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

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