ATRAIN+748_Lec+5_Thorax+%26+Abdominal+Pathology_Student_SP25 copy

Thorax Pathology Overview

• ATRAIN 748

Anatomy – Rib Cage

• Components: Sternum, ribs, costal cartilage, thoracic vertebrae

• Function: Protects the heart and lungs

• Ribs 1-7: Directly articulate with sternum

  • Ribs 1-2 attach at the manubrium

  • Ribs 2-7 attach along the body of the sternum

• Ribs 8-10: Conjoined costal cartilage (False ribs)

• Ribs 11-12: Floating ribs, do not connect to the sternum

Anatomy – Lungs

• Connection: Lungs attached to trachea via right and left bronchial tubes

• Structure: Up to 23 levels of branches leading to alveoli

  • Function of Alveoli: Serve as diffusion chambers for gas exchange

• Lung Coverage: Typically span ribs 1-12

• Note: Left lung smaller than right to accommodate the heart

Abdominal Pathology – Abdominal Viscera

• Solid Organs: Spleen, liver, pancreas, kidneys, adrenal gland

• Hollow Organs: Stomach, gall bladder, intestines, bladder, ureter

• Location: Found between the diaphragm and pelvic floor

Quadrant Anatomy

• Right Upper Quadrant:

  • Liver, Gall Bladder, Pancreas (head), Large Intestine

• Right Lower Quadrant:

  • Small Intestine, Large Intestine, Ovary/Fallopian Tube, Appendix

• Left Upper Quadrant:

  • Stomach, Spleen, Pancreas (tail), Large Intestine

• Left Lower Quadrant:

  • Small Intestine, Large Intestine, Ovary/Fallopian Tube

Examination – History

• Difference from musculoskeletal evaluations

• Key question areas:

  • Pain Location: Localized pain common in thoracic injuries

  • Cardiac Pathology: Need to consider mechanism of injury

  • MOI: Direct blow or impact

Examination – Inspection & Palpation

• Inspection:

  • Posture, Deformity, Ecchymosis

• Palpation:

  • Location of pain, Crepitus in the thoracic cage, Deformity/step-off

  • Symmetry in chest wall movement

  • Abdominal examination performed in hook-lying position (systematic)

Special Tests

• Auscultation:

  • Listen to heart, lungs, bowels

• Percussion:

  • Identify sounds associated with hollow or solid organs

Red Flags

• Indicators for urgent intervention:

  • Shortness of breath or difficulty breathing

  • Deviated trachea or movement during breathing

  • Anxiety, confusion, restlessness

  • Distended neck veins, bulging or bloodshot eyes

  • Rapid, weak pulse, low blood pressure

  • Severe chest pain with deep inspiration

  • Abnormal or absent breath sounds, cyanosis

  • Signs of rib or sternal fractures

Thoracic Pathology – Contusions

• MOI: Direct blow

• Signs & Symptoms:

  • Localized pain, swelling, discoloration, pain with breathing

  • Periosteal irritation, point tenderness

  • Differential: No signs of bony crepitus or pain with indirect compression

• Management: Ice, NSAIDs, support, rest if necessary

Thoracic Pathology – Rib Fracture

• MOI: Direct blow or single traumatic incident

• Signs & Symptoms:

  • Localized pain, swelling, ecchymosis, muscle guarding

  • Crepitus, rapid, shallow breathing, posture leaning toward injury

• Management:

  • Confirm with rib compression test

  • Ace wrap distal to injury

  • Pain most severe in the first 3-5 days, dissipates over 3-6 weeks

Thoracic Pathology - Costochondral Injury

• MOI: Anterior trauma or lateral chest wall compression

  • Example: Bouncing barbell off chest, severe twisting motion

• Signs and Symptoms:

  • Similar to rib fractures, pain at costal-cartilage junction

  • Possible snap/pull sensation, increased pain with breathing/movement

  • Swelling and tenderness on palpation

Thoracic Pathology - Pectoralis Major Rupture

• MOI: Powerlifting, water skiing, football, wrestling (eccentric overload)

• Signs & Symptoms:

  • Pop, snap, or tear sensation, retraction of tissue

  • Immediate achy/fatigue-type pain, weakness in specific movements

• Management: Control pain/inflammation, ROM exercises, gradual stretching

Thoracic Pathology – Breast Injuries

• Types: Sprain, strain, bruise due to violent movements

  • Coopers ligament plays a supportive role at the chest wall

• Runner’s Nipple: Friction injury

• Cyclists Nipple: Result of cold temperatures and sweat evaporation

Abdominal Pathology – Abdominal Muscle Contusions or Strains

• Contusions: Rare due to underlying tissues

  • Signs & Symptoms: Local pain, swelling, tenderness

• Strains:

  • MOI: Not defined in the content, but common causes include heavy lifting

  • Signs & Symptoms: Pain below umbilicus, muscle spasms, tenderness

  • Management: Ice, rest, minimize ROM

Intra-Abdominal Pathology – Splenic Contusion/Rupture

• Quadrant: Typically in Left Upper Quadrant

• Common Risks: Enlarged spleens in patients with mononucleosis

• Key Sign: Kehr’s Sign (referred pain to the left shoulder)

Intra-Abdominal Pathology – Kidney Contusion

• Location: Bilateral, T12 to L3

• MOI: Blunt trauma to upper lumbar and lower thoracic region

• Signs & Symptoms: Deep aching pain, nausea, hematuria

• Management: ER referral

Intra-Abdominal Pathology – Contusion of Ureters, Bladder, and Urethra

• MOI: Blunt force trauma

• Signs & Symptoms: Hematuria, pain in lower abdomen

  • Inability to urinate from bladder contusion

Intra-Abdominal Pathology – Liver Contusion/Rupture

• Quadrant: Typically Right Upper Quadrant

• Signs & Symptoms: Palpable pain, hypotension, shock

Intrathoracic Pathology – Pulmonary Contusion

• MOI: Blunt force trauma

• Signs & Symptoms: Chest pain, rapid breathing, hypoxia

• Management: Keep individual calm, ED referral

Intrathoracic Pathology – Pneumothorax

• Spontaneous: Unexpected occurrence with or without disease

  • Symptoms: Pain, dyspnea, and chest discomfort

• Nonspontaneous (Traumatic): Caused by blunt trauma

  • Symptoms: Severe chest pain, cyanosis, deviated trachea

Intrathoracic Pathology - Pneumothorax (Tension)

• MOI: Air accumulation in pleural space compressing the lung

• Symptoms: Mediastinal shift, severe pain, hypotension

Intrathoracic Pathology - Pneumothorax Management

• Keep individual calm, focus on breathing

• Emergency medical services required

Intrathoracic Pathology – Traumatic Asphyxia

• MOI: Direct massive trauma to thorax

• Signs & Symptoms: Bluish discoloration, sub-conjunctival hemorrhage

• Management: CPR, EMS

Intrathoracic Pathology – Hyperventilation

• MOI: Pain, stress, anxiety

• Signs & Symptoms: Chest pain, dizziness

• Management: Focus on slow breathing techniques

Thoracic & Abdominal Pathology – On Field Management

• Evaluate for injury and red flags

• Control breathing, manage airway if needed

• Monitor vital signs

• Call EMS if necessary