The organs of the abdomen involve a variety of both hollow and solid viscera that produce symptoms differently. Clearly, injuries to these viscera can, and often do, occur in concert with one another. Solid visceral injuries produce symptoms in a variety of ways. Substantial blood loss will produce alterations in vital signs, and patients often will present with or rapidly develop hypotension. 2 Some patients develop tachycardia, skin changes, and mental confusion with progressive blood loss. 2 These signs are tremendously nonspecific. Young patients may lose 60 percent of their total circulating blood volume and remain relatively asymptomatic. 3 Thus the assumption that a stable patient does not have an intraabdominal injury is hazardous. Abdominal tenderness, distension, and/or tympany may not be present until patients have nearly exsanguinated into their abdomen. In addition, it may be difficult to determine whether initial abdominal findings reflect hemoperitoneum or simply the patient's body habitus. Some patients develop exquisite abdominal tenderness early after development of hemoperitoneum. Others, however, remain asymptomatic for many hours or days. Thus, relying on physical examination to make the determination of hemoperitoneum will lead to an unacceptable rate of missed injuries.
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