Etiology blunt trauma
– Symptoms and Signs- hemorrhage, shock, pain below scapula and
right shoulder and sometimes substernal and anterior left chest,
rigid to palpation
– Management – surgical intervention (if severe); referral always
 Pancreatitis
– Etiology obstruction of pancretic duct; scar tissue
– Symptoms and Signs- vomitting,m belching, constipation, shock,
tender and rigid to palpation, pain radiates to back
– Management- rehydration, referral, manage shock
 Indigestion (Dyspepsia)
– Etiology- emotional stress, esophageal and stomach
spasm, inflammation of lining
– Symptoms and Signs-sour stomach, gas, and nausea
– Management- eliminate source of irritation, avoid
anxiety, referral possible
 Solar Plexus / “stitch in side”
– Etiology- direct blow- “wind knocked out”
– Symptoms and Signs-respiration stops/ cramplike pain
– Management- calm athlete, loosen clothing
 Food Poisoning
– Etiology- consuming bad food
– Symptoms and Signs-nausea, vomitting, cramps,
diarrhea
– Management- replace lost fluids
 Peptic Ulcer
– Etiology- acid from stomach destroys mucousal lining
– Symptoms and Signs- gnawing pain 1-3 hrs following
meal
– Management- may disappear, antacids
 Diarrhea
– Etiology diet, inflammation or intestinal lining, GI
infection, consuming drugs
– Symptoms and Signs- ab cramps, nausea, lose and
frequent stools
– Management-knowledge of the cause is required, ;
replace lost fluid
 Hemorrhoids
– Etiology-constipation or straining
– Symptoms and Signs- bleeding and itching
– Management- make comfortable and allow healing
 Constipation
– Etiology-lack ab muscle tone, insufficient moisture in
feces
– Symptoms and Signs-full feeling, cramping, lower abd
pain
– Management-regulate eating; avoid laxative useless
prescribed
 Appendicitis
– Etiology-fecal obstruction, lymph swelling, tumors
– Symptoms and Signs- pain in lower R quad; fever,
nausea, vomitting
– Management-referral
 Spleen Contusion
– Etiology-direct blow
– Symptoms and Signs- pain, hemorrhage, shock
– Management- referral
Recognition and Management of
Specific Injuries of Reproductive Organs
 Scrotal Contusion
– Etiology- trauma
– Symptoms and Signs- hemorrhage, fluid effusion, muscle spasm,
pain, nausea, disabling
– Management-lift few inches form ground; cold pack; possible
referral (>15mins painful)
 Spermatic Cord Torsion
– Etiology-direct blow, coughing
– Symptoms and Signs-pain, nausea, vomitting, local inflmmation
– Management-IMMEDIATE REFERRAL
 Traumatic Hydrocele of Tunica Vaginalis
– Etiology- severe blow results in fluid accumulation
– Symptoms and Signs-pain, large amounts of swelling
– Management-cold pack, referral
 Contusion of Female Genitalia
– Etiology- direct blow
– Symptoms and Signs- pain, hemorrhage to external
surface; possible damage to pubic symphisis
– Management- cold pack, referral if necessary
 Vaginitis
– Etiology-STDs, bacterial infection, chemicals, tampons,
poor hygeine
– Symptoms and Signs- red, painful to touch, strong odor
and itching, urination frequent and painful
– Management- if STD, treat that; education