Abdomen & Thorax

KNSS 220 Introduction to Athletic Therapy

Abdomen & Thorax

Abdomen Anatomy

Kidneys
Adrenal Glands
Anatomy of Human Urinary System
- Organs Involved:
- Ureters
- Urinary bladder
- Right ureter
- Urethra
- Left ureter

Anatomy of the Digestive System

Organs Involved:
- Liver
- Gallbladder
- Pancreas
- Stomach
- Small intestine
- Large intestine

Anatomy of the Lymphatic System

Spleen

Anatomy of the Reproductive System

Female Organs:
- Ovaries
- Uterus
- Uterine tubes
- Vagina
Male Organs:
- Seminal vesicles
- Prostate gland
- Testes
- Vas deferens
- Epididymis
- Urethra
- Penis

Conditions and Injuries

1. Condition: Kidney Stones

Etiology:
The formation of hard deposits made of minerals and salts that develop in the kidneys, often due to dehydration, high sodium intake, or underlying metabolic disorders.
Signs and Symptoms
- Severe pain in the back or side, often radiating to the lower abdomen and groin
- Blood in urine (hematuria)
- Frequent urination or urgency
- Nausea and vomiting
- Cloudy or foul-smelling urine
Management:
- Encourage increased fluid intake to dilute urine.
- Monitor for signs of urinary tract infection (UTI) and consider urinalysis.
- Provide analgesics for discomfort as needed.
- Consider prescribing antibiotics if a bacterial infection is confirmed.

Involves the Bladder, Ureter, and Kidney
- Stones:
- Stone Location: Ureter
- Types of Stones: Various stone types based on composition

2. Injuries: Kidney Contusion

Etiology:
- The primary causes of kidney contusions include blunt trauma from falls, sports injuries, or vehicular accidents, leading to potential bleeding and tissue damage.
Signs and Symptoms
- Hematuria: Presence of blood in the urine, often one of the most noticeable signs.
- Flank pain: Patients may report sharp or dull pain in the side or back where the kidneys are located.
- Abdominal pain: General discomfort in the abdominal area may occur due to associated injuries.
- Nausea and vomiting: Some individuals may experience gastrointestinal symptoms as a reaction to pain or stress.

Management

Hydration: Ensuring adequate fluid intake is crucial, especially if vomiting is present, to prevent dehydration.

Diagnostic imaging: Utilizing ultrasound or CT scans can help identify any underlying conditions affecting the abdomen and thorax.
Surgical intervention: In cases of severe injury or complications, surgical options may be necessary to relieve symptoms and address the cause.
Understand bruises and lacerations related to kidney injuries

3. Condition: Urinary Tract Infection

Etiology:
- Bacterial infection: The most common cause, often originating from bacteria in the bowel or skin.
- Urinary stasis: Conditions that hinder normal flow of urine can encourage bacterial growth.
- Catheterization: Indwelling catheters can introduce bacteria into the urinary system, leading to infection.
Signs and Symptoms:
- Painful urination (dysuria): A common symptom experienced by patients.
- Increased urgency and frequency: Patients may feel an overwhelming need to urinate.
- Fever and chills: Indicating a systemic response to the infection.
- Back pain: May occur if the infection ascends to the kidneys.
- Cloudy or foul-smelling urine: A result of the bacterial presence.
Management
- Pathway of bacteria from skin or rectum to the urethra
- Involvement of kidney, ureter, bladder
- Mechanism of Infection: Bacteria travel up the urethra to the bladder

