Abdominal Pain and Trauma

The abdomen region is defined as the region between the diaphragm and pelvis, and due to the variety of structures within this region, it becomes difficult to identify injuries. It is sometimes difficult to identify trauma caused abdominal pain, as the injury maybe internal which is why it does not appear in the initial assessment. Treatment for abdominal pain can be misleading as patients do not realize the extent of their injury and may attribute abdominal pain to dietary issues.

Blunt Trauma: Compression

Abdominal pain that arises from a blow received by the abdomen through a fixed object, is called a compression force trauma. This may include a seat belt or lap belt strain during colission. This may cause a hematoma inside the abdomen or cause the small intestine to be ruptured or compressed.

Blunt Trauma: Deceleration force

A deceleration force causes the liver or renal artery to be injured and can also tear the inner bowel vessels. Spleen injuries are common in abdominal trauma cases. However, as the injury cannot be seen without a Computed tomography [CT-a CT is a medical image of the inside of the body made through computer processing], the trauma may go undetected until symptoms of pain, fever and infection arise. Automobile crashes are the most common cause of such injuries.

Solid Organ Trauma
When a solid organ, such as the liver, spleen, kidney or pancreas, is injured, internal bleeding may occur. Depending on the severity of the bleeding, the patient can have pain over a large span of time without realizing the severity of the injury. Liver and intestinal injuries in particular can take days to manifest. This can cause shock and even death.

Symptoms of Trauma-related Abdominal Pain

Symptoms of trauma-related abdominal pain include tachycardia (when the heart beats too fast), hypotension, pale skin. There may be hypovolemic shock (a condition where blood and fluid loss does not allow the to pump enough blood to the body) without indications, tender abdomen and pain in uninjured body parts like the arm or shoulder. Bruises and obvious open injuries are indicative of abdominal trauma. Any injury over the umbilicus may involve the chest and a CT scan must be done.

Guidelines for Assessing Abdominal Injuries

Check for deformities, burns, tenderness, lacerations, swelling, abrasions, contusions or any obvious penetrating injuries after a trauma. Hemorrhages are common after a blast. In the case of a trauma that causes a person to go into shock, doctors assume there is an abdominal injury, unless tests prove otherwise.

Management of Internal Abdominal Trauma

Internal abdominal injuries at times cause the lungs to collapse. That is why when a patient comes in with abdominal pain, doctors ensure that the respiratory passages are clear. Establishing adequate breathing and circulatory support is essential for any abdominal injury. As injuries may be hard to locate, clinical symptoms are first managed, then diagnosis is done. It is important to leave the airways open so nothing should be given via the mouth.

Diagnosis of Trauma-Related Abodminal Pain

If there has been a car accident or indirect collision, blast and/or stabbing incident, patients should be assessed for abdominal injuries. Even without symptoms, a CT scan must be given, as internal injuries are hard to diagnose. The patient should be monitored for at least 24 hours, either in a hospital or at home so that any abdominal injuries, direct or indirect, related to the trauma can be diagnosed.

Sources:
Abdominal Pain and Trauma: http://www.slideshare.net/narenthorn/abdominal-trauma-presentation