Hypovolemic Shock, Peritonitis, Abdominal Regions, and Trauma

Posted on Feb 23, 2025 in Biology

What is Hypovolemic Shock?

Hypovolemic shock is a clinical status characterized by poor peripheral perfusion and circulatory loss of volume. Presenting symptoms include:

  • Pale skin
  • Cold and clammy skin
  • Anxiety and agitation
  • Increased heart rate (tachycardia)
  • Initially rapid breathing, which progresses to a feeling of drowning and becomes slower and more superficial
  • Final shutdown of breathing

Classification of Abdominal Organs

Abdominal organs can be classified as follows:

  • Hollow: Intestines, stomach, and gallbladder
  • Solid: Spleen, liver, pancreas, and kidneys
  • Vascular: Aorta and vena cava

What is Peritonitis?

Peritonitis is an acute or chronic inflammation of the peritoneum, the serous membrane lining the abdominal cavity and the viscera contained within. This inflammation can be localized or generalized. It can be caused by bacteria (bacterial etiology) or secondary to blunt trauma to the abdomen, rupture of a hollow organ with leakage of gastric juice, bile salts, or other non-infectious causes.

Complications of Peritonitis

Complications may include:

  • Sequestration of fluid and electrolytes, leading to decreased central venous pressure, electrolyte disorders, and hypovolemia. This can result in shock or renal failure.
  • Peritoneal abscess (e.g., below the liver)
  • Sepsis (detectable through blood cultures)

Abdominal Regions and Organs

The abdomen is divided into nine anatomical regions:

  • Right Upper Quadrant: Right lobe of the liver, gallbladder, upper pole of the right kidney, hepatic flexure of the colon, adrenal gland.
  • Epigastric Region: Part of the left lobe of the liver, pyloric part of the stomach, transverse colon. Epigastric pain is common in this region.
  • Left Hypochondrium: Spleen, tail of the pancreas, upper pole of the left kidney, splenic flexure of the colon.
  • Right Lumbar (Flank) Region: Ascending colon, part of the duodenum and jejunum.
  • Mesogastric (Umbilical) Region: Omentum, mesentery, jejunum, ileum, and the navel.
  • Left Lumbar (Flank) Region: Descending colon.
  • Right Iliac Fossa (Inguinal Region): Cecum, appendix, right ovary (in women), spermatic cord (in men).
  • Hypogastric (Suprapubic) Region: Bladder, uterus.
  • Left Iliac Fossa (Inguinal Region): Sigmoid colon, left ovary.

Types of Abdominal Trauma

Abdominal trauma can be classified as:

  • Closed Abdominal Trauma: Difficult to diagnose without prehospital action. Involves significant internal damage that progresses slowly. Stabilization and transfer to the hospital are crucial.
  • Open Abdominal Trauma: Caused by injury mechanisms that produce two main situations:
    • Bleeding from injured abdominal viscera.
    • Intestinal perforation with extravasation of contents into the peritoneum (a sterile area).
  • Genital Trauma: Requires assessment for lesions and signs of urethral injury, such as blood in the meatus and scrotal hematoma.

Gunshot vs. Stab Wounds

Gunshot wounds, being high-energy injuries, are often more harmful than stab wounds. Gunshot wounds penetrating the peritoneum result in significant damage to major intra-abdominal structures in over 90% of cases.