4. Condition: Amenorrhea

Etiology:
- Hormonal imbalances, such as those resulting from thyroid disorders or polycystic ovary syndrome (PCOS)
- Stress and excessive exercise, which can disrupt normal menstrual cycles by affecting hormonal regulation.
- Environmental factors, including nutritional deficiencies or excessive body weight changes, can also contribute to the onset of amenorrhea.
Signs and Symptoms
- Irregular menstrual cycles or missed periods
- Extreme weight loss or gain
- Hot flashes or night sweats
- Fatigue or weakness
- Difficulty concentrating or mood swings
- Hair loss or excessive hair growth (hirsutism)
- Pelvic pain or discomfort
- Changes in skin texture or appearance
Management:
- Hormonal assessment to identify underlying endocrine disorders
- Lifestyle modifications including diet and exercise
- Medications such as hormonal therapies or anti-androgens

5. Condition: Indigestion (Dyspepsia)

Etiology: Common causes of indigestion include overeating, consuming spicy or fatty foods, and stress, which can lead to gastric disturbances.
Signs and Symptoms: Indigestion manifests in various ways, including bloating, belching, nausea, and discomfort or pain in the upper abdomen. Other symptoms may include loss of appetite and a feeling of fullness after eating.
Management: Lifestyle modifications such as avoiding trigger foods, eating smaller meals, and managing stress through relaxation techniques are essential.

6. Condition: Appendicitis

Etiology: Appendicitis typically arises from obstruction of the appendiceal lumen, which can result from fecaliths, lymphoid hyperplasia, or foreign bodies, leading to inflammation and infection of the appendix.

Signs and Symptoms: Common signs and symptoms of appendicitis include right lower quadrant abdominal pain, nausea, vomiting, loss of appetite, and fever. Additionally, patients may experience tenderness upon palpation of the abdomen and rebound tenderness, indicating irritation of the peritoneum.
Management:
- Management of appendicitis typically involves surgical intervention, specifically an appendectomy.

Injuries Related to Abdomen

1. Scrotal Contusion

Etiology:
- Scrotal contusion is usually caused by blunt trauma to the groin area, which can occur during contact sports, accidents, or falls.
Signs and Symptoms:
- Localized pain and swelling in the scrotum
- Bruising may appear
- Discomfort during walking or sitting
- Nausea or vomiting in severe cases
Management:
- Assess the severity of the bruising and monitor for signs of internal injury.
- Rest and Immobilization
- Initiate IV fluid therapy to maintain hydration and electrolyte balance.
- Consider pain management options to alleviate discomfort.

2. Abdominal Muscle Strain

Normal Muscle Structures:
- Abdominal muscle types involved include:
- Rectus abdominis
- External oblique abdominal muscle
- Injured Muscles: Identifying which abdominal muscle is strained
Etiology:
- The etiology of abdominal muscle strain can often be attributed to sudden twists, heavy lifting, or prolonged activities that require excessive force or repetitive motion, leading to muscle fatigue and damage.
Signs and Symptoms:
- Pain or tenderness in the affected area, often worsening with movement or palpation
- Swelling or bruising around the site of injury
- Limited range of motion due to discomfort
- Muscle spasms and stiffness in the abdominal region
- Difficulty performing daily activities that require trunk movement.
Management:
- Incorporating gentle stretching exercises to improve flexibility and reduce tension.
- Utilizing heat therapy to alleviate muscle spasms and promote relaxation.
- Consulting with a physical therapist for personalized rehabilitation programs that focus on enhancing trunk mobility. Implementing core strengthening activities to support abdominal and thoracic stability, thereby maintaining proper posture and reducing strain on surrounding muscles.

Abdomen Assessment

History Compilation
- Who: Name, age, gender, job
- Mechanism: What, how and when did it happen
- Pain:
- Location
- Onset
- Duration
- Severity
- Radiation
- Associated symptoms:
  - Nausea
  - Vomiting
  - Diarrhea
  - Constipation
  - Fever
  - Fatigue
  - Painful urination
  - Blood in urine
- Aggravating or Alleviating Factors
- Medications/Allergies
- Appetite & Food Intolerance
- Bowel Habits
- Health History/Surgeries

