Is it possible to break off internal organs in a fall? Contusions of the anterior abdominal wall in children. Symptoms of bruises of internal organs

Contusion of internal organs is an injury without violating the integrity of tissues, bones, and mucous membranes. It can occur due to a fall, blunt trauma to the abdomen, or as a result of a car accident. The condition is dangerous due to impaired body functions and the likelihood of complications.

According to localization, the following bruises of internal organs and accompanying symptoms are distinguished:

• Liver bruise. Causes a feeling of sharp pain at the site of impact. The body experiences stress, the limbs cool down, the heartbeat quickens, and the blood pressure drops. The abdomen is depressed or protruded. Changing body position causes pain.
• Lung contusion. Symptoms: increased pain when inhaling, coughing up blood, tachycardia, pale skin, bruising in the area of ​​impact, swelling. A similar bruise to internal organs can be caused by a sharp fall on your back.
• When the spleen is bruised, the patient tries to take a certain position to relieve suffering: squat down, lie on his left side and bend his legs. The pulse is increased, blood pressure is low, there is severe pain in the left hypochondrium area, radiating to the forearm and shoulder blade. Internal bleeding is possible, accompanied by bloating.
• Kidney bruise. The injury causes paroxysmal pain in the lower back, spreading to the stomach and groin. Nausea or vomiting is present. Body temperature rises. Blood is detected in the urine. The number of clots indicates the severity of the condition. Injury to these paired internal organs can occur when falling from a height, as a result of unsuccessful sports activities, or accidents.
• Heart contusion is accompanied by tachycardia, pain in the area of ​​the organ, shortness of breath (suffocation), a gradual decrease in pressure, and pallor of the skin.
• A bladder bruise makes it impossible to urinate. The urge is frequent, but without results. Instead of urine, blood is released. In the lower abdomen there is pain, swelling, and bluish discoloration of the skin.

Classification by severity:

First aid for bruises of internal organs

Impacts from a blunt object or a blow from a fall from a height often cause bruises to internal organs. Symptoms may not appear immediately. If the consequence is internal bleeding, then pallor, cold sweat, dizziness and weakness appear after 10-30 minutes as blood accumulates in the abdominal cavity or chest.

It is impossible to stop internal bleeding without medical help. Before the arrival of a team of specialists, the victim is provided with first aid aimed at stopping the bleeding.

In everyday life, if you fall on your back from your own height or from a ladder, you can easily damage the spine and lower back, and bruise internal organs: the genitourinary system, kidneys, intestines. The victim is immobilized. Before doctors arrive, you need to secure the injury site with a tight bandage, lay the injured person on his back and leave him alone.

First aid for bruises of the heart and lungs involves freeing the patient from clothing; keeping it in a horizontal position; cleansing mucus and blood from the mouth and nose; turn your head to the side; if a person faints, let him smell ammonia; cold compress to the site of the blow; ensuring a flow of fresh air.

How to determine a bruise of internal organs?

The task of doctors is to determine the degree of injury to internal organs based on symptoms and diagnostic test data:

• Electrocardiogram - shows a violation of cardiac impulses.
• Echocardiography is prescribed to detect hemodynamic disorders.
• Holter - measures pulse, heart rate, and blood pressure within 24 hours.
• X-ray – allows you to detect associated injuries (fractures of the chest, ribs)

If there are symptoms of injury to internal organs, especially the genitourinary organs, blood and urine tests are prescribed to monitor changes in chemical reactions in the body.

The degree of damage and assessment of kidney performance are determined using the following methods:

• Chromocystoscopy - abnormalities are detected by staining urine. A special substance is used - contrast, which is injected into the urethra.
• An X-ray examination allows you to see the outline of the kidneys and examine the bruise of a contusion due to a bruise of an internal organ.

In the case of liver contusion, the results of a biochemical blood test indicate a halving of total protein, a drop in albumin, and an increase in ALT and AST. Instrumental methods for examining the organ include computed tomography and MRI; they determine the degree and depth of damage and the amount of blood accumulated in the abdominal cavity.

Basic methods of treating bruises

The obtained results of hardware studies and analyzes are taken by doctors as a basis in choosing a method of treating bruised internal organs.

UHF therapy expands capillaries, enhances lymph flow and the flow of leukocytes to the site of injury. The procedure resolves accumulated fluid and stimulates regeneration processes. Microwave expands capillaries and increases their permeability. Magnetotherapy enhances the phagocytic activity of leukocytes. Manual massage is very effective in resolving hematomas.

Bleeding often occurs as a result of bruising internal organs during a fall. Symptoms are expressed in signs of hematomas. This condition requires surgery. Damaged vessels and small cracks are sutured. Severe cases of bruises require complete or partial removal of the organ.

What medications are used to treat bruises of internal organs at home?

Several groups of medications are used in home therapy:

• Troxevasin, Rescuer, Lyoton - a group of heparin-based drugs that resolve hematomas.
• Capsicam or Arpisatron are ointments that allow you to dilate blood vessels.
• Wobenzym or Phlogenzym are enzyme preparations that relieve swelling and pain.
• Fastum or Indovazin are non-steroidal anti-inflammatory drugs.

Traditional methods of treating bruises of internal organs

The use of herbal decoctions resolves fluid accumulated from the impact of internal organs, restores injured blood vessels, and enhances tissue regeneration.

• Decoction No. 1. 1 tbsp. hawthorn flowers, 1 tbsp. horsetail, 1 tbsp. knotweed herbs, add 1 liter of water, boil for 15 minutes, leave for 2 hours. Drink 100 g on an empty stomach once a day. Course 10-14 days.
• Decoction No. 2. Pour 15 g of bay leaf into 1 liter of water. Boil for 10 minutes. Leave the solution for 4 hours. Take 250 g before meals, once a day. Duration of treatment is 7 days.

Since childhood, we have been familiar with bruises. Bruises on the arms and legs are a common thing that you simply don’t pay attention to. But damage to internal organs is a much more dangerous injury than soft tissue bruise. At the slightest suspicion of a liver hematoma, you should immediately consult a doctor.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

In most cases, bruising of an internal organ occurs due to a blow with a blunt object. But it could also be:

• injury sustained during sports(rugby, martial arts, football);
• consequence of an accident. Since the passenger is usually positioned sideways to the vehicle, it is the rib, liver and thigh that are affected;
• a fall . As a rule, a fall from a great height (at least 2-3 meters) leads to a liver bruise. But there are cases where the injury was even caused by a person slipping on ice;
• sudden rise in weight;
• pinching between two objects. For example, these could be elevator or bus doors.

Depending on the nature of the damage, there are:

• liver hematoma. This is an accumulation of blood in the liver area, which is limited to the muscle layers;
• ruptures - subcapsular (when hemorrhage occurs under the capsule) and transcapsular (when the fibrous membrane of the liver is disrupted).

Symptoms of liver contusion. How to distinguish a bruise from a rupture

Since the nerve endings in the liver area are unevenly distributed, the pain syndrome can be either very pronounced or practically absent. In most cases, local pain is observed at the site of injury, including from damage to deep muscles. The discomfort may spread to the lumbar and groin area. Doctors often notice difficulty breathing of the patient, tension during palpation, Kulenkampf's symptom, increased blood pressure and skin abrasions.

In the first few hours, the pain may intensify with movement and pressure on the abdominal cavity. But already 2-3 days after the injury, a symptom is likely to occur Shchetkin-Blumberg. It lies in the fact that acute pain in the liver appears immediately after the doctor sharply removes his hand, stopping the pressure on the stomach. Also on the second day there is yellowness of the skin and a rise in temperature to subfebrile levels.Sometimes at this stage it is no longer possible to cure the disease without dangerous consequences for the body.

In case of liver contusion, timely diagnosis is extremely important.

Primary diagnosis

When the patient is taken to the emergency room, the doctor examines the color of the skin and measures blood pressure and temperature. Then he performs a thorough palpation of the abdominal cavity. The final stage in making a diagnosis is ultrasound. It will show the location of the hematoma and its size.

X-rays are also often ordered. The picture shows: if the contours are clear, then everything is in order. If the diaphragm is displaced, the colon and stomach are deformed, and the contours of the liver are blurred, there is a high probability of a hematoma.

One of the diagnostic options is laparoscopy. The procedure is carried out under anesthesia: a small incision is made in the abdominal cavity, through which an endoscope is inserted.

Providing emergency assistance

From painful shock, the victim may well lose consciousness. First thing, bring him to his senses letting it inhale ammonia or spraying it with cold water. Next, strictly follow the instructions:

1. Lay the patient on a flat surface so that there is no pressure on the stomach and the legs are bent.
2. Apply a cold pack wrapped in cotton cloth to the right side of your abdomen.
3. If the person cannot bear the pain until the ambulance arrives, give him a pain-relieving injection.

If a liver injury is suspected, the patient should not be given any pills, food or even drink.

If there is an open injury in the abdominal area, cover it with a clean cloth and secure it with a bandage.

Under no circumstances should you reset prolapsed internal organs!

Treatment: in hospital and at home

Depending on the severity of the injury, the doctor chooses one of three rehabilitation methods:

• surgery. Prolonged bleeding can only be stopped by surgery. In medical practice, ligation of damaged vessels and suturing of small cracks are widely used. In cases where an organ has been severely damaged, we will talk about its resection (partial removal);
• drug treatment. If there is no serious blood loss, the doctor will prescribe conservative treatment using hemostatic, healing and cleansing drugs. It is possible to prescribe physiotherapeutic procedures that will accelerate the restoration of soft tissues: magnetic therapy, UHF, electrophoresis;
• physiological recovery. If the damage is very minor and there is no internal bruising, the doctor may simply order rest at home and bed rest for a few days. Vitamin complexes and hepatoprotectors will not interfere.

In a hospital setting, after liver surgery, a blood transfusion or reinfusion (infusion of your own, but filtered) blood is often prescribed. It is also necessary to follow a strict diet with the exclusion of alcohol, fatty and fried foods, sweets, and citrus fruits.

Treatment with folk remedies for liver contusion only aggravates the problem. After all, every hour counts! And the longer the victim self-medicates, the less likely it is that doctors will be able to return him to a full life.

Complications of liver hematoma

During a moderate impact, a subcapsular hematoma of the liver occurs. With proper treatment, it has no consequences and does not affect the general condition of the body. If there is acute pain, most likely it is a bruise with capsule rupture. Then you urgently need to stop the bleeding so that large volumes of fluid do not enter the abdominal cavity and damage other organs.

When a very severe injury occurs, but there is no pain in the area of ​​the right hypochondrium, the development of central hematoma. This is a dangerous injury that does not have any associated symptoms. If timely surgical intervention is not performed, this type of rupture due to bruise can even lead to death. Other common complications include:

• traumatic cysts;
• parenchyma compression;
• abscess formation.

Full recovery after a liver injury is possible only if qualified medical care is provided in a timely manner.

Rehabilitation sometimes lasts up to several months, but, in general, the prognosis for patients is positive.

Liver injuries. How to act. What you should never do.

No matter how closely parents monitor their child, injuries cannot always be avoided. However, some injuries may be minor, while others lead to the development of serious complications. Adults should know how to provide first aid to a baby and the specifics of further therapy.

Features of injuries in children

Children in the first years of life actively explore the world, knowing nothing about safety. The most common cause of injury is adult neglect. A small child should not be left unattended even for one minute. However, most of the damage is minor. Thus, a fall often ends in injury. This is due to the small body weight of children, and therefore the insignificant impact force when falling. However, serious fractures cannot always be avoided.

Children often get injured when riding a bicycle or during outdoor games.

Injuries received by infants during childbirth deserve special attention. The risk of complications increases with premature pregnancy and too much fetal weight. A common occurrence is a broken collarbone. The cause may be a narrow pelvis of the mother or incorrect presentation of the child. It will be possible to exclude injuries to the baby if the pregnant woman is regularly monitored in a medical facility.

Falls are a common cause of injury in infants. The problem is that the mass of the child’s head significantly exceeds the mass of the body. If a child falls, he or she is at risk of suffering a traumatic brain injury. The parietal region is most often affected.

Children 3–5 years old often suffer burns and other injuries to their limbs due to their curiosity. Frostbite on the cheeks and hands is a consequence of prolonged exposure to the street in winter. Any injury can be avoided by carefully monitoring the child.

What are the types of injuries in children?

