Penetrating abdominal trauma (mechanism of disease)

Summary

This video provides an in-depth overview of penetrating abdominal trauma, covering its causes, pathophysiology, and clinical manifestations. It explains the mechanisms of injury from stab wounds and gunshot wounds, highlighting the impact on tissues and the resulting complications. Key manifestations include hollow viscous perforation, shock, air and blood in the abdomen, and organ-specific injuries such as liver and splenic lacerations. Additional concerns such as diaphragmatic injury and genitourinary trauma are also discussed, with a focus on how these conditions present in patients and the clinical signs to look for during diagnosis and management.

Takeaways

• 😀 Penetrating abdominal trauma can occur from stab wounds or gunshot wounds, with the former causing tissue laceration and the latter causing tissue crushing and cavitation.
• 😀 The severity of a gunshot wound injury is related to the bullet's kinetic energy, determined by its mass and velocity.
• 😀 Hollow viscous perforation (e.g., bowel rupture) is a major complication of penetrating abdominal trauma, leading to peritonitis, nausea, vomiting, and paralytic ileus.
• 😀 Peritonitis results from bowel contents leaking into the peritoneum, leading to inflammation, pain, and shock due to fluid loss (hypovolemic shock).
• 😀 Air entering the abdomen, either from the bowel or the penetrating injury, causes hyper-resonance on percussion, whereas blood in the abdomen leads to dullness.
• 😀 Hemorrhagic shock can result from large volume bleeding into the abdomen, retroperitoneum, or pelvic cavities, potentially causing severe hypovolemic shock.
• 😀 Vascular injury, particularly to the abdominal aorta, can be life-threatening and is a significant risk with penetrating abdominal trauma.
• 😀 Liver and splenic lacerations can cause localized pain (RUQ for liver, LUQ for spleen), and splenic injury may also cause referred pain to the left shoulder (Kehr's sign).
• 😀 Diaphragmatic injury can lead to diaphragmatic hernia, resulting in shortness of breath, decreased breath sounds, and possible bowel sounds in the chest.
• 😀 Genitourinary trauma in penetrating abdominal injuries may present with blood at the urethral meatus, hematuria, or difficulty voiding, and could lead to bladder rupture or scrotal hematoma.

Q & A

What are the two primary types of penetrating abdominal trauma discussed in the video?

The two primary types of penetrating abdominal trauma are stab wounds and gunshot wounds. Stab wounds are caused by sharp, pointed objects like knives or broken bottles, while gunshot wounds involve tissue laceration and crushing due to the kinetic energy of the bullet.

How does the severity of a gunshot wound to the abdomen relate to the kinetic energy of the bullet?

The severity of a gunshot wound is directly related to the bullet's kinetic energy, which depends on the bullet's mass (weight) and velocity (speed). A higher kinetic energy results in more tissue damage due to greater displacement and cavitation.

What is hollow viscous perforation and how does it affect the body?

Hollow viscous perforation occurs when part of the gastrointestinal (GI) tract is perforated, causing a full-thickness loss of the bowel wall. This allows GI contents to spill into the peritoneal space, leading to inflammation (peritonitis), pain, shock, and gastrointestinal distress like nausea, vomiting, and obstipation.

What signs might suggest the presence of peritonitis in a patient with penetrating abdominal trauma?

Signs of peritonitis include rebound tenderness (pain upon releasing pressure), abdominal distension, fever, and guarding. Patients may also experience severe abdominal pain that worsens with movement or palpation.

What is the significance of hyperresonance during abdominal percussion in a trauma patient?

Hyperresonance during abdominal percussion suggests the presence of air in the abdomen, which could result from a hollow viscous perforation or the penetrating trauma itself. It indicates a potential issue like pneumoperitoneum (air in the peritoneal cavity).

How can blood in the abdomen be detected during a physical examination?

Blood in the abdomen can be detected through dullness on abdominal percussion. Blood is more dense than air, so it produces a dull sound during percussion, which contrasts with the hyperresonance produced by air.

What is the primary cause of hemorrhagic shock in penetrating abdominal trauma?

Hemorrhagic shock in penetrating abdominal trauma is primarily caused by significant blood loss into the peritoneal or retroperitoneal spaces. This leads to hypovolemia and a decrease in circulating blood volume, resulting in low blood pressure and other signs of shock.

What specific clinical signs are associated with liver and splenic lacerations?

Liver lacerations cause pain in the right upper quadrant, which worsens with deep inspiration. Splenic lacerations cause pain in the left upper quadrant, and may refer pain to the left shoulder (Kehr's sign) due to irritation of the diaphragm.

What are the potential manifestations of diaphragmatic injury from penetrating trauma?

Diaphragmatic injury can lead to a diaphragmatic hernia, where bowel can protrude into the chest cavity. Symptoms include shortness of breath, decreased breath sounds, and possible bowel sounds heard in the chest. This may also cause bowel obstruction.

What are the clinical signs of genitourinary trauma following penetrating abdominal injury?

Signs of genitourinary trauma may include blood at the urethral meatus, hematuria (blood in urine), difficulty voiding, and lower abdominal or pelvic pain. In cases of bladder rupture, urine may leak into the peritoneum, causing peritonitis and increased levels of BUN and creatinine.