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Visceral Blunt Trauma

Topic updated on 01/18/14 12:31pm
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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Qbank (2 Questions)

TAG
(SBQ07.24) 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? Topic Review Topic

1. Regular creatine usage
2. Sustaining a spider bite
3. Drinking alcohol
4. Sharing water-bottles with teammates
5. Taking NSAIDS on an empty stomach

PREFERRED RESPONSE ▶
TAG
(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? Topic Review Topic

1. Fractured kidney
2. Ruptured appendicitis
3. Ruptured gallbladder
4. Splenic rupture
5. Pneumothorax

PREFERRED RESPONSE ▶



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Video Length: 13:12 (minutes:seconds) Title: Visceral Blunt Trauma Focus: Sports...
9/30/2013
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