Abdominal trauma is any blunt or penetrating injury that damages structures within the abdominal cavity. Clinical pictures range from subtle discomfort to life-threatening hemorrhage or peritonitis; key pointers are listed below.

1. Abdominal pain and tenderness
   Pain is present in almost every case, but its intensity can mislead: severe organ injury may cause only mild ache, while apparently trivial wounds sometimes produce marked discomfort. Localized tenderness on palpation, guarding, or rebound pain suggests peritoneal irritation .
2. External marks
   Bruises, abrasions, seat-belt imprints, stab wounds or bullet holes over the abdomen, flank or back provide visible evidence of impact and raise suspicion for deeper damage .
3. Swelling and distension
   Progressive abdominal distension may indicate accumulating blood, bile, urine or intestinal contents. A rigid, board-like abdomen implies significant intraperitoneal bleeding or spillage of enteric contents .
4. Shoulder-tip pain
   Irritation of the diaphragm by free blood or fluid can produce referred pain at the tip of either shoulder, especially when the patient lies supine .
5. Hypovolaemic and haemorrhagic signs
   Tachycardia, hypotension, cool peripheries, pallor and narrowing pulse pressure follow major solid-organ (spleen, liver, major vessel) laceration. Delayed shock may appear hours after the initial event as contained haematomas rupture .
6. Gastro-intestinal symptoms
   Nausea, vomiting and absent bowel sounds are common with bowel perforation or mesenteric injury. Subsequent fever and leukocytosis herald peritonitis.
7. Urinary changes
   Haematuria, flank pain or inability to void suggests renal, ureteric or bladder trauma. Penetrating wounds at any level between the nipples and the perineum can injure intra-abdominal organs.
8. Neurological overlay
   Head injury, intoxication or distracting fractures may mask abdominal findings; repeated examination is mandatory.

Because clinical signs can be subtle in the early phase, any patient with a suggestive mechanism plus pain, tenderness or unexplained hypotension requires urgent imaging and surgical review.