Abdominal and Pelvic Trauma

1. Two kinds of organs, two kinds of problem

Open the abdomen up in your head and you've got two categories of organ in there. That split is where this whole topic starts.

Solid organs are the liver, spleen, kidneys, and pancreas. They're packed with blood vessels. Tear one, and it bleeds. Fast, and a lot.

Hollow organs are the stomach, intestines, and bladder. They don't bleed the same way. They spill. Stomach acid, bacteria, and waste leak into the abdominal cavity and cause infection over hours, not blood loss over minutes.

So a blunt hit to the right upper quadrant is a liver problem. A hit to the left upper quadrant is a spleen problem. A penetrating wound through the intestines is a contamination problem that will make the patient septic tomorrow, not today.

Here's the part that runs through this entire lesson: you can't fix either one in the field. Not the bleeding, not the spillage. The treatment for both is a surgeon and an operating room. So your job is not treatment in the traditional sense. Your job is recognizing it early, from mechanism and from how the patient is perfusing, packaging the patient without making the injury worse, and driving.