Penetrating abdominal trauma (mechanism of disease)

This is a flowchart on penetrating abdominal trauma, covering the etiology, pathophysiology, and manifestations.

ADDITIONAL TAGS:
Hollow viscus perforation: full-thickness loss of bowel wall integrity
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Biochemistry / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental / exposure
Cancer / neoplasm
Flow physiology
Pathophysiology
Etiology
Manifestations
Thrusting action of a pointed object (e.g., knife, broken bottle)
Tissue is lacerated and torn along the path of the object
Stab wounds:
Depth of injury usually greater than the width
Tissue is lacerated and crushed along the path of the bullet
Gun shot wounds:
Tissue displaced forward and radially → cavitation and pressure injury of nearby structures.
Dense organs (liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury
Severity of injury is related to the kinetic energy of the bullet (i.e., weight, velocity)
Penetrating abdomen trauma: open wound injury with deep but narrow entry wound
Penetrating abdominal trauma
Solid organ injury
Genitourinary trauma
Diaphragmatic hernia
Diaphragmatic injury
Bowel obstruction
Dyspnea; ↓ breath sounds; bowel sounds in chest
Obstipation: complete inability to pass stool or gas
Abdominal pain and abdominal distention
Nausea, vomiting, obstipation
Peritonitis
Shock
Fever
Hypotension, tachycardia, tachypnea, pale, cyanosis
Third-spacing
Paralytic ileus
↓ or absent bowel sounds
Air enters abdomen
Air between diaphragm, liver
↓ liver dullness on RUQ percussion
Hyperresonance on abdominal percussion
Dullness on abdominal percussion
Splenic laceration
Pain in LUG; L flank, tender epigastric
Blood irritates L diaphragm
Referred pain to left shoulder: Kehr's sign
Liver laceration
Pain in right upper quadrant
Worse with inspiration
Possible large-volume hemorrhage into abdominal, retroperitoneal, pelvic cavities
Abdominal pain worse with motion
Vascular injury (abdominal aorta)
Blood at urethral meatus, initial hematuria, and difficulty voiding
Pain in lower abdomen, pelvis
Rupture of bladder dome
Urine leaking into peritoneum
Peritoneal absorption
Diapgramatic irritation
↑ BUN, ↑ creatinine
Anterior urethral trauma
Scrotal hematoma