This power point is beneficial for health workers trainers and trainee to acquire extra knowledge regarding abdominal injuries, management and signs and symptoms
2. ABDOMINAL INJURIES
•The abdomen contains numerous organs
and related structures that can be injured.
•Abdominal trauma ranks 3rd as a cause of
death and is preceded only by head and
chest injuries.
•Death is primarily a result of hemorrhage,
however, after 48 hours, sepsis and
complications.
•Accompanied by other injuries.
•The failure to diagnose and treat early.
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3. Anatomy and Physiology of the abdomen
Bordered superiorly by the diaphragm, inferiorly by the
pelvis, posteriorly by the vertebral column and anteriorly
by the abdominal and iliac muscles.
Made up of Peritoneal Cavity and Retroperitoneum
Peritoneal cavity composed of; Stomach, Liver,
Gallbladder, Spleen, Transverse Colon, Sigmoid Colon,
Upper third of rectum, Uterus in women.
Retroperitoneum composed of; Ascending and descending
colon, Small intestine, Kidneys, Pancreas, Adrenal glands,
Vena cava, Part of duodenum, Major vessels.
Injury to abdominal organs, especially those in the
retroperitoneal space, can lead to bleeding .
Injury to hollow organs such as the stomach and bowel
presents a serious risk of infection, especially if there is a
delay in diagnosis.
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4.
5.
6.
7. Etiology of abdominal injury
Assault
Fall from a height
Road traffic accident
Stab wounds
Shooting
Explosives fragments
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8.
9. Mechanism of Injury
Blunt Injury
Compression Injury
•Direct injury to organ
•Compression of organ to the vertebral
bone
•Increases intrabdominal pressure
Acceleration and deceleration
•Organs move against ant abdominal
wall
•Shearing and tearing force
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10. Mechanism of injury con’t
Penetrating Injury
Depends on the type of weapon
Stabbing – glass, knives,
•25% chance of damage to internal organs
•Local tissue injury
•Life threatening if large vessel or hollow
organ is damaged
Shooting and explosives
•75% chance of major vessel injury
•Massive injury by bullet or fragment to
abdomen.
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11. Pathophysiology
Vessel or organ Injury
•Hemorrhage Shock
Hollow viscous rupture
•Intestinal content leakage
peritonitis
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15. History taking
•Take history from the relatives , friends,
ambulance staff.
•H/O of abdominal pain, referred to shoulder
tip
•Mechanism of injury
•Mechanism of impact
•Seat belt, steering wheel injury
•Type of weapon
•Medical conditions
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16. Physical Examination
•Initially unreliable – 25% Initially
missed abdominal injuries. If there
is head injury – 50% Missed
•Assume associated abdominal injury
if a patient presents with,
•Chest injury
•Pelvic injury
•Spinal injury
•Do not forget the back
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17.
18. Inspection
•Expose the patient well
•Inspect systematically
•Anterior abdomen, the flanks, the back,
the buttocks, urethral meatus, perineum
•Look for
•Bruises
•Lacerations
•Entry and exit wounds
•Seatbelt or steering marks
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19. Palpation and Percussion
Superficial and deep palpation
Localized tenderness, guarding, rigidity,
Percussion tenderness, shifting dullness, Fluid
thrill
Examine all intra abdominal organs
Start from the firth rib
Press on the pelvis greater trochanter, anterior
superior iliac spines, pubic symphysis
Back- spinal deformity, tenderness, Para vertebral
haematoma
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20. Auscultation
•Presence of bowel sounds
•Does not exclude presence or absence of
abdominal injury
•Absence of bowel sounds
•Peritonism (Any condition having the sign
and symptoms of peritonitis but without the
inflammation of the peritoneum) Eg.
Hemoperitoneum
•Peritonitis Eg. chemical (results from escape
of the contents of the digestive tract into the
peritoneum)and frank peritonitis
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21. Rectal and PV examination
Rectal wall
Blood on the examining finger
High riding prostate
VE mandatory, if fracture of pubic
ramie, symphysis pubis is suspected
Perineum and Urethral meatus
Blood on external meatus
Bruised scrotum
Bruised perineum
High riding prostate
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24. Primary survey
•Immobilize the cervical spine
•Airway - Secure air way
•Breathing – optimize ventilation
•Circulation – control external hemorrhage,
establish IV access
Persistent shock
Distended neck veins
•Cardiogenic shock: Myocardial contusion,
Pericardial tamponade
No distended neck veins
•Hypovolemic shock: Chest, abdomen, pelvic
fracture
•Neurogenic shock: Spinal injury
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25. Stable patient - Go to Secondary
Survey
To identify the potentially life threatening injuries such as;
• Head, Chest, Abdomen, Extremity, Spinal
Indications for Laparotomy
•Unexplained shock, hemoperitoneum
•Rigid silent abdomen
•Evisceration (removal of the viscera)
•Radiological evidence of air under the diaphragm
•Radiological evidence of rupture of the diaphragm
•All penetrating gunshot and missile injuries.
•Stab wound with peritoneal signs
•Solid organ injury, unstable patient
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26. Objectives of laparotomy
•To control the hemorrhage
•To stop or minimize contamination
•Explore abdomen to identify the injuries
•Repair injuries and stop the bleeding
Open wounds and evisceration
•Open abdominal wounds
•Evisceration, omentum or intestine
•Do not push inside the abdomen but cover with
clean sheet or towel soaked in warm saline
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27. Assignment
•Read about the pre-operative and post-
operative management for a patient
undergoing laparotomy
•Read about; diaphragmatic injury, liver
injury and pancreatic injury.
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