ch.12 pt 2

liver

Second to the brain, the ______ is the largest organ and performs the most functions

the liver metabolizes

carbohydrates, proteins, and fats to keep energy levels consistent.

liver primary role

to store glucose as glycogen and collect fat-soluble vitamins and iron for future use

where is the liver located

upper-right quadrant (URQ)

• Under the diaphragm, above the stomach, and right of the pancreas.

Glisson's capsule (similar to pericardium of heart)

• Tough capsule surrounding the liver

• Protects the parenchyma (functioning tissue of the organ).

• Damage to liver is referenced to amount of damage to this capsule

gall bladder

• Located under liver and work together to store and process fats indigestion.

Injury to the liver can present in referred pain to the right shoulder or as an acute, sharp pain over the organ, depending on the area of injury

true

the liver has the abilily to

regenerate

• A small but healthy portion of a liver will grow and adapt to the size of the host and reassume all usual functions.

Where is the spleen located

Upper-left quadrant (ULQ) und the left lower rib cage

Pregnancy, mononucleosis, or other blood disorders inflame the spleen

true

Spleen is not fully protected by the _______ in children

ribs

main function of the spleen

Filtering blood and supplying antibodies

One can live without a spleen; marrow of long bones and certain glands will take over the majority of its functions

true

Highly vascular organ

At any time holds 5%-6% of cardiac output while filtering 10% to 15% of total blood volume per minute.

Liver injury overview

Potentially life threatening•

MOI: Blunt force•

Primary complaint: "Wind knocked out of me"•

Can rapidly deteriorate from internal bleeding and shock

spleen injury overview

Potentially life threatening

• MOI: Blunt force; may seem like trivial contact

• Pain is often referred to upper-left shoulder (Kehr's sign)

risk factors of spleen and liver injury

• History of hepatic conditions

• Participation in American football and lacrosse

• Pregnancy, infectious mononucleosis, and some blood disorders (can enlarge spleen)

Liver injury symptoms

-Sharp URQ pain that may radiate to the right shoulder

• Signs may be subtle at first, but reevaluation is paramount

• Nausea and vomiting are not unusual

• Immediate Transfer is needed when:

• Anxiety, dyspnea, pale and sweaty skin, and confusion (all are signs of shock)

spleen injury symptoms

• Wind knocked out with vague abdominal pain/distress to follow

• Pain on lower-left ribs and ULQ, abdominal guarding, swelling, and muscle spasm, nausea, and urge to defecate.

• Signs of shock include: thready pulse, pale and sweaty skin, and lowering blood pressure

American Association for the Surgery of Trauma (AAST) Grading System

Grade 1-6

Grade l

Subcapsular hematoma with less than 10%surface area involved

Grade ll

Capsular tear less than one centimeter

Grade lll

Subcapsular hematoma of 10%-50% in surfacearea

Grade VI

Where the hepatic artery is avulsed

Grades I-V

correspond with increasing challenges in liver damage; grade VI is fatal

immediate management for spleen/liver injuries

Critical management/treatment: Patients that present with dyspnea and who are pale, tachycardic, and hypotensive

immediate management for spleen/liver injuries continued

Once athlete is removed from play, all that can be done is monitor vitals and activate EMS

• Place patient in hook-lying position

• Provide supplemental oxygen (12-15 L/min via non-rebreather) as precaution for shock• If injury is suspected, patient must be transferred to hospital

Kidneys

Located outside the peritoneal cavity, along the lower thoracic spine and largely under the final ribs

.• Attached to the diaphragm and move slightly with breathing

Kidneys primary function

Maintain homeostasis through maintaining fluid balance, removing waste from blood and regulating both blood pressure and red blood cells in the body

Kidneys are highly vascular organs and are vital in urine production

true

Hematuria

blood in the urine

• Possible sign of kidney trauma

MOi for kidneys

Direct blow to the lower posterior rib cage can injure a kidney

Posterior back plate

can help prevent kidney injury•

Does require a tight fitting jersey to cover the pad and firmly secure it to the body

Kidney is ______% of all abdominal trauma

3%

Only risk factor for kidney trauma is participation incollision/contact sport.

true

signs/symptoms of kidney inury

• Painful breathing, dyspnea, tachycardia, and later hypotension

• Can also include nausea, dizziness, and abdominal pain

• Extremely painful injury

• Hematuria post practice/game (delayed sign)

• Idiopathic hematuria

• Dehydration

• Foot-strike hemolysis

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Hypoxic kidney damage

• Increased circulation rate

• Myoglobinuria release

Blow to the _______or flank area is suspicion of kidney injury

posterior lower ribs

When assessing for kidney injury

Inspect for visible sign of injury (not likely); palpation of the area will help in assessment

Injury is graded similarly to kidney and spleen classification(AAST)

• Grades II-V each have larger tears and advancing detrimental urinary sequelae

true

Transport if patient is deteriorating or hemodynamically unstable for kidney injury

true

kidney stones

Salts crystalizing within the ureters, urinary bladder, or urethra,often forming a blockage

signs and symptoms of kidney stones

sudden acute pain, hematuria, nausea, and vomiting

• Abdominal sounds are normal

• If symptoms are accompanied by a fever, refer immediately

Acute kidney stones can create pain on either side of the back(either ureter), over the pubis (bladder,) or anywhere along the urethra

true

Once the stone passes, the patient is usually free of symptoms but may have residual _______from the stone scraping or stretching the urethra.

hematuria

appendix

Formally known as vermiform appendix

where is the appendix located

Located in the LRQ at the juncture of the small and large intestines

• Not firmly attached to anything which creates a challenge to palpate or elicit pain when palpated in a specific spot.

the appendix lies in the peritoneum and tends to have referred or diffuse pain instead of pain directly over the organ

true

McBurney's point

the location and special test to determine an injury

Appendicitis

• Not brought on by trauma

• Inflammation of the appendix

• If appendix ruptures, patient can become septic, which can be fatal

signs and symptoms of Appendicitis

Vomiting and unspecific abdominal pain•

McBurney's point: Rebound pain

• Rovsing's sign: RLQ pain when palpating LLQ

• Dunphy's sign: Right-sided abdominal pain, which can be associated with coughing