**6. Evaluation of heamatological disorders**

Internal bleeding is a major complication of both blunt and penetrating trauma. Signs and symptoms are Abdominal pain, distension of abdomen and these symptoms get worse as the bleeding continues. Light-headedness, fainting can cause hypotension and hypovolemic shock. A large area of skin can get deep purple stained known as ecchymosis caused as a result from bleeding into the skin or soft tissues [7] (**Figures 1** and **2**).

#### **6.1 Indications for phlebotomy in erythrocytosis**


**Figure 1.**

*Diagnostic evaluation of anemia. MCV, mean corpuscular.*

**Figure 2.** *Evaluation of erythrocytosis.*

Other common hematological disorders needing attention:- sickle cell anemia, leukcopenia, nutritional deficiencies, bone marrow suppression, thalassemia, chronic renal failure, hemolytic anemias etc.

### **6.2 Steps of homeostasis**

Injury to vessel wall ➔ primary vasoconstriction ➔ interaction of von Willebrand protein with sub endothelium ➔ formation of platelet plug ➔ fibrin formation ➔ clot dissolution and endothelial regeneration (**Figure 3**).

*Assessment of homeostasis*: careful history, bleeding time, prothrombin time, APTT, PT-INR, platelet count (**Table 3**).

Differential diagnosis for deranged coagulation test


After diagnosis of bleeding disorder the treatment should be initiated accordingly with platelet or fresh frozen plasma infusions, corticosteroids, anti D etc [8].

*Life Threatening but Preventable and Treatable Medical Complications of Abdominal Trauma DOI: http://dx.doi.org/10.5772/intechopen.106134*

#### **Figure 3.**

*Coagulation scheme with anticoagulant mechanisms. FSP:- fibrin split products; PT:-prothrombin time; PTT: partial thromboplastin time; tPA:- tissue plasminogen activator.*


#### **Table 3.**

*Causes of thrombocytopenia: which needed to be treated according to cause after abdominal trauma for optimal homeostasis.*

#### **7. Assessment of respiratory pathologies**

See **Figures 4** and **5**.

#### **7.1 Risk factors for post traumatic pulmonary complications**

See **Table 4**.

#### **Figure 4.**

*Pathophysiology of the events leading to postoperative pulmonary complications. V/Q, ventilation/perfusion.*

**Figure 5.** *Pathogenesis of major post traumatic pulmonary complications.*

### **7.2 Causes of post traumatic pleural effusions**


*Life Threatening but Preventable and Treatable Medical Complications of Abdominal Trauma DOI: http://dx.doi.org/10.5772/intechopen.106134*


#### **Table 4.**

*Risk factors for post traumatic pulmonary complication.*


#### B) Exudate:-

