Hole’s Human Anatomy and Physiology, Student Edition, 12th Edition

Book Preface

Judith R. had not been wearing a seat belt when the accidentoccurred because she  had to drive only a short distance. She hadn’t anticipated the intoxicated driver in the oncoming lane who swerved right in front of her. Thrown several feet, she now lay near her wrecked car as emergency medical technicians immobilized her neck and spine. Terrifi ed, Judith tried to assess her condition. She didn’t think she was bleeding, and nothing hurt terribly, but she felt a dull ache in the upper right part of her abdomen.

Minutes later, in the emergency department, a nurse checked Judith’s blood pressure, pulse and breathing rate, and other vital signs that reflect underlying metabolic activities necessary for life. Assessing vital signs is important in any medical decision. Judith’s vital signs were stable, and she was alert, knew who and where she was, and didn’t have obvious life-threatening injuries, so transfer to a trauma center was not necessary. However, Judith continued to report abdominal pain. The attending physician ordered abdominal X rays, knowing that about a third of patients with abdominal injuries show no outward sign of a problem. As part of standard procedure, Judith received oxygen and intravenous fl uids, and a technician took several tubes of blood for testing.

A young physician approached and smiled at Judith as assistants snipped off her clothing. The doctor carefully looked and listened and gently poked and probed. She was looking for cuts; red areas called hematomas where blood vessels had broken; and treadmarks on the skin. Had Judith been wearing her seat belt, the doctor would have checked for characteristic “seat belt contusions,” crushed bones or burst hollow organs caused by the twisting constrictions that can occur at the moment of impact when a person wears a seat belt. Had Judith been driving fast enough for the air bag to have deployed, she might have suff ered abrasions from not having the seat belt on to hold her in a safe position. Finally, the doctor measured the girth of Judith’s abdomen. If her abdomen swelled later on, this could indicate a complication, such as infection or internal bleeding.

On the basis of a hematoma in Judith’s upper right abdomen and the continued pain coming from this area, the physician ordered a computed tomography (CT) scan. It revealed a lacerated liver. Judith underwent emergency surgery to remove the small torn portion of this vital organ.

When Judith awoke from surgery, a diff erent physician was scanning her chart, looking up frequently. The doctor was studying her medical history for any notation of a disorder that might impede healing. Judith’s history of slow blood clotting, he noted, might slow her recovery from surgery. Next, the physician looked and listened. A bluish discoloration of Judith’s side might indicate bleeding from her pancreas, kidney, small intestine, or aorta (the artery leading from the heart). A bluish hue near the navel would indicate bleeding from the liver or spleen. Her umbilical area was somewhat discolored.

The doctor gently tapped Judith’s abdomen and carefully listened to sounds from her digestive tract. A drumlike resonance could mean that a hollow organ had burst, whereas a dull sound might indicate internal bleeding. Judith’s abdomen produced dull sounds throughout. In addition, her abdomen had become swollen and the pain intensifi ed when the doctor gently pushed on the area. With Judith’s heart rate increasing and blood pressure falling, bleeding from the damaged liver was a defi nite possibility.