Chapter 12-13

1. Chapter 12-13 Abdomen and Thorax Injuries

2. Bones of the Thorax • Ribs • 12 pairs (sometimes a 13th) • Pairs 1-7 True Ribs • Pairs 8-12 False Ribs • Pairs 11-12 AKA Floating Ribs • Costal Cartilage: ____________________ • Sternum • 3 Parts: ________, _______, _____________

3. Anatomy of the AbdomenWhere is the abdominal cavity?

4. Anatomy of the Thorax • What separates the thorax from the abdomen? • What two vital organs are in the thorax?

5. Hollow organs: 1 2 3 EX: bladder, intestines, stomach, appendix Solid Organs: 1 2 EX: liver, kidney, spleen Hollow vs. Solid Organs

6. Digestive Organs • Liver • Gallbladder • Pancreas • Stomach • Small Intestine • Large Intestine

7. LIVER • Liver – The largest internal organ of the body. Located in the RUQ. 2 lobes. Performs digestive and excretory functions, absorbs and stores excessive glucose, processes nutrients, and detoxifies harmful chemicals. It secretes bile, which is essential in neutralizing and diluting stomach acid and for digesting fat in the small intestine during the digestive process.

8. GALLBLADDER • pear-shaped, saclike structure located on the inferior surface of the liver. Serves as a storage site for bile. Shortly after a meal, the gallbladder secretes bile into the small intestine. Gallstones are a result of large amounts of cholesterol in the diet. Gall stones can block release of bile. They will need to be removed surgically.

9. PANCREAS • Located between the small intestine and the spleen. Secretes pancreatic juice, which is critical in the digestion of fats, CHOs, and PROs. Produces insulin and glucagon, hormones that control the amount of glucose and amino acids in the blood.

10. STOMACH • LUQ Sits between the esophagus and the small intestine. Main function is for food storage and a mixing chamber. Some digestion and absorption occurs in the stomach. Gastric secretions assist in the partial digestion of proteins and the absorption of alcohol and caffeine. Ingested food is mixed w/secretions from the stomach to form a semifluid mixture called chyme, which passes from the stomach to the small intestine.

11. SMALL INTESTINE • Connected to the inferior portion of the stomach. 3 parts: duodenum, jejunum, and the ileum. Approx 20 ft. long. Secretions from the liver and pancreas mix with secretions from the small intestine to help break down chyme into smaller nutrients that can be absorbed. Chyme is moved through the small intestine through a series of peristaltic (wave-like) contractions. Chyme can stay in the small intestine for 3-5 hours. Most of the digestion and absorption of nutrients occurs in the small intestine.

12. LARGE INTESTINE • The large intestine is approximately 6 ½ feet long. 3 divisions: Cecum, Colon, Rectum. The appendix extends from the cecum. Water absorption occurs in the large intestine.

13. Urinary Organs • Kidneys • Maintain acid-base balance of the blood/body • Removes waste products from the body in liquid form • Can survive with only 1 • Ureters • Tubes that go from the kidneys to the bladder • Bladder • Stores urine

14. Heart – Parts and Circulation • Divided into 4 sections • Right • Right • Left • Left • Valves of the Heart • 1 • 2 • 3 • 4

15. Pathway of circulation

16. Pathway of Circulation • Right Ventricle • Pulmonary Trunk • To pulmonary arteries • LUNGS • Left Atrium • Left Ventricle • Aorta • Head and neck • Lower body • Superior Vena Cava • Inferior Vena Cava • Right Atrium With Oxygen Without Oxygen

17. Lungs • Pathway into the lung • Nose/mouth • Trachea • Bronchi • Bronchi divide into smaller and smaller divisions until they end in Alveoli (air sacs) • Alveoli = • Elastic and Spongy • Expand and contract in response to contraction of the diaphragm muscle

18. Lobes of the lungs • Left Side • 2 lobes • Upper • Lower • Right Side • 3 lobes: • Upper • Middle • Lower • Lobes divided by fissures • Left side (1) • oblique • Right side (2) • Horizontal • Oblique

19. Thoracic Muscles • External Intercostals • Origin: Inferior border of the ribs and the costal cartilage • Insertion: Superior border of the rib below the rib of origin • Action: • Internal Intercostals • Origin: Inner surface of the ribs and costal cartilages • Insertion: Superior border of the rib below the rib of origin • Action: • Diaphragm • Origin: Inferior border of the rib cage, the xiphoid process, the costal cartilages, and the lumbar vertebrae • Insertion: Central tendon of the diaphragm • Action:.

