Updated: 1/18/2014

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
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 boxers and football players
  • Presentation
    • look / ask for hematuria but not always present
  • 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
http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed/16278543
 

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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? Tested Concept

QID: 3029
1

Fractured kidney

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(5/2798)

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Ruptured appendicitis

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(3/2798)

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Ruptured gallbladder

0%

(8/2798)

4

Splenic rupture

99%

(2776/2798)

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Pneumothorax

0%

(1/2798)

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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? Tested Concept

QID: 1409
1

Regular creatine usage

10%

(212/2184)

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Sustaining a spider bite

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(23/2184)

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Drinking alcohol

3%

(73/2184)

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Sharing water-bottles with teammates

84%

(1835/2184)

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Taking NSAIDS on an empty stomach

1%

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Topic COMMENTS (2)
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