1. A Lot Going on Inside
Trauma to the abdominal area may cause a serious, life-threatening injury that may go untreated because immediate symptoms may not be evident. The membranous peritoneum surrounds some organs suspended from the abdominal wall, and others such as the kidneys, pancreas, vena cava, aorta and duodenum have the added protection of being located in the retroperitoneal space, partially covered by the peritoneum. Lack of bony protection in the abdominal area makes the underlying organs and surrounding structures susceptible to serious injury from blunt force trauma. Although there may be minimal injury to the outside of the body, there may be life-threatening internal damage. The examiner may overlook some of the subtle symptoms associated with abdominal injuries during the initial exam. For this reason a series of examinations over a period of hours and days are crucial.
2. Right Upper Quadrant
The liver weighs 3 to 4 pounds and is located in the right upper quadrant of the abdomen. Blood circulating through it accounts for about 30 percent of cardiac output, and it stores up to 17 ounces of blood. For these reasons, liver injuries may lead to profuse hemorrhaging in the capsule surrounding the organ or from rupture of the organ itself. Some symptoms of injury to the liver include pain in the upper right quadrant, a rigid abdomen with rebound tenderness and inactive bowel sounds. If enough blood is lost within the abdominal cavity, circulatory collapse and death can occur without prompt treatment.
3. Left Upper Quadrant
The left upper quadrant of the abdomen houses the spleen. It's located under the diaphragm, and to the side of the stomach. This organ receives about 5 percent of cardiac output and holds about 7 ounces of blood. It's also susceptible to injury from blunt force trauma and fractures of the tenth and twelfth ribs. Some of the same symptoms of a liver injury apply to the spleen, except that the pain is in the left upper quadrant. Kehr's sign may also be present, which is pain radiating to the left shoulder. You can live without a spleen, because the liver will take over for it, but you can't do without a liver.
4. External Bruising May Be a Sign
Your kidneys are located in the retroperitoneal space, with the right one being lower than the left. Fatty tissue surrounds them and fascia holds them in position. Since they have no attachment to the abdominal wall, they move with inspiration and expiration. The most common injury is laceration or bruising. Some things to look for with a kidney injury are flank tenderness, blood in the urine, Grey-Turner's Sign, which is a blue or purplish discoloration over the flank area, and Cullen's sign, which is bruising around the navel area.
5. Ensure a Positive Outcome
Other serious intra-abdominal injuries may include rupture of the stomach, duodenum, large and small intestines, and bladder. These injuries result in abdominal pain, distention and rigidness, with a decrease in or absence of bowel sounds. The symptoms become more intense, as the condition progressively deteriorates. Prompt medical attention for any of these injuries is critical to help ensure a positive outcome.