The most common fall injuries are:

• bruises (forehead, nose, arm, leg, testicles in boys, lips, etc.);
• scratches, abrasions and cuts (face, knees, elbows, fingers, etc.);
• sprains (muscles of the neck, arm, ankle);

Almost every child experiences such injuries sooner or later. If the pain syndrome is mild and there is no bleeding, the baby can be helped at home.

If a child falls, a fracture may be diagnosed

An unfortunate fall can result in more serious injury:

• fractures. Children are often diagnosed with “greenstick” bone injuries, where the periosteum remains intact. The most common injuries are to the extremities. However, the bones of the skull, spine, and pelvis can also be damaged. Compression fractures are common;
• dislocations and subluxations. Often we have to deal with dislocations of the neck, collarbone, and limbs. Rotational subluxation with unnatural rotation of the head has its own characteristics;
• bleeding. Such injuries require immediate medical attention. Internal (for example, pulmonary) bleeding is especially dangerous. With arterial bleeding, minutes count. Wrong actions can cause the death of a child. You can only cope with capillary bleeding at home without special medical care;
• traumatic brain injuries. A severe blow to the head may result in a concussion. Damage can be closed or open. Some injuries of this kind are incompatible with life;
• pinching. Compressing soft tissue over a long period of time can be dangerous. Often pinching leads to necrosis. A pinched umbilical hernia deserves special attention. If there is a sharp deterioration in the child’s well-being, you must immediately call an ambulance.

In case of a serious fall or blow, a child can damage his eyes, teeth, or bite his tongue.

Head injury can cause serious complications

Children often get injured when exposed to too low or high temperatures. We are talking about burns and frostbite. Sunburn in children is common, as is damage to soft tissues due to exposure to electric current.

Natal injuries (received during childbirth) deserve special attention. The most common include:

• bone fractures;
• nerve damage;
• cephalohematoma (bleeding under the periosteum of the cranial bone);
• dislocations (neck and limbs).

Often, during difficult labor, one has to deal with natal trauma to the child’s cervical spine, especially when it is necessary to use obstetric forceps. Such damage is fraught with serious consequences, such as cerebral palsy, paralysis of the limbs of a newborn, etc.

Causes of injuries

Children receive most injuries during outdoor games. Abrasions, bruises, cuts and even fractures in children are often diagnosed after unsuccessful falls while running or cycling. Activities such as trampolining are also considered traumatic. An unsuccessful landing on the buttocks or back can cause a compression fracture of the spine. The same injury can occur when riding on a roller coaster.

Jumping on a trampoline can cause sprains or compression fractures

At the same time, an unsuccessful fall does not always cause serious injury to a child. The condition of its epidermis, circulatory system and bones is of great importance. Thus, healthy babies who eat well rarely get fractures. The blow in most cases ends in an abrasion, which quickly passes without special help.

Natal injuries deserve special attention. Often, problems during childbirth occur in those women who are not observed in the antenatal clinic during pregnancy. If the expectant mother has an exchange card that indicates the estimated weight of the fetus and the width of the mother’s pelvis, the specialist will decide to perform an operation, which will significantly reduce the likelihood of injury to the newborn.

During a difficult birth, the baby may be injured

Burns and frostbite in preschool children are in most cases associated with the inattention of adults. The baby can get injured when coming into contact with a hot iron or boiling water. Frostbite is a consequence of prolonged exposure to the street in winter.

Signs of various damage

Most often, an injury can be recognized without hardware diagnostics. Each group of damage has its own characteristic signs.

Natal trauma may be indicated by the baby's restless behavior, prolonged crying, lethargy, and frequent regurgitation.

Severe pain may be a sign of injury

Signs of bleeding may depend on its type:

• capillary bleeding. Pathology develops when small vessels are damaged. Characteristic is the uniform release of blood over the entire surface of the wound. Often found with cuts;
• venous bleeding. The release of blood occurs slowly but continuously. The dark red color of the blood is characteristic;
• arterial bleeding. The blood is released in a stream and pulsates. The patient needs help immediately. The patient loses consciousness, the skin becomes pale;
• internal bleeding. Pathology develops with damage to the liver, spleen, lungs and other organs. Often the bleeding is hidden and does not come out. In this case, a sign of a pathological process can only be a loss of consciousness of the patient.

