injuries poisoning
Overview of Abdominal Trauma
Symptoms and Signs of Abdominal Trauma
Abdominal pain typically is present; however, pain is often mild and thus easily obscured by other, more painful injuries (eg, fractures) and by altered sensorium (eg, due to head injury, intoxication, shock). Pain from Splenic Injury sometimes radiates to the left shoulder. Pain from a small intestinal perforation typically is minimal initially but steadily worsens over the first few hours. Patients with renal injury may notice hematuria. On examination, vital signs may show evidence of hypovolemia (eg, tachycardia, narrow pulse pressure) or Shock (eg, dusky color, diaphoresis, altered sensorium, oliguria, hypotension). Penetrating injuries by definition cause a break in the skin, but clinicians must be sure to inspect the back, buttocks, perineum, flank, and lower chest in addition to the abdomen, particularly when firearms or explosive devices are involved. Cutaneous lesions are often small, with minimal bleeding, although occasionally wounds are large, sometimes accompanied by evisceration. Not all penetrating abdominal injuries originate from wounds on the abdominal wall; be suspicious of entrance wounds on the back, buttocks, flank, perineum, and lower chest. Blunt trauma may cause ecchymosis (eg, the transverse, linear ecchymosis termed seat belt sign), but this finding has poor sensitivity and specificity. Abdominal distention after trauma typically indicates severe hemorrhage (2 to 3 L), but distention may not be apparent even in patients who have lost several units of blood. Abdominal tenderness is often present. This sign is very unreliable because abdominal wall contusions can be tender and many patients with intra-abdominal injury have equivocal examinations if they are distracted by other injuries or have altered sensorium or if their injuries are mainly retroperitoneal. Although not very sensitive, when detected, peritoneal signs (eg, guarding, rebound) strongly suggest the presence of intraperitoneal blood and/or intestinal contents. Rectal examination may show gross blood due to a penetrating colonic lesion, and there may be blood at the urethral meatus or perineal hematoma due to genitourinary tract injury. Although these findings are quite specific, they are not very sensitive. 