Observations During Assessment

Evaluate the following:
- Costal margin
- Xiphoid process
- Midabdominal line
- Lateral border of rectus muscles
- Anterior superior iliac spine
- Shape and symmetry

Skin Assessment:
- Scars (discoloration, swelling, deformity)
- Inguinal ligament

Abdomen Assessment Techniques

1. Auscultation

Listen to bowel sounds for:
- Presence or absence
- Frequency
- Loudness
- Quality
- Duration
Use the 4 quadrants of the abdomen to auscultate specific organs

2. Percussion

Technique:
- Place fingers on the abdomen and strike with the other hand
- Sound Identifier:
- Solid organ: dull sound
- Hollow organ: tympanic sound

3. Palpation

Light Palpation: Assess tenderness across all 4 quadrants
Deeper Palpation: Identify masses in all 4 quadrants
Organs to Assess:
- Liver
- Spleen
- Appendix
- Kidneys
- Pancreas
- Stomach
Muscles to Assess:
- Rectus abdominus
- Obliques
- Transverse abdominus

Four Quadrants of Palpation

Right Upper Quadrant:
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Right adrenal gland
- Portion of right kidney
- Portions of ascending and transverse colon

Left Upper Quadrant:
- Left lobe of liver
- Spleen
- Stomach
- Body of pancreas
- Left adrenal gland
- Portion of left kidney
- Portions of ascending and transverse colon

Right Lower Quadrant:
- Lower pole of right kidney
- Cecum and appendix
- Portion of ascending colon
- Bladder
- Ovary
- Uterus
- Right spermatic cord
- Right ureter

Left Lower Quadrant:
- Lower pole of left kidney
- Sigmoid colon
- Portion of descending colon
- Bladder
- Ovary
- Uterus
- Left spermatic cord
- Left ureter

Introduction to Athletic Therapy - Thorax

Thorax Anatomy

Bones Involved:
- 12 Thoracic Vertebrae
Rib Classifications:
- Upper 7 ribs: True Ribs
- Ribs 8-10: False Ribs
- Ribs 11-12: Floating Ribs

Sternum Components

Parts:
- Manubrium
- Body
- Xiphoid process

Muscles of the Thorax

Intercostal Muscles:
- External intercostals (Function: inhalation)
- Internal intercostals (Function: exhalation)
Diaphragm

Anatomy of the Lungs

Pathway: Pharynx → Larynx → Trachea → Bronchus → Bronchioles → Alveoli
Gas Exchange: Capillaries in the alveoli facilitate exchange of oxygen and nutrients in, and carbon dioxide and waste products out

Anatomy of the Heart

Chambers:
- Left and Right Chambers
Blood Flow:
- Deoxygenated Blood: Travels to the right atrium → right ventricle → lungs
- Oxygenated Blood: Travels from lungs → left atrium → left ventricle → to the body

Blood Circulation

Pulmonary Arteries: Supply deoxygenated blood to lungs
Vena Cavae: Carry oxygen-poor, CO₂-rich blood to the right atrium
Pulmonary Veins: Bring oxygen-rich, CO₂-poor blood back to the left atrium
Systemic Circuit: Flow to and from all body tissues for gas exchange

Injuries Related to Thorax

1. Rib Contusion

Etiology:
- This injury typically occurs due to direct trauma to the chest, such as a blow or impact to the rib cage, which can cause bruising of the rib muscles and surrounding tissues.
Signs and Symptoms:
- Localized pain at the site of impact, which may worsen with movement or deep breaths
- Swelling or bruising visible on the skin over the affected area
- Tenderness when pressing on the affected ribs
- Difficulty breathing, particularly taking deep breaths
- Possible referred pain to the back or abdomen, depending on the location of the contusion.
Management
- Rest and avoid activities that exacerbate the pain.
- Application of ice packs to reduce swelling and alleviate discomfort.
- Pain management with over-the-counter analgesics such as ibuprofen or acetaminophen.
- In severe cases, consider evaluation for rib fractures or other complications.