If, after a serious fall, the child feels relatively normal and does not complain of pain, there is no need to postpone a visit to the doctor. The victim must be examined to exclude hidden injuries.

Symptoms of injuries - table

Diagnostics

In most cases, a specialist can identify the nature of the damage by visually examining the victim. To carry out differential diagnostics to clarify the condition of bones and soft tissues, the following methods can be used:

• X-ray. The study allows you to determine the nature of the damage and identify the location of the fracture or dislocation. If internal organs are damaged, this will also be noticeable in the image;
• MRI. The examination allows us to identify hidden damage. The technique is often used for traumatic brain injuries and spinal injuries;
• CT. Thanks to the study, it is possible to identify the nature of the damage, clarify the morphological changes in soft tissues and bones;
• Ultrasound. The technique makes it possible to identify damage to internal organs.

X-ray will help clarify the diagnosis

If internal bleeding is suspected, the following studies may be performed (taking into account the suspected organ damage):

• sigmoidoscopy;
• cystoscopy;
• gastric probing;
• bronchoscopy;
• laparoscopy (for hemorrhage in the abdominal cavity).

To carry out differential diagnosis, consultation with a vascular surgeon and neurologist may be necessary. If hospitalization is necessary, the child will additionally need to undergo general urine and blood tests.

Treatment

If, after a full examination, it is determined that the injury does not pose a threat to the child’s life, further treatment can be carried out at home. Patients with complex fractures requiring surgical intervention, as well as children with injuries to internal organs, are subject to mandatory hospitalization. A child with fever, dizziness, and poor health should remain under the supervision of medical personnel.

First aid for injuries

The life of an injured child often depends on the reaction of adults. Parents need to know how to stop bleeding and what actions to take if a fracture is suspected. The first thing to do is call an ambulance, even if the injury seems minor. Further actions depend on the type of damage.

Bruises

First of all, the child must be laid down and the bruise site must be elevated. In this way, it will be possible to ensure the outflow of blood from the area of ​​​​damage. To reduce swelling and pain, apply cold to the site of the injury.

Dislocation

First of all, it is necessary to fix the limb in the position that it assumed after the injury, in order to avoid further damage to the joint. It is recommended to apply cold to the site of the dislocation. In case of severe pain, the child can be given an age-appropriate painkiller.

Sprains and ligament tears

Fracture

Initially, it is necessary to fix the damaged area with a splint. Sticks, metal rods, and rolled up magazines are suitable for this purpose. In the absence of available materials, the body of the injured child can be used as a splint (for example, the injured arm is bandaged to the chest).

Splinting is the basis of first aid for a fracture

If a fracture of the spine is suspected, the patient should absolutely not be seated or put on his feet. It should be placed on a hard surface.

If a rib is broken, the child's chest should be tightly bandaged. In case of any bone damage, in order to avoid the development of shock, it is necessary to give the child an anesthetic before the ambulance arrives.

Bleeding

Venous or capillary bleeding can be stopped by a pressure bandage that is applied directly to the site of injury. It is recommended to use a sterile bandage, but if this is not available, any clean cloth will do.

In case of arterial bleeding, the bandage should be applied above the wound. With this type of damage, minutes count. Therefore, in the absence of available means, it is recommended to pinch the artery with a finger.

A pressure bandage will help stop bleeding

If you have a nosebleed, apply a handkerchief or ice soaked in cold water to the bridge of your nose. Throwing your head back, as many do reflexively, is absolutely forbidden. Blood will flow down the walls of the nasopharynx into the larynx or respiratory tract, causing vomiting. To stop the bleeding, it is usually enough to pinch the wings of the nose with your thumb and forefinger.

In case of internal bleeding, only a qualified specialist can provide assistance to the victim. The problem is that it is impossible to determine which organ is damaged. Therefore, calling an ambulance and creating complete peace for the injured child are the only measures that adults can take.

Burn

First of all, it is necessary to eliminate the damaging factor and cool the burn site with ice. You can place the damaged area under running cold water and hold for 10–15 minutes. Then the burn site must be covered with a damp bandage. It is recommended to give the child a pain reliever.

