ABDOMINAL INJURIES

By Neha Sarfraz (Roll Number 15)

The abdomen comprises of 4 quadrants. These consist of different

organs which include;
 Right Upper Quadrant- Liver, Stomach, Gall bladder, Duodenum,
Right kidney, Pancreas
 Left Upper Quadrant- Liver, Stomach, Pancreas, Left kidney,
Spleen
 Right Lower Quadrant- Appendix, Uterus, Right Ureter
 Left Lower Quadrant- Reproductive Organs.
Injuries to the various organs include;
1. ABDOMINAL WALL CONTUSION- Most common sports injury. It
involves injury to epigastrium resulting in transient dyspnea.
Swelling of abdominal wall and abdominal mass below the
umbilicus may be present. This can be treated with a period of
rest.
2. SPLENIC INJURIES- Injuries to spleen are most commonly caused
by trauma to left lower chest wall or left upper abdominal
quadrant. Patient may initially present with fainting, dizziness and
weakness from blood loss. He / She may also experience Left
Shoulder pain (Kehr’s Sign). Ballone sign may also occur which is
fixed dullness in left flank and shifting position dullness in right
flank. X-rays may show splenomegaly in case of subcapsular
hematoma. Patients with hemodynamic instability may require
surgical treatment.
3. LIVER INJURIES- Usually occur due to direct blow to right upper
quadrant and are uncommon in sports. Symptoms include Right
upper quadrant tenderness. It may result in associated injuries of
 other abdominal structures. AST and ALT enzymes are elevated in
liver injuries.
4. RENAL INJURIES- Most common sports injury. Symptoms include
flank pain and hematuria. They may be treated with
nephrectomy.
5. INTESTINAL INJURIES- Duodenal injury is more common and may
occur due to direct blow to epigastric region. It may also be found
in association with pancreatic injury.
6. PANCREATIC INJURIES- These are very rare and difficult to
diagnose. Marathon Pancreatitis is a rare condition that presents
with abdominal pain during a race and becomes more painful on
completion of race. It is more common in young female athletes.
7. APPENDICITIS- It is an a-traumatic condition which causes
inflammation of appendix. Symptoms include right lower
quadrant tenderness, abdominal rigidity, rebound tenderness,
pain aggravated by coughing or movement. Loss of appetite and
low grade fever are also present at onset. Treatment usually
involves appendectomy.
8. ECTOPIC PREGNANCY- It is the implantation of a fertilized ovum
outside of endometrial cavity. Patient presents with abdominal or
pelvic pain. If undiagnosed it may result in rupture of fallopian
tube, hemorrhage and death.

CASE STUDIES;
 A female soccer player complains of fatigue and nausea. She tells
you she has missed her last period which she relates to her
nausea, poor diet and stress of school. She relates a vague history
of abdominal discomfort over the past week. ( ectopic pregnancy
may be suspected)