abdominal trauma-hamisi mkindi
TRANSCRIPT
ABDOMINAL TRAUMA
• Classified into two: - Blunt abdominal trauma. -Penetrating abdominal trauma
BLUNT ABDOMINAL TRAUMA
• Road traffic accidents• Fall from a height and dashing against an
object• Seat belt syndrome• Assault
Mechanism• Intra-abdominal injuries secondary to blunt force are
attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the person’s internal organs.
• Blunt force injuries to the abdomen can generally be explained by 3 mechanisms:
-Rapid deceleration. -Crushing effect. -Sudden dramatic rise in I.A.P. due to external compression.(Boyle’s law)
History
• Initially, evaluation and resuscitation of a trauma patient occur simultaneously.
• ABCDE according to ATLS protocol.
• Allergy, Medications, Past medical illness, last meal and Event leading to incident.
Physical Examination
• Most reliable signs and symptoms in alert patients are as follows:
-Pain -Tenderness -Gastrointestinal hemorrhage -Hypovolemia -Evidence of peritoneal irritation
• Large amounts of blood can accumulate in the peritoneal and pelvic cavities.
• Bradycardia may indicate the presence of free intraperitoneal blood
Physical examination
• Ecchymosis involving the flanks (Grey Turner sign) or the umbilicus (Cullen sign).
• Lap belt marks.• Abdominal distention.• Auscultation of bowel sounds in the thorax.• Abdominal bruit.• Local or generalized tenderness, guarding, rigidity, or rebound
tenderness.• Fullness and doughy consistency on palpation.• Rib # on right side: Liver injury.???• Rib # on left side: Splenic injury.???
Cullen’s sign
Gray turner’s sign
Seat belt sign
Blunt injury
Spleen (40-55%) Liver (35-45%)Small bowel (5-10%)Retroperitoneal hematoma: 15%
INVESTIGATIONS
• 1.Complete blood count.• 2.Serum amylase/lipase.• 3.Plain X-rays. -Haemodynamically stable patient. -CXR:Pneumoperitoneum-Air bubble in thorax(Diaphragmatic injury) -Pelvic fractures
INVESTIGATIONS
• In the hemodynamically unstable patient, a rapid evaluation for hemoperitoneum can be accomplished by means of DPL or FAST.
Diagnostic Peritoneal Lavage Indications for DPL in blunt trauma:
1. Hypotension with evidence of abdominal injury.
2. Multiple injuries and unexplained shock.
3. Potential abdominal injury in patients who are unconscious, intoxicated, or paraplegic.
4. Equivocal physical findings in patients who have sustained high-energy forces to the torso.
+VE DPL:-10 ml of gross blood aspirate before infusion of lavage fluid-More than 100,000 RBC/ml-More than 500 WBC/ml
FAST• Four View Technique:
The current FAST examination protocol consists of 4 acoustic windows (pericardiac, perihepatic, perisplenic, pelvic) with the patient supine.
An examination is interpreted as positive if free fluid is found in any of the 4 acoustic windows, negative if no fluid is seen, and indeterminate if any of the windows cannot be adequately assessed.
CT scan Standard for detecting solid organ injuries.
Excellent imaging of the pancreas, duodenum, and genitourinary system.
CT scanning often provides the most detailed images of traumatic pathology and may assist in determination of operative intervention.
Unlike DPL or FAST, CT can determine the source of hemorrhage.
Management
• Stable patient• CT Scan• Operative– Solid organ injury, hypotensive– Hollow viscus organ injury– Intraperitoneal bladder injury– Diaphragmatic injury
• Non-operative management– Observation