Frostbite

Initially, it is necessary to remove the child from the cold and warm him up. The best option is to slowly warm up indoors and drink warm sweet tea. It is strictly forbidden to rub the damaged area.

Doctor Komarovsky: first aid for frostbite - video

Traumatic brain injury

The injured child must be placed on his back and ensure complete rest. If he is unconscious, his head should be turned to the side to prevent vomit from entering the respiratory tract. In addition, such measures help prevent tongue retraction. If there is a wound, apply a sterile bandage and apply cold to the damaged area.

Further treatment

Therapy depends on the nature of the injury and the well-being of the victim. For simple fractures or other injuries, the child is given a bandage or plaster at the emergency room and sent home. You will have to visit a doctor once a week until the injured area is completely restored.

If a limb is fractured, a plaster cast must be applied.

Drug treatment is mandatory. A specialist can prescribe drugs from the following groups:

• non-steroidal anti-inflammatory drugs. Medicines from this category can relieve pain and normalize the victim’s body temperature. Children may be prescribed Paracetamol, Nurofen, Panadol;
• antibacterial drugs. These medications are prescribed for open lesions of the skin. Most often, broad-spectrum antibiotics are used, such as Azithromycin, Sumamed, Amoxiclav;
• anti-inflammatory and wound-healing drugs for external use. Troxevasin and Troxevenol gel show good results;
• warming drugs. Medicines in this category can be used for bruises and sprains. Patients over 12 years of age may be prescribed Finalgon ointment;
• vitamins. Most often, complex medications are prescribed to restore the child’s body’s defenses. The product Complivit is popular;
• medications to accelerate the growth of cartilage tissue. In case of a fracture, the child may be prescribed Chondroitin Sulfate.

Medicines for injuries in children - photo gallery

Panadol relieves pain and normalizes body temperature Chondroitin Sulfate will speed up the process of building cartilage tissue
Sumamed is a broad-spectrum antibiotic
Complivit is a popular vitamin complex
Finalgon has a warming effect
Troxevasin will accelerate the recovery of damaged tissue

When is surgery needed?

Complex spinal injuries or displaced fractures may require surgery. Under general anesthesia, the specialist combines bone fragments and, if necessary, installs splints or plates.

In case of complex injuries, it is not always possible to do without surgical intervention.

It is impossible to do without surgery if internal organs are damaged. This is the only way to stop bleeding and restore tissue integrity. The sooner the operation is performed, the greater the chance of saving the victim’s life.

For burns and severe frostbite, surgical intervention may also be required, involving plastic surgery of the damaged areas.

Serious injuries with disruption of the integrity of the skin and mucous membranes, as well as burns and frostbite are indications for emergency vaccination against tetanus.

Physiotherapy

Physiotherapeutic procedures help a child recover faster:

• electrophoresis. Through intact areas of the skin, medications are introduced into the body using direct electric current;
• UHF. Treatment with alternating electric current accelerates the restoration of damaged tissues and increases local immunity;
• phonophoresis. The technique involves simultaneous exposure to ultrasound and medicinal substances. An integrated approach allows you to speed up the process of restoring damaged areas;
• healing mud. This therapy allows you to quickly restore muscle functionality during ruptures and sprains.

Treatment prognosis and complications

If you seek medical help in a timely manner, as a rule, the prognosis for simple injuries is favorable. But refusal to see a doctor can lead to the development of serious complications, such as:

• addition of a bacterial infection;
• anemia due to large blood loss;
• deformation of the limbs due to improper bone fusion;
• loss of sensitivity in certain areas of the body;

Traumatic brain injuries can cause dangerous complications. The most common include:

• sleep problems;
• strabismus;
• frequent headaches;
• decreased performance.

Some children may develop epilepsy or amnesia (memory loss) due to trauma. Spinal injuries are considered dangerous. A common complication is paralysis of the limbs.

Prevention

Parents' attentive attitude towards children will help avoid terrible injuries. And it will be possible to strengthen the child’s musculoskeletal system with the help of proper nutrition, simple physical activity and regular walks in the fresh air.

Doctor Komarovsky: what is a dislocation and how to recognize it - video

Even if injury could not be avoided, the timely reaction of adults will avoid dangerous complications. A seemingly minor injury is not a reason to refuse qualified medical care.

6th year medical student at the Faculty of Medicine. I have a good understanding of the medical and scientific industries. She is also no stranger to literature, music and other creative works. Our union with you will definitely be extremely fruitful!

From the anamnesis, the mechanism of injury, the position and condition of the body at the time of injury, the direction and force of the blow, the state of the abdominal wall at the time of injury (muscle tension or relaxation), the degree of filling of the gastrointestinal tract with food and liquid preceding the injury, and diseases of the abdominal organs are determined. . Subjectively, patients complain of pain, general weakness, nausea, and less commonly, vomiting. Pain sensations can be in the first hours without a specific localization, throughout the abdomen or with a predominance in the upper or lower sections. Often the pain is associated with rib fractures with concomitant chest injuries (after intercostal blockade with novocaine, these pains disappear). The diffuse nature of the pain is typical for rupture of the intestines, mesentery, intracavitary or retroperitoneal bleeding. Localization of pain in the right or left hypochondrium with irradiation to the shoulder of the same name is characteristic of damage to the liver and spleen.

The duration and intensity of pain are important in diagnosis. If the intensity of pain subsides 2-3 hours after the injury and the victim’s condition improves (hemodynamics and breathing normalize), then with a high degree of probability damage to internal organs can be excluded (in the absence of objective signs of internal bleeding and peritonitis). If the pain progressively increases and becomes diffuse, indications for laparotomy should be given (even in the absence of objective signs of intra-abdominal pathology). It should be remembered that with local damage to the intestines, patients can walk for a long time, seek medical help on their own, and feel quite satisfactory. However, gradually, intensifying every hour, their signs of peritonitis increase.

Signs of severe shock in the first 1.5-2 hours after injury indicate massive internal bleeding, the source of which is often a rupture of the spleen or liver. In this case, the pulse becomes thread-like, 130-140 beats per minute, sharp (dead) pallor of the skin and mucous membranes, a decrease in the temperature of the extremities, ears, nose, forehead are noted, and cold sweat appears. Psychomotor agitation (with low or uncertain pressure) confirms the diagnosis and serves as a formidable harbinger of the approaching death of the victim. Patients may complain of increasing tinnitus, dizziness, excruciating thirst, and lack of air. Their abdomen is swollen, moderately tense and painful. Only emergency surgery can save the patient.

One of the reliable signs of intra-abdominal damage is the absence of abdominal breathing (or, as they say, the stomach does not participate in the act of breathing). Another reliable sign is pronounced tension (rigidity) of the abdominal wall. The stronger this tension, the more likely the internal organ will rupture. With a sharp tension in the abdomen (“like a board”), an intra-abdominal catastrophe is beyond doubt. The absence of sounds of intestinal peristalsis (auscultation) in the first hours after injury indicates more intra-abdominal bleeding; in the later stages (2-3 days), “deathly silence” of the abdomen indicates diffuse peritonitis. Symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, etc.) are not specific to abdominal injuries, but they always indicate an acute irritant in the abdominal cavity. The combination of these symptoms with other objective and subjective data significantly increases the reliability of the diagnosis.

A common symptom of intra-abdominal injury is vomiting; in the early period it is associated with irritation of the vagus nerve, in the later period - with intoxication of the body. You should always be wary of the “vanka-stand up” symptom - the patient’s desire to return to the previous position after turning over on his back, the other side, etc. This phenomenon is based on a sharp increase in pain from irritation of new areas of the peritoneum by the spilled contents of the gastrointestinal tract or blood (even in small quantities). The appearance of dullness in the sloping areas of the abdomen indicates the presence of fluid in the abdominal cavity. This sign becomes clear when about 1 liter of liquid accumulates. If blood accumulates, then objective signs of massive blood loss must be determined at the same time. The reliability of the sign increases if the fluid boundary moves when the patient's position changes.

A simple but very informative diagnostic technique is bladder catheterization (especially with concomitant pelvic fractures). An overfilled bladder can obscure the clinical picture of damage to the abdominal organs, lack of urine can be the cause of intra-abdominal rupture of the bladder, and the presence of blood in the urine is a consequence of kidney damage.