2. Rib Fracture

Etiology:
- Rib fractures are commonly caused by direct trauma, such as falls or sports-related injuries, but can also result from severe coughing or underlying conditions that weaken the bones.
Signs and Symptoms:
- Localized pain at the site of injury, often worsening with movement or deep breaths
- Swelling and bruising in the affected area
- Difficulty breathing or shortness of breath (due to pain)
- Crepitus (a crackling or popping sound) at the injury site
- Potentially associated injuries to internal organs or vessels, depending on the location and severity of the fracture.
Management:
- Administer oxygen as needed to mitigate hypoxia.
- Stabilize the patient and prepare for potential transportation to a medical facility.
- Order imaging studies to assess for internal injuries and confirm the extent of fractures.
- Initiate fluid resuscitation if signs of hemorrhage are present.

3. Costochondral Separation

Etiology
- Trauma to the chest wall, commonly from blunt force injuries such as falls or vehicle accidents.
- Repeated stress or overuse in athletes, especially those involved in contact sports.
- Broken rib directly causing a separation
Signs and Symptoms:
- Localized pain at the site of injury, which may worsen with movement or palpation
- Tenderness and swelling in the affected area
- Possible difficulty breathing or deep breathing due to pain
- Crepitus (a crackling sensation) may be felt upon examination
- Bruising or discoloration of the skin over the site of injury.
Management:
- Administer supplemental oxygen if necessary to improve oxygenation levels.
- Monitor vital signs closely, focusing on respiratory rate and effort.
- Provide pain management options to facilitate easier breathing, such as analgesics or positioning.
- Consider further imaging studies, like a chest X-ray or CT scan, to assess for underlying injuries.

Sudden Death Syndrome in Athletes

1. Commotio Cordis

Etiology
- Complex pathways involving cardiac rhythm analysis (QRS intervals, QT intervals)

2. Hypertrophic Cardiomyopathy

Etiology: Abnormal thickening of the ventricular wall
- Important structural components include:
  - Right atrium
  - Arch of aorta
  - Left atrium
  - Left ventricle
  - Ventricular septum

3. Wolff-Parkinson-White Syndrome

Etiology:
- This condition is caused by an abnormal electrical pathway in the heart, leading to episodes of rapid heartbeat due to reentrant tachycardia.
- Description involves heart rhythm disruptions

4. Myocarditis

Etiology:
- Myocarditis can result from various factors including viral infections, autoimmune diseases, and exposure to certain toxins or medications, which can lead to inflammation of the heart muscle and subsequent heart failure.
- Inflammation of the heart muscle

Respiratory Tract Conditions

Conditions to understand include:
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Pneumonia
- Upper respiratory infections like sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis

Thorax Assessment

Assessment Process:
- Compiling history regarding:
- Name, age, gender, job
- Mechanisms of injury: what, how, and when
- Pain characteristics: location, onset, duration, severity, radiation
- Associated symptoms: difficulty breathing, coughing, shortness of breath, chest pain
- Aggravating/Alleviating Factors
- Medical History: Previous respiratory conditions (e.g., asthma, bronchitis, TB)
- Observations:
- Assess shape and symmetry
- Skin condition (discoloration, swelling, deformity)

Thorax Assessment Techniques

1. Palpation

Comprehensive palpation of the entire chest wall:
- Noting tenderness
- Skin temperature
- Moisture
- Lumps or lesions

2. Special Tests

Rib Compression Test to identify potential rib injuries

3. Auscultation

Listen for respiratory and cardiovascular sounds:
- Presence or absence, frequency, loudness, quality, duration

4. Percussion

Systematic tapping to compare sides and assess chest condition

Condition: Kidney Stones

Etiology:
Signs and Symptoms
Management:

Involves the Bladder, Ureter, and Kidney
- Stones:
- Stone Location:
- Types of Stones: