abdominal trauma l.m ntlhe department of surgery sbah-up
DESCRIPTION
ABDOMINAL TRAUMA L.M NTLHE Department of Surgery SBAH-UP. ABDOMINAL TRAUMA. Universal precautions against communicable diseases Principles of initial assessment & resuscitation apply May be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock. Mechanism of Injury. - PowerPoint PPT PresentationTRANSCRIPT
ABDOMINAL TRAUMAL.M NTLHE
Department of SurgerySBAH-UP
ABDOMINAL TRAUMA
Universal precautions against communicable diseasesPrinciples of initial assessment & resuscitation applyMay be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock
0%
10%
20%
30%
40%
50%
60%
Minutes Hours Days
1. Penetrating: stab wound gunshot wound
2. Blunt- MVA/blunt assault/fall from heights
3. Blast
Mechanism of Injury
PENETRATING ABDO TRAUMA
BLUNT ABDOMINAL TRAUMA (BAT)
• SCENARIO
DEFINITION
• INJURIES TO MORE THAN ONE ANATOMICAL AREA
• INCIDENCE – 10-15% OF TRAUMA PATIENTS
BAT
BAT
BAT
BAT
CLINICAL PRESENTATIONGENERAL-Stable or Unstable
-Coma or conscious & cooperative -PalePrimary survey done, now secondary survey
ABDOMINAL EXAMINATIONInspectionPalpationPercusionAuscaltationRectal examination
Local-open wound± -bruising -Distension -Tender (peritonitic) -B/S ± absent -PR - ±blood
MANAGEMENT – INVESTIGATIONS: Blood – U + E/FBC Radiology – CXRay/AbdXRay -U/S (FAST), CT Scan, DPL, LaparascopyTREAT MENT : Resuscitation TREAT THE INJURED ORGAN
SOLID VISCERASpleen:
Liver:
Pancreatico-Duodenal:
Kidneys:
Spleen
Liver
HOLLOW VISCERAStomach:PenetratingBlunt (rare)Treatment: debride and suture (nonabsorbable sutures, two layers)Corrosive ingestion
Small Bowel:Penetrating – GSW -StabBlunt BlastTreatment: debride and suture
Duodenal and Pancreatic injuries:•3-5 %•Penetrating 75%-GSW 85%•Blunt-crushing against vertebral column -shearing forces -duodenal blow out
DIAGNOSIS :History and ExaminationDuodenal haematoma→copious bilious vomitingAXRay-retroperitoneal air ( air nephrogram) -Scattered air bubbles -Obliterated psoas shadow -Free extra luminal air -Lumber & lower thoracic spineBlood- serum amylaseFASTCT
Pancreatico-Duodenal
Treatment – Pancreas: hemorrhage→haemostasis – Major duct :→distal pancreatectomy – Proximal→Whipple procedure(↑mortality)Colon →1⁰ repairRectum/Anus: Diverting colostomy
Vascular injury- Vascular unitKidney-urology department