Updated: 6/2/2021

Visceral Blunt Trauma

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https://upload.orthobullets.com/topic/3123/images/rectus sheath hematoma.jpg
https://upload.orthobullets.com/topic/3123/images/liver injury.jpg
https://upload.orthobullets.com/topic/3123/images/renal lac.jpg
https://upload.orthobullets.com/topic/3123/images/hematocoele.jpg
https://upload.orthobullets.com/topic/3123/images/splenomegaly.jpg
  • Introduction
    • Injuries include (specifics below)
      • abdominal wall injuries
      • spleen injuries
      • liver injuries
      • kidney injuries
      • testicular and penile injuries
    • Risk factors
      • contact sports and direct blows are risk factors for visceral injury
      • deceleration pattern of injury is more likely to cause injury to the spleen, liver, or kidney
  • Diaphragmatic Spasm
    • Commonly known as "wind knocked out"
      • caused by a direct blow to epigastrium causing diaphragmatic spasm
    • Treatment
      • observation
        • resolves spontaneously
        • may continue play
  • Abdominal Wall Injury / Rectus Sheath Hematoma
    • Introduction
      • injury to epigastric or intramuscular vessels
    • Presentation
      • acute pain in a localized area is usually a sign of abdominal wall injury
      • symptoms mimic surgical abdomen with nausea and vomiting
      • pain with active trunk flexion or rotation
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • ice and rest
          • indications
            • most cases
      • operative
        • surgery decompression
          • indications
            • required if persistent progression and pain
  • Spleen Injuries
    • Introduction
      • the most common organ injured in the abdomen as the result of blunt trauma
      • most common cause of death because of an abdominal injury
      • increased risk with splenomegaly after infectious mononucleosis
    • Presentation
      • nausea and vomiting
      • sharp LUQ pain that becomes dull after a time and more diffuse
      • localized pain that progresses to diffuse pain is concerning for visceral injury
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • clinical observation
          • indicated in most cases
      • operative
        • splenectomy
          • indicated only in severe injuries
  • Liver Injury
    • Introduction
      • the liver is the second most commonly injured organ.
    • Presentation
      • symptoms include right upper quadrant pain that may radiate to right shoulder
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • conservative treatment with monitoring and rest
  • Kidney Injuries
    • Introduction
      • more common in contact athletes
      • usually occurs with blunt abdominal trauma to flank
    • Presentation
      • look / ask for hematuria
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • operative
        • urgent surgery
          • indications
            • extensive bleeding with renal fx or vascular pedicle injury
  • Penile & Testicular Injuries
    • Pudendal nerve neuropraxia
      • introduction
        • common in bicyclists
      • presentation
        • causes penile shaft numbness
      • treatment
        • nonoperative
          • seat modifications
    • Testicular Injury
      • introduction
        • mechanism is usually a kick
        • leads to rupture of tunica albuginea (outer covering)
          • causes a hematocoele
      • presentation
        • painful firm scrotal mass that does not transilluminate
      • diagnosis
        • ultrasound by urology
      • treatment
        • observation
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Questions (2)

(OBQ09.216) A 17-year-old football player presents to the emergency department with the acute onset of left upper quadrant abdominal pain, nausea, vomiting, and tachycardia after being tackled during a game. His medical history reveals he had mononucleosis 1 month ago. What is the most likely explanation for these findings?

QID: 3029
1

Fractured kidney

0%

(5/2985)

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Ruptured appendicitis

0%

(3/2985)

3

Ruptured gallbladder

0%

(10/2985)

4

Splenic rupture

99%

(2960/2985)

5

Pneumothorax

0%

(1/2985)

L 1 D

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(SBQ07SM.24) A high school hockey player develops diffuse abdominal pain accompanied by nausea and vomiting after a typical body check into the boards. A CT scan shows a ruptured spleen. Which of the following is a recognized risk factor for splenic rupture in this patient?

QID: 1409
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Regular creatine usage

10%

(248/2507)

2

Sustaining a spider bite

1%

(27/2507)

3

Drinking alcohol

4%

(93/2507)

4

Sharing water-bottles with teammates

84%

(2095/2507)

5

Taking NSAIDS on an empty stomach

1%

(31/2507)

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Evidence (7)
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