abd trauma
TRANSCRIPT
Abdominal TraumaFrequent cause of preventable death
Dr. Shahzad Alam Shah FCPS
Assistant Professor
Fatima Jinnah Medical College/Sir Ganga Ram Hospital Lahore
Pakistan
Recognizing Acute Abdomen
Recognizing differences between the Blunt& Penetrating abdominal injuries
Significance of different anatomic regions
Application of the diagnostic procedures
specific to abdominal trauma
OBJECTIVES
OBJECTIvES
Management
Most common factors leading toDeath
Inadequate volume
Inadequate evaluation
Inadequate diagnosis
Delayed surgery
Delayed resuscitation
Frequent cause of preventable death
Anatomy of Abdomen
Abdominal Anatomy and Regions
Left Upper QuadrantSpleenStomachPancreasLeft KidneyTransverse ColonDescending Colon
Right Upper QuadrantLiverGall Bladder Right KidneyAscending ColonTransverse Colon
Right Lower QuadrantAscending ColonAppendixRight Ovary (female)Right Fallopian Tube (female)
Left Lower QuadrantDescending ColonSigmoid colonLeft Ovary (female)Left Fallopian Tube (female)
Abdominal Regions
•Intrathoracic Abdomen
•Pelvic Abdomen
•Retroperitoneum
Injured Solid organs, bleed heavily
Rupture causes
spillage
Hollow OrgansStomach
Gall bladderIntestines
Ureters, Bladder
Solid OrgansLiverSpleenKidney
Pancreas
Injury can cause severe blood loss
Vascular InjuryAorta
Vena CavaMajor Branches
Peritonism ShockExsanguination
(bleeding out)
Abdominal Anatomy and Organ Injury
Initial Assessment
Initial Assessment/Management: ABCDE
Airway with cervical spine control Breathing Circulation: Resuscitation; stop external
bleeding Disability Exposure
No abdominal injury have the precedence over the initial assessment of the trauma patients
EviscerationWith large laceration
abdominal contents
may spill out
Cover exposed organs with saline soaked dressingCover first dressing with second dry dressing
Do not try to replace
Abdominal Trauma Management
Maintenance of I/V line Draw blood for cross
matching/CBC/amylase Fluids Nasogastric tube Foley's Catheter High flow O2
Assist ventilations if needed Give nothing by mouth
Nasogastric Tube
Removes air and fluidAssess for bleedingMinimize risk of aspiration
Caution --> Facial #
Foley's Catheter
Rectal / genital Exam firstDecompress bladderMonitor urine outputDiagnostic: Hamaturia Caution --> Pelvic #
Assessment of Injured Abdomen
Pain Pain referred to shoulder = Organ under
diaphragm involved (?spleen) Pain referred to back = Retroperitoneal organ
involved (?kidney) Diffuse tenderness Abdominal Rigidity
NOT reliable Bleeding may not cause rigidity Bleeding in retroperitoneal space may not
cause rigidity
Assessment
Primary factor To determine that an abdominal injury is present
(accurate diagnosis is not important)
Positive Exam: Significant
Negative Exam: Does not preclude injury
Negative Exam. may become +ve with time
Re-evaluate !
Unexplained Shock
In trauma, if there are signs of shock
and no obvious cause is present
Abdominal injury?(Assess vital signs; skin color, temperature;
capillary refillTachycardia; restlessness; cool, moist skin)
Management
re-establish vital functions (resuscitate)
delineate the injury mechanism
maintain high index of suspicion related to occult vascular and retroperitoneal injuries
repeat a meticulous examination, assessing for changes
Select special diagnostic maneuvers as needed
Diagnostic Maneuvers OR
Modalities
Abdominal Ultrasound Screening Radiographs
CT Scan
Diagnostic Peritoneal Lavage
Contarst Studies
Diagnostic Laparoscopy
Mechanism
Trauma to
lower chest,
Trauma to
back, flank,
Trauma to
buttocksHigh Index of Suspicion
Hypovolemic shock with no readily
identifiable cause
Diffusely
tender abdomen
Pain in
uninjured shoulder
Trauma toperineum
Indications for Laparotomy
Signs of Peritonitis
BP + Evidence of Abdominal injury
• Extra luminal Air
• Injured Diaphragm
• Intraperitoneal Injury (+ DPL or + CT)
• Persistent Amylase elevation with abdominal findings
Splenic Trauma
A young patient of about 30 years sustained injury in a RTA with a bruise mark on left lower chest
Renal Trauma
A hemodynamicaly stable patient received in ED having a single gun shot entry wound in the left lumber area was having frank haematuria after Cathetrization.
Pancreatic Trauma
A motorcyclist had an tonga bamboo injury in the epigastrium. What finding in the CT scan is evident
Diaphragmatic Injury
Plain X-Ray of a patient who sustained a blunt abdominal injury revealed absent dome of diaphragm on the left side.
Liver Trauma
A car driver had an head on collision with another car brought to the emergency department. The C.T. Scan revealed.
KEY POINTS
It is not always easy to recognize peritonitis secondary to abdominal trauma
Less important to diagnose exact injury Management same regardless of specific
organ(s) injured No Abdominal injury has precedence
over the initial assessment
?