The initial evaluation of the injured abdomen looks for hemorrhage or spillage of bowel content. Other injuries, such as pancreatic or biliary injury, are not acutely life-threatening and are therefore less urgent. The primary goal is to decide if surgery is necessary. If you find no need for immediate surgery, further evaluation of the abdomen can wait until other urgent problems are treated.
Abdominal evaluation presents special problems.
The unconscious patient's exam provides virtually no clues. Even in alert patients, the level of pain and the reaction to palpation are of little help in differentiating severe from trivial injury during the critical early period following injury. Peritoneal signs may not develop for one to four hours. And the abdomen contains a multitude of organs whose function is largely invisible, and whose pain response to injury helps very little in identifying the injured organ. If the patient is hypotensive, or will undergo urgent surgery for a non-abdominal problem, perform peritoneal lavage.