20. Abdominal Muscles • External Obliques • Most superficial layer of abdominal muscle • Origin: External surface of the lower 8 ribs • Insertion: Linea alba and the anterior half of the iliac crest • Action

21. Abdominal Muscles • Internal Obliques • Intermediate layer of abdominal muscle under the external obliques • Origin: Inguinal ligament, the iliac crest, and the lumbodorsal fascia • Insertion: Compresses the abdominal cavity, assists in flexing and rotating the vertebral column • Action

22. Abdominal Muscles • Transverse Abdominis • Deep under the external and internal obliques • Origin: Inguinal ligament, the iliac crest, the lumbodorsal fascia, and the costal cartilages of the last six ribs • Insertion: Linea alba and the pubic crest • Action

23. Abdominal Muscles • Rectus Abdominis • “Six Pack Muscles” • superficial layer of muscle • Origin: Pubic Crest • Insertion: Xiphoid process and the costal cartilages of the 5th through 7th ribs • Action

24. Abdominal Muscles • Quadratus Lumborum • Origin: Iliac crest and the iliolumbar ligament • Insertion: Lower border of the 12th rib and the transverse processes of the first 4 lumbar vertebrae • Action

25. Referred PainPain that is felt somewhere other than it’s origin

26. Splenomegaly Pancreatitis Kidney Contusion Hernias Liver Contusion “Side Stitch” Appendicitis Rib Fracture Sternum Fracture Pneumothorax Flail Chest Hemothorax Sucking Chest Wound Hyperventilation Thoracic & Abdominal Injuries

27. SplenomegalyEnlargement of the spleen • Cause • fall/direct blow to LUQ when an existing medical condition (MONO) has caused splenomegaly • Signs and Symptoms • Hx of severe blow to LUQ, signs of shock, abdominal rigidity, nausea, vomiting • Kehr’s sign (pain in L shoulder and arm 30 min after injury

28. Splenomegaly cont • Complications • Spleen cannot splint itself and can produce a delayed hemorrhage • Splinting = loose hematoma formation and surrounding structures provide pressure to prevent hemorrhage • Slight strain can disrupt splinting • Treatment • MONO: no activity for at least 3 weeks & possible antibiotics • Surgery to repair a ruptured spleen: • Minimum 3 months recovery • Surgery to remove spleen: • Minimum 6 months to recover

29. Pancreas Injury • Cause • May be acute or chronic and is often related to an obstruction of the pancreatic duct like a gall stone. • ACUTE inflammation can lead to: • necrosis: Death of cells or tissues through injury or disease, especially in a localized area of the body • Suppuaration: The formation or discharge of pus • Gangrene: the localized death of living cells (as from infection or the interruption of blood supply) • Hemorrhage: heavy bleeding • CHRONIC inflammation may result in scar tissue formation that may cause malfunction of the pancreas (usually from alcoholoism)

30. Pancreas injury cont. • Signs/Symptoms • Acute: epigastric pain, vomiting, belching, constipation, and potentially shock. May also be tenderness and rigidity to palpation. • Chronic: jaundice, diarrhea, mild to moderate pain that radiates to the back • Treatment • Acute: rehydration, pain reduction, treatment of shock, reduction of pancreatic secretions using medications, and prevention of secondary infection. Surgery would be indicated only if the pancreatic duct is blocked • Chronic: : Difficult and requires large doses of analgesics, the administration of pancreatic enzymes, and a low fat diet

31. Kidney Injuries • Causes • An external force, usually applied to the back of the athlete

32. Kidney Injuries cont. • Signs/Symptoms • Shock • Nausea • Vomiting • Rigidity of the back muscles • Blood in urine • Referred pain • Contusion/ecchymosis • Edema • Treatment • If blood in urine: 24 hour observation at hospital • If bleeding doesn’t stop: surgery possible • Up to 2 weeks of bed rest and close surveillance • Pad area if possible when playing a contact sport

33. Hernia Refers to the protrusion of abdominal viscera through a portion of the abdominal wall • TYPES: • Inguinal: in the groin (75% in males) • Femoral: in the groin (most often in females) • Strangulated: wall of the abdomen encloses around protrusion, cutting off blood flow and leading to gangrene and death if not treated

34. Hernia cont. • Causes • Abdominal organs push through abdominal wall due to weakness or trauma to the abdomen • Signs/Symptoms • History of blow or strain to the groin • Protrusion in abdomen or groin that is increased by coughing • Feeling of weakness and pulling sensation in the groin • Treatment • Surgery to repair damage to abdominal wall and prevent more hernias from occuring

35. Liver Contusion • Cause • Infrequent in sports • Hard blow to the right side of the ribcage • Vulnerable if liver is inflamed due to disease or hepatitis (viral infection or alcohol consumption) • Signs and Symptoms • Hemorrhage, shock, referred pain (below R scapula, R shoulder & Substernal area and sometimes anterior L chest area • Treatment • Immediate referral to a physician for diagnosis and treatment

