Abd Trauma


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Abd Trauma

  1. 1. Abdominal TraumaFrequent cause of preventable death Dr. Shahzad Alam Shah FCPS Assistant Professor Fatima Jinnah Medical College/Sir Ganga Ram Hospital Lahore Pakistan
  2. 2. OBJECTIVES Recognizing Acute AbdomenOBJ Recognizing differences between the Blunt & Penetrating abdominal injuriesECT Significance of different anatomic regionsIv Application of the diagnostic proceduresES specific to abdominal trauma Management
  3. 3. Inadequate evaluation Inadequate diagnosisMost commonfactors leading to Inadequate volumeDeath Delayed surgery Delayed resuscitation Frequent cause of preventable death
  4. 4. Anatomy of Abdomen
  5. 5. Abdominal Anatomy and Regions Left Upper Quadrant Right Upper Quadrant Spleen Liver Stomach Gall Bladder Pancreas Left Kidney Right Kidney Transverse Colon Ascending Colon Descending Colon Transverse ColonLeft Lower Quadrant Right Lower Quadrant Descending Colon Ascending Colon Sigmoid colon Appendix Left Ovary (female) Right Ovary (female) Right Fallopian Tube (female) Left Fallopian Tube (female)
  6. 6. Abdominal Regions •Intrathoracic Abdomen •Pelvic Abdomen •Retroperitoneum
  7. 7. Abdominal Anatomy and Organ InjuryHollow Organs Solid Organs Vascular Injury Liver Stomach Aorta Spleen Gall bladder Vena Cava Kidney Intestines Major Branches Pancreas Ureters, BladderRupture causes Injured Solid organs, Injury can cause spillage bleed heavily severe blood loss ExsanguinationPeritonism Shock (bleeding out)
  8. 8. Initial Assessment
  9. 9. Initial Assessment/Management:ABCDE Airway with cervical spine control Breathing Circulation: Resuscitation; stop external bleeding Disability Exposure
  10. 10. No abdominal injury have the precedenceover the initial assessment of the traumapatients Evisceration With large laceration abdominal contents may spill out Do not try to replace Cover exposed organs with saline soaked dressing Cover first dressing with second dry dressing
  11. 11. Abdominal TraumaManagement Maintenance of I/V line Draw blood for cross matching/CBC/amylase Fluids Nasogastric tube Foleys Catheter High flow O2 Assist ventilations if needed Give nothing by mouth
  12. 12. Nasogastric TubeRemoves air and fluidAssess for bleedingMinimize risk of aspiration Caution --> Facial #Foleys CatheterRectal / genital Exam firstDecompress bladderMonitor urine outputDiagnostic: Hamaturia Caution --> Pelvic #
  13. 13. 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
  14. 14. 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 !
  15. 15. Unexplained ShockIn trauma, if there are signs of shockand no obvious cause is present ? Abdominal injury (Assess vital signs; skin color, temperature; capillary refill Tachycardia; restlessness; cool, moist skin)
  16. 16. 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
  17. 17. Diagnostic Maneuvers OR Modalities Abdominal Ultrasound Screening Radiographs CT Scan Contarst StudiesDiagnostic Peritoneal Lavage Diagnostic Laparoscopy
  18. 18. Trauma to lower chest, Pain in  Trauma to uninjured shoulder back, flank, Trauma toMechanism High Index of Suspicion buttocks Diffusely Trauma to perineum tender abdomen Hypovolemic shock with no readily identifiable cause
  19. 19. 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
  20. 20. A young patient of about 30 years sustained injury in a RTAwith a bruise mark on left lower chest Splenic Trauma
  21. 21. A hemodynamicaly stable patient receivedin ED having a single gun shot entrywound in the left lumber area was havingfrank haematuria after Cathetrization. Renal Trauma
  22. 22. A motorcyclist had an tonga bamboo injury in the epigastrium.What finding in the CT scan is evident Pancreatic Trauma
  23. 23. Plain X-Ray of a patient who sustained a blunt abdominal injury revealed absent dome of diaphragm on the left side.Diaphragmatic Injury
  24. 24. A car driver had an head on collision with another carbrought to the emergency department. The C.T. Scan revealed. Liver Trauma
  25. 25. 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
  26. 26. ?