Which statement is true regarding indicators of intraabdominal injury in trauma?

• A. Fresh blood in the abdomen always causes peritonitis
• B. A significant amount of blood loss occurs after distention is noticed
• C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity
• D. Signs of shock greater than can be explained by other injuries are a reliable indicator of intraabdominal injury

Answer: (D)

Intraabdominal injury often hides bleeding, so a key clue is hypoperfusion that is disproportionate to what you’d expect from external injuries. Internal bleeding can progress and cause significant shock even when the abdomen isn’t notably tender or distended right away, or when there isn’t immediate peritoneal inflammation. When signs of shock exceed what other injuries can explain, it strongly suggests hidden abdominal hemorrhage and the need for rapid evaluation and transport. The other statements rely on early physical findings that aren’t consistently present: fresh blood in the abdomen doesn’t always trigger peritonitis immediately, distention isn’t a reliable early indicator of blood loss, and substantial bleeding doesn’t always present with tenderness or rigidity right away.