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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