A digital rectal examination can also be very informative. This is the only method of direct palpation of the peritoneum. Collection of blood or other fluid in the rectovesical recess in men or in the uterorectal recess in women can be directly palpated through the rectum and thereby definitively confirm the diagnosis.

X-ray examination can be of great help in diagnosis if the patient’s general condition allows him to be turned on his side or put his body in a vertical position. You can find in the X-ray picture of the abdomen shadows corresponding to fluid in the free abdominal cavity, and clearing in the form of a strip, crescent in the subdiaphragmatic spaces or along the lateral surface of the abdomen (with the patient positioned on his side).

A laboratory blood test can reveal a decrease in hemoglobin, hematocrit, number of red blood cells, and an increase in the number of leukocytes. In the early period, these changes are not typical, but determining these indicators over time will undoubtedly be useful to clarify the diagnosis. Additionally, you can determine the blood mass and use nomograms to calculate the approximate amount of blood loss.

The most reliable method for diagnosing damage to the abdominal organs is diagnostic laparotomy. Visually determine the nature and extent of intra-abdominal damage, stop bleeding, and restore the integrity of internal organs.

Refusal of this method must be strictly justified, since wait-and-see tactics can be disastrous for the patient. The accuracy of diagnosis is significantly increased by laparoscopy and laparocentesis.

Where can you find a boy who doesn’t run around headlong, climb trees and fight with offenders? But our sons rarely think about their own safety and the consequences of their actions. Unfortunately, sometimes this can lead to disaster. In addition to bruises and bumps, abdominal trauma is not uncommon in boys. The cause may be an accidental fall, collision with an obstacle, or an unintentional blow while playing. It is important that you, dear parents, notice something is wrong in time and consult a doctor.

Abdominal injury: possible symptoms

1. Damage small intestine This happens most often when struck in the stomach. Unfortunately, symptoms are variable, making diagnosis difficult. It all depends on how badly the organ is damaged, how much time has passed since the injury, etc. The pain can be localized anywhere in the abdomen. To varying degrees, tension in the abdominal muscles, dry mouth, vomiting, fever, and a rare or, conversely, rapid pulse may be present. Sometimes there is a temporary improvement in the condition, which after a few days can result in a sharp deterioration in health, necrosis and tissue perforation.
2. Abdominal trauma can occur as a result of a very strong blow and lead to partial or complete rupture spleen. If the injury is small, internal bleeding may begin even 1.5 weeks after the injury. This option is most typical for children. Symptoms include pain in the left hypochondrium, which can extend to the left shoulder, as well as signs of hemorrhagic shock (the body’s reaction to large blood loss) - dizziness, spots before the eyes, lightheadedness, pale skin, cold sweat, heart rhythm disturbances, weakness.
3. Abdominal trauma often causes damage liver. Due to the large number of blood vessels, liver rupture is accompanied by large blood loss. A characteristic symptom is pain in the right hypochondrium, which can extend to the right collarbone. In addition to pain, all the signs of internal bleeding are present - a drop in blood pressure, pallor, general weakness and even loss of consciousness, increased heart rate and breathing.
4. If at the moment of impact bladder the baby was full, that is, there was a risk of it rupturing. With such an injury, sharp pain occurs, frequent false urges to pass urine, the presence of blood in the urine, possible hematoma in the lower abdomen, bloating, impaired intestinal motility. Urine in the abdominal area can lead to peritonitis.

First aid for a child with abdominal injury

If after a bruise a child came to his senses within 5 minutes and ran to continue playing, most likely nothing terrible happened. Unfortunately, abdominal injuries do not always appear immediately after an impact. Observe your son for 2 hours and if any warning signs from the list above appear, immediately consult a doctor.

If, after a blow to the stomach, the child complains of pain, dizziness, weakness and other unfavorable signs, call an ambulance or take the boy to the hospital yourself. Very often, such injuries require surgery.

Abdominal injury: what to do before doctors arrive

• Place the child in a comfortable position.
• If vomiting occurs, turn the child's head to the side to prevent the child from choking.
• Do not give food, drink, or medicine. And no painkillers!
• Apply a cold compress to the injury site.

Dear Parents! Your son's health depends on your actions. Behave calmly, don’t panic, don’t make your child nervous, be there. During treatment and during the rehabilitation period, follow your doctor's recommendations.