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Abdominal/Thorax Unit

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ABDOMINAL CAVITY ANATOMY

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Terminology

• Absorption: a process where digested food moves into the bloodstream to be used throughout the body

• Antibodies: a type of cell produced by the spleen to defend the body against foreign cells

• Bile: a substance produced by the liver that neutralizes the acid of the stomach and helps digest fat in the small intestine

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Terminology

• Chyme: a semi-liquid substance formed when ingested food is mixed with digestive fluids from the stomach

• Detoxify: the process of breaking down harmful chemicals

• Diaphragm: a large muscle located between the chest and the abdomen that helps control breathing

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Abdominal Cavity Borders

• Anterior– Abdominal

musculature

• Posterior– Lumbar spine

• Superior– Diaphragm

• Inferior– Pelvis

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The Abdominal Cavity• Divided into 4

quadrants which intersect at the navel– Upper right– Upper left– Lower right– Lower left

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The Abdominal Cavity• Contains organs from 3 body systems– Digestive– Urinary– Reproductive

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The Liver

• Secretes bile for digestion• Detoxifies harmful chemicals

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The Gall Bladder• Stores bile from the liver used in digestion

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The Pancreas

• Produces insulin & glucagon• Secretes pancreatic juice for digestion

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The Kidneys

• Filter blood from the rest of the body & excrete waste products in the form of urine

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The Stomach

• Food mixes with secretions to form chyme

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The Spleen

• Stores and regulates the number of red blood cells in the body

• Produces antibodies

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Small Intestine

• The majority of digestion and absorption occurs here

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Large Intestine

• Final digestion and absorption of food occurs

• Chyme is converted to feces to be expelled

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Urinary Bladder• Stores urine

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Abdominal Organs

• Solid organs– Organs that contain a large blood supply– Injury to these organs is generally life-threatening– Examples: liver, kidneys, spleen & pancreas

• Hollow organs– Organs that are able to bend & move– Injury to these organs is less serious– Examples: stomach, intestines, appendix

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THORACIC CAVITY ANATOMY

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Terminology

• Atrium: upper chamber of the heart• Intercostal: refers to the area between the

ribs• Thorax: the chest; the part of the body

located between the neck and the abdomen• Ventricle: lower chamber of the heart

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Thoracic Cavity Borders

• Superior– Clavicle

• Inferior– Diaphragm

• Anterior– Sternum, ribs and intercostal muscles

• Posterior– Spine, ribs, scapulae & erector spinae muscle

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The Rib Cage

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The Rib Cage

• 12 pairs of ribs– True ribs (first 7 pairs): attach directly to the

sternum by individual cartilage– False ribs (next 3 pairs): attach indirectly to the

sternum by shared cartilage– Floating ribs (next 2 pairs): have no attachment to

the sternum

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Organs in the Thoracic Cavity

• Esophagus• Trachea• Lungs• Heart

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The Esophagus

• Location:– In the throat,

behind the trachea

• Function:Structure for

food to pass from the mouth to the stomach

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The Trachea

• Location:–A cartilage structure in the throat, directly

in front of the esophagus– The trachea divides into 2 branches

(bronchi) which enter the lungs• Function:–Allows air to pass into and out of the lungs

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Divisions of the Respiratory System

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The Lungs

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The Lungs• Location:

On either side of the heart

• Functions:• Exchange carbon dioxide for oxygen • Help to remove heat from the body

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The Heart

• Location:–Under the sternum (slightly to the left) and

between the lungs• Function: to pump blood throughout the body–Blood carries oxygen and nutrients to the

cells–Blood carries carbon dioxide and waste

products away from the cells

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The Heart

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The Heart

• Divided into 4 chambers– R and L atrium (upper chambers)– R and L ventricles (lower chambers)

• Heart valves separate each chamber and prevent a backflow of the blood– Tricuspid valve– Biscuspid (mitral) valve– Pulmonary valve– Aortic valve

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ABDOMINAL INJURIES (EXTERNAL)

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Terminology

• Hernia: a section of abdominal tissue comes through the abdominal wall

• Solar plexus: a group of nerves in the upper part of the abdomen that control breathing

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Abdominal Injuries

• 1. Contusion / solar plexus injury• 2. Abdominal strain• 3. Hernia• 4. Testicular pathology

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Contusion / Solar Plexus Injury

