Abdominal trauma


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Abdominal trauma

  1. 1. Abdominal trauma By: Mohamed Soliman El-Sheshtawy Faculty of Medicine Alexandria .Egypt. http://www.facebook.com/sheshto2014
  2. 2. 1- Introduction 2-causes 3-symptoms and signs 4-management
  3. 3. Introduction -Abdomen is a black box i.e it is impossible to know what special injuries have occurred -Our aim to save lives in Abdominal Trauma not to make an accurate diagnosis -Don’t spend the precious time of the victim in sophisticated investigation.
  4. 4. Types of the abdominal trauma. 1-Blunt abdominal trauma. 2-Penetrating abdominal trauma.
  5. 5. Blunt Trauma
  6. 6. penetrating
  7. 7. Penetrating Abdominal Trauma is usually diagnosed based on clinical signs, blunt abdominal trauma is more likely to be missed because clinical signs are less obvious.
  8. 8. Symptoms and signs 1-Penetrating Trauma: Abdominal pain Bleeding Shock Impalement Injury Evisceration
  9. 9. Evisceration
  10. 10. 2-Blunt Trauma: Abdominal pain Distension Discoloration of abdomen Unexplained shock
  11. 11. Examination and Evaluation 1- visually note wounds and abrasions 2-palpate abdomen for localized and diffuse tenderness 3-consider possible internal injuries eg: liver ,spleen and kidney 4-diffuse severe tenderness: a sign of internal bleeding.
  12. 12. Liver injury
  13. 13. Kidney Injury
  14. 14. signs Cullen’s Sign:1918 Bluish discoloration around umbilicus Diffusion of blood along periumbilical tissues or falciform ligament Hemoperitoneum Severe pancreatitis
  15. 15. Grey-Turner’s Sign: (1877-1951) Bluish discoloration of the flanks Retroperitoneal Hematoma hemorrhagic pancreatitis.
  16. 16. Kehr’s sign (1862-1916). Referred pain in left shoulder irritation of the diaphragm (Splenic injury, free air, intra-abdominal bleeding)
  17. 17. Balance’s Sign Dullness on percussion of the left upper quadrant ruptured spleen
  18. 18. Labia and Scrotum : Pooling of blood from abdominal and pelvic cavities and you should Examine the back.
  19. 19. Diaphragmatic injuries Diaphragmatic injuries are difficult to diagnose. Small diaphragmatic injuries on the right side may heal without incident, and the liver protects against potential hernias. Small injuries on the left side may result in symptomatic diaphragmatic hernias. Acute diaphragmatic defects are best approached through the diaphragm
  20. 20. Diaphragmatic Injury: respiratory paradox “inward movement of abdomen during Inspiration.
  21. 21. Managment
  22. 22. Primary survey Identification & treatment of life threatening conditions • Airway , with cervical spine precautions • Breathing • Circulation • Disability • Exposure
  23. 23. Emergency Care • I V fluids • Control external bleeding • Dressing of wounds • Protect eviscerated organs with a sterile dressing • Stabilize an impaled object in place • Give high flow oxygen • Immobilize the patient with a fractured pelvis • Keep the patient warm • Analgesics
  24. 24. Secondary Survey • General &Systemic Examination-to identify all occult injuries . • Special attention to Back, Axilla , Perineum • PR - sphincter tone ,bleeding ,perforation , high riding prostate • Foley’s catheter- monitor urine out put • Nasogastric tube
  25. 25. Secondary Survey(cont.) • AMPLE History • A: Allergy • M: Medications • P: Past medical history • L: Last meal • E: Event - What happened
  26. 26. (Investigations) (A) Blood Tests (B) Radiological Studies (Plain abdominal X-ray, CXR) (C) Peritoneal lavage (DPL) (D) USS abdomen (E) CT abdomen (F) Peritoneoscopy (Diagnostic laproscopy)
  27. 27. X-ray
  28. 28. Post traumatic diaphramatic hernia
  29. 29. Diagnostic peritoneal lavage
  30. 30. C.T Liver trauma
  31. 31. Splenic injury
  32. 32. Splenic injury
  33. 33. Pancreatic injury
  34. 34. Ultra-sound Splenic injury
  35. 35. Thank you
  36. 36. References Schwartz_Principles-of-Surgery_9th-Edition Sabiston 18th Edition Bailey and love EssentialSurgery Problems Diagnosis And Management 4thEdition Radiology_for_Surgeons_in_Clinical_Practice