36. “Side Stitch” • Cause: not sure but many theories exist: • Constipation, gas, overeating, diaphragmatic spasm, lack of visceral support from weak abdominal muscles, distended spleen, breathing techniques that lead to lack of oxygen in the diaphragm, ischemia of either the diaphragm or the intercostal muscles, fluid-engorged gut that tugs on visceral ligaments. • Signs and Symptoms • Cramp-like pain that develops inferiorly to the rib cage during physical activity. • Treatment • Relax the spasm • Reccurent: check eating habits, training regimen and elimination habits

37. Appendicitis • Cause • variety of conditions such as: fecal obstruction, lymph swelling, or even carcinoid tumor • Commonly mistaken for gastric complaints • Signs and Symptoms • Mild to severe pain in lower abdomen, nausea, vomiting, low-grade fever, cramps localized on the right side (McBurney’s Point), abdominal rigidity • Treatment • Surgical removal • If not removed it could rupture which can lead to a bacterial infection in the body.

38. Rib Fracture • Cause • Usually result from a direct blow • Have been cases though where a rib has broken due to a sneeze • Signs and Symptoms • Usually easy to detect • History from athlete will usually explain how it could be a fx • Pain on inspiration and point tenderness • Treatment • Send to physician for x-rays. • Usually managed with support and rest. • May heal in 3-4 weeks

39. Sternum Fracture • Cause • Results from a high impact blow to the chest. • More likely in automobile accident than in athletics. • Signs and Symptoms • Pt. tenderness over sternum. • Painful inspiration and expiration. • Signs of weak, rapid pulse may also indicate more severe internal injury. • Treatment • Send for x-rays and closely monitored for signs of trauma to the heart.

40. Pneumothorax • Cause • a condition in which the pleural cavity fills with air that has entered the chest through an opening. • As the negatively pressured cavity fills with air, the lung on that side collapses • Signs and Symptoms • Pain • difficulty breathing • anoxia (Lack of Oxygen) • Also some sort of wound to the chest would be present • Treatment • Activate EMS and get athlete to hospital ASAP. • Air needs to be removed from the pleural cavity via a chest tube.

41. Flail Chest • Cause • Fracture of three or more ribs on the same side, each in two or more places, usually caused by a direct blow to the chest. • Signs and Symptoms • Injured section will move in and out with inspiration/expiration, however it will be moving in the opposite direction. • On inspiration, the loose section will move into the body and on expiration, the loose piece will move out. • Extremely painful and difficult to breath with. • Treatment • try and stabilize loose piece to prevent movement as much as possible • treated for shock and EMS should be activated and the athlete should be transported to the hospital for further care

42. Hemothorax • Cause • Results from tearing or puncturing of the lung or pleural tissue. • Blood accumulates in the pleural space collapsing the lung on the affected side. • Breathing becomes painful. • Signs and Symptoms • severe pain while breathing • dyspnea (difficulty breathing) • coughing up frothy blood • signs of shock • Treatment • Athlete should be treated for shock, EMS should be activated, and a physician will most likely use a chest tube to remove the fluid from the lung at the hospital

43. Sucking Chest Wound • Cause • The wall of the chest is punctured by some object. • The lung may or may not be punctured as well. • Signs and Symptoms • difficulty breathing • circulation may become impaired • Cyanotic (blue) skin color • breathing will cause a noise from the wound as air is drawn into the wound • Treatment • The athlete should be treated by controlling the bleeding and sealing the wound with a cellophane wrap, piece of plastic bag, or vaseline gauze. • EMS should be activated immediately and the athlete should be transported to the hospital for further evaluation.

44. Hyperventilation • Cause • An athlete who has excessively rapid rate of ventilation usually due to anxiety-induced stress or asthma gradually develops a decrease amount of CO2 in the blood (hypocapnia). • Signs and Symptoms • Difficulty breathing • struggling to get air • panic state • gasping or wheezing • While it appears that the athlete is not getting enough O2, in reality it is the level of CO2 that is too low.

45. Hyperventilation cont. • Treatment • Reduce the amount of CO2 loss: have athlete start to slow down respirations by concentrating on breathing in through the nose and out through the mouth. Also having the athlete breath in a paper bag will help. This keeps the CO2 that is expired in the bag which the athlete will then breath in again, eventually raising the CO2 levels. Typically the athlete will return to a normal breathing rate within 1-2 minutes. After normal breathing is returned it is important to determine the underlying cause and take appropriate treatment measures.

46. The End • For your quiz • You should be able to: • Name the three parts of the small intestine • Name the three parts of the large intestine • List the two main functions of the liver • Name the three parts of the sternum • Match Injuries to their cause