• Mechanism– A blow to the area causes a contusion or temporary paralysis of

the diaphragm muscle (“wind knocked out”)• Signs & Symptoms

– Pain– Temporary breathing difficulty - usually resolves quickly but may

result in loss of consciousness with more serious injury• Treatment

– Reassure the athlete– Loosen any restrictive clothing / padding– Apply ice for contusion– Monitor athlete for possible complications including shock

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Abdominal Strain

• Mechanism– Hyperextension or reaching over head (rectus

abdominis) – Twisting / over-rotation , ie, baseball pitcher (obliques)

• Signs & Symptoms– Pain that increases during movement– Possible swelling / discoloration

• Treatment– Follow RICE – Gentle stretching / strengthening– Gradual pain-free return to activity

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Hernia• Mechanism– Increase in abdominal pressure, such as holding one’s breath

during weightlifting• Signs & Symptoms– Deformity – bulge in abdominal area– Pain (usually decreases while lying & increases while

standing)– Increase in pain with activity

• Treatment– Temporary – strap to put pressure over the area– Surgery needed for repair, followed by extended recovery

period– Untreated may lead to tissue strangulation and death

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Testicular Pathology• Explanation

– Injury to reproductive organs are more common in males because the genitalia of males are exposed.

• Mechanism:– Direct blow to the area or twisting mechanism (cut to the side while

foot is planted)• Signs & Symptoms:

– Acute testicular pain– Localized swelling– Nausea / vomiting possible

• Treatment:– Ice for contusion or area– Refer if pain doesn’t resolve or increases after 20 minutes– Need prompt medical attention to prevent atrophy/ other

complications

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ABDOMINAL INJURIES (INTERNAL)

Kehr’s sign: radiating pain in the left shoulder and arm, resulting from an injury to the spleenReferred pain: pain that begins in one area, but is felt in another area of the body

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TERMINOLOGY

Internal Abdomen Injuries

• 1. Kidney contusion / laceration• 2. Liver contusion• 3. Spleen rupture• 4. Pancreas injury

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Kidney Contusion / Laceration

• Mechanism– Direct blow over area results in a contusion, laceration or rupture of

the kidney• Signs & Symptoms

– Pain under – Pain with trunk extension + hip and knee flexion– Blood in urine– Monitor for shock– Nausea, vomiting

• Treatment– Call EMS– Treat for shock– Surgical repair required– Long-term complications may include tissue scarring, hypertension 42

Liver Contusion• Mechanism– Blow to area (more vulnerable during hepatitis)

• Signs & Symptoms– Abdominal pain & referred pain in R shoulder– Rapid blood loss resulting in shock, weak pulse, ↓

blood pressure• Treatment– Call EMS– Treat for shock– Surgical repair required

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Spleen Rupture• Mechanism

– Fall or direct blow to upper left quadrant (more likely to rupture when enlarged or infected, i.e., mononucleosis)

• Signs & Symptoms– Abdominal pain– Pain in L shoulder (Kehr’s sign)– Shock, progressing to loss of consciousness (LOC)– ↑ heart rate, ↓ blood pressure– Nausea, abdominal spasms & cramping

• Treatment– Call EMS– Treat for shock– Generally requires surgical removal– Unable to participate in contact sports 44

Pancreas Injury• Mechanism– Deceleration injury– Occurs when athlete is running and hits a wall, causing

pancreas to change directions suddenly• Signs & Symptoms– Pain in middle abdomen to back– Signs of shock– Vomiting / nausea

• Treatment– Call EMS– Treat for shock– Requires surgical repair 45

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THORACIC INJURIES

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Apnea: temporary stopping of breathingAsthma: condition in which the air passages constrict in response to a stimulus Dyspnea: difficulty breathingHemothorax: blood in the thoracic cavityPneumothorax: air in the thoracic cavity due to a collapsed lung

TERMINOLOGY

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Thoracic Injuries

• Rib contusion / fracture• Exercise-induced asthma• Pneumothorax• Hemothorax• Myocardial contusion• Sudden death syndrome

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Rib Contusion / Fracture • Mechanism

– Impact over area / compression• Signs & Symptoms

– Dyspnea– Pain is key to determine whether there is a contusion or a

fracture• Contusion? Pain remains constant during inhalation and exhalation• Fracture? Pain ↑ during inhalation and ↓ during exhalation

– Point tenderness– Possible deformity

• Treatment– Apply ice– Refer for x-ray

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Exercise-Induced Asthma• Mechanism

– Physical activity and/or environmental conditions trigger a stimulus– The stimulus causes airway to constrict and/or ↑ mucous production

• Signs & Symptoms– Coughing– Wheezing– Dyspnea– Chest pain / tightness– Anxiety

• Treatment– Treat with inhaler (medication used to dilate bronchi)– Reassure and calm athlete– Call EMS if condition worsens– Gradual increase of activity in athletes with EIA

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Hemothorax• Mechanism

– Internal injury: ruptured blood vessel or ruptured lung– External injury: penetrating wound

• Signs & Symptoms– Dyspnea– Bluish skin tone– Rapid, weak pulse– No breath sounds from injured side– Loss of consciousness

• Treatment– Call EMS– Control bleeding– Perform CPR if necessary

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Pneumothorax

• Mechanism– Spontaneous (non-traumatic): lung tissue weakness– Tension (traumatic): laceration or rib fracture punctures lung

• Signs & Symptoms– Dyspnea / gasping for air– Chest pain– Bluish tint to skin

• Treatment– Call EMS– Place athlete on side with injured lung closest to the ground– Treat for shock

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Myocardial Contusion• Mechanism

– Compression force (i.e., baseball player hit by pitch, barbell dropped on chest)

• Signs & Symptoms– Immediate, severe pain in chest– Rapid onset of shock– Possible complications of myocardial contusion

• Fluid buildup around the heart• Failure of electrical activity of heart• Fluid backup in lungs (congestive heart failure)• Damage to heart valves or muscle

• Treatment– Call EMS– Treat athlete for shock; administer CPR if needed

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Sudden Death Syndrome• Mechanism

– Non-traumatic - caused by a pre-existing heart condition such as:• Thickening of heart muscle (hypertrophic cardiomyopathy)• Weakness of connective tissue (Marfan’s syndrome)• Congenital heart disease

• Signs & Symptoms– Chest pain during exercise– Irregular heart beat / racing of the heart– Shortness of breath– Excessive sweating– LOC due to lack of oxygen to the brain

• Treatment– Call EMS– Perform CPR with AED

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REHAB/EVALUATION

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HOPS Injury EvaluationHistory—a series of questions asked to determine nature and location of injuryObservation—A visual examination of the injury

Palpation—A hands-on approach where examiner feels for deformity or other abnormal findings Stress tests—A series of tests to check range of motion and degree of function of tissues at a joint

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SOAP NOTES

Subjective—detailed information about the history of injury and athlete; chief complaints, sign, and symptoms

Objective—information that is record of test measurements; data gained from inspection

Assessment---Identification of problem; determine injury; severity of injury

Plan of Action--Treatment

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Subjective - Questioning PromptsWhat happened? When did it happen?Was there a previous injury?What did you feel then?How do you feel now?Describe the type of pain.Where does it hurt?Did it make a sound?Have you had difficulty breathing?Are certain positions more comfortable than others?

Do you feel faint, light-headed or nauseous?How long has it been since you last ate?What did you eat?Do you have a personal or family history of any heart problems or abdominal problems?

* Ask for a witness if the person is incapable of answering

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Objective: Inspection Prompts

Observe for the following:ApneaDyspneaBreathing patternsLack of deep breathingChest symmetry during breathingBody posture/position including leaning to the side or splinting/protecting with opposite hand

Deformity or protrusionsDiscolorationSwelling Gait / WalkFacial expressionsBleedingSkin colorScars

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Completing the S & O

Subjective:History(Symptoms)

Objective:Observation & Palpation (Signs)

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Abdomen & Thorax Palpation

• Bones– R & L chest walls– Movement of chest during inspiration & expiration– Rib(s) and intercostal space specific to injury

• Musculature– Rectus abdominis– Transverse abdominis– Obliques

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Abdomen & Thorax Palpation• Palpate kidneys with athlete:

– Lying prone or standing

• Palpate the rest of the organs in each of the abdominal quadrants with athlete:– Lying supine– Arms at side– Hips and knees flexed

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Abdomen & Thorax Palpation• When palpating , begin with upper right quadrant and move

clockwise.• Palpate for the following indications of abdominal injury or

internal bleeding:

– Muscle guarding or involuntary muscle contraction– Areas of rigidity or tightness– Areas of abdominal pain– Rebound tenderness– Referred pain

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Abdomen & Thorax – Special Tests

• Trunk movements – perform active ROM, followed by resistive– Forward flexion or bending– Twisting– Side bending– Extension