This lesson will be let you know how to diagnosis and some assessment on patients

1. Prepared by : PS
Created by groups: 09DCEM2- 2018
 University of Health Sciences(UHS)
Abdominal Trauma

2. .Objectif
After learning you will be know about:
• type of causes abdominal trauma
• How many organs in abdomen was effected by abdominal trauma
• How to examination patients abdominal trauma
• How to management patient prehospital and in hospital
• How to treatment and technique of surgery on patient.

4. Epidemiology
global in the world WHO
• Peak incidence Abdominal Trauma 15 – 30 years.
• More than 15,000 people die every year as a result of injuries by
motor vehicle accident, fall.
• Injury accounts for 10% of all deaths.
• Estimates indicate that by 2020, 8.4 million people worldwide will die
annually.
• Prevalence: 13%.

5. Complication of abdominal injuries
●Blunt trauma: ●Penetrating trauma
-Aortic rupture -Laceration blood vessels
-Splenic rupture -Splenic rupture
-Liver rupture or laceration - Liver rupture or laceration
-Diaphragmatic tea -Kidney laceration
-Pelvic fracture -Intestinal lacerations
-Intestinal tear -Bladder rupture
-Bladder rupture

6. The most commonly Injured Abdomen.organs
●Blunt:
-Liver
-Spleen
-Kidney
●Penetrating:
-Small intestine

8. Blunt Trauma Abdomen
• Prehospital
-The goal of prehospital is to delivery patient to hospital for definitive
care as rapidly as possible. <Scoop and Run>
-Maintain airway & start IV line
-Care of spinal cord
-Communicate to medical control
-Rapid transport of patient to trauma centre

9. • Primary survey:
Identification & Treatment of life threatening conditions ABCDE
Airway, with cervical spine precautions
Breathing
Circulation
Disability
Exposure
Initial Assessment and Resuscitation

10. Emergency Care
• IV fluids
• Control external bleeding
• Dressing of wound
• Protect eviscerated organs with a sterile dressing
• Stabilized an impaled object in place
• Give high flow oxygen
• Immobilize the patient with fractured pelvis
• Keep the patient warm
• Analgesics

11. Secondary Survey
• General & systemic examination to identify all occult injuries
• Foley’s catheter for monitor urine out put
• Nasogastric Tube
• History of Patient( allergy, past medical history and event)

12. Examination physic
• Inspection:
-Laceration
-Abrasion
-Entry/Exit wounds
-Involvement chest & head injury
-Seat Belt Sign

13. • Cullen’s Sign:1918
• Bluish discoloration around umbilicus
• Diffusion of blood along periumbilical tissues or falciform ligament
• Hemoperitoneum
• Severe pancreatitis

16. • Auscultation :
-Bowel sounds in the thoracic cavity(Diaphragmatic rupture)
-Haemothorax
Palpation :
-Mass
-Tenderness
-Signs of peritonitis
-Ribs
-Chest & Pelvic compression test.

17. Investigations
• FAST
• X-Ray chest & abdomen
• Ultrasound
• CT-scan
• Paracentesis
• Diagnostic peritoneal lavage
• Diagnostic Laparoscopy

18. Focused Assessment with
Sonography in Trauma
(FAST)
• Rapid , Accurate
• Sensitivity 86- 99%
• Can detect 100 mL of blood
• Four different views
- Pericardiac
-Perihepatic
-Perisplenic
-Peripelvic space
• Eliminates unnecessary CT scans
• Helps in management plan

19. Laparoscopy
• Most useful to evaluate
penetrating wounds to
thoracoabdominal region in
stable patient.
• Specific for diaphragm injury:
sensitivity 87.5%, specificity
100%(can repair organs via the
Laparoscopy.
• If patients with abdominal injury
frequently underwent
laparotomy& most often for
unstable vital sign with evidence
of abdominal injury.
• Useful in penetrating injury.

20. Diagnostic
peritoneal lavage
• DPL introduced to allow trauma
surgeons to determine whether
there was blood in the
peritoneum if positive, directly to
Operating Room.

21. Current Therapy
• Non-operative management(NOM) has now become the most common
approach to blunt abdominal injury
• “Standard of Care” for blunt abdominal trauma in the hemodynamically
stable patient
• Underlying drivers:
.CT-scan Technology
.Bleeding stops(mostly)
▪Requires:
.ICU level monitoring .Surgical available and expertise
.Blood bank .Ready access to the Operating Room

22. Management: Blunt
• Stable patients optimal candidates for NOM
• Unstable patients with evidence of intra-abdominal injury→ to OR
-Laparotomy(benefits)
• More recently: unstable patients who response to resuscitation( 2 to
3 liters of crystalloid) are candidates for NOM
• NOM success rates vary by organs, severity grade and degree of
hemoperitoneum:
-Liver generally better than spleen

23. SPLENIC INJURY
• Most common intra- abdominal organ to injured (40-55%)
• 20% of splenic injuries due to left lower rib fractures
• Commonly arterial hemorrhage
• Conservative management :
-Hemodynamic stability
-Negative abdominal examination
-Absence of contrast extravasation in CT
-Absence of other indication of Laparotomy
-Grade 1to 3 (Subcapsular Hematoma ,Laceration <3 cm)
Monitoring
• Serial abdo. Examinations & Hematocrit are essential
• Success rate of conservative NOM is >80%
Major Laceration not involving hilum (IV) Partial Splenectomy
Hillar injury (V)–Total Splenectomy

24. Liver injury
• Liver is the largest organ in abdomen
•2nd most common organ injured (35-45%) in BTA
•Driving and fighting responsible for 50% of deaths due to liver injury
•Usually venous bleeding
•85% of all patients with blunt hepatic trauma are stable
•CT is the mainstay of diagnosis in stable patients.
• 50% liver injury have stop bleeding spontaneously

25. Liver Injury
Operative management
• Packing
-Bleeding can be stopped by packing of abdomen
-Pack removed after 48 h
-haemostatic agents
-34 % survival in packing only
• Suturing: -Simple suture
-Deep mattress suture
• Laceration: -Mesh hepatorrhaphy
-Omental flap to cover the laceration
-Debridement
• Lobe Resection
• Liver Transplantation
• Ligate or repair damaged blood vessels & bile duct
• Mortality of liver injury is 10%

26. Pancreatic Injury
• Rare 10-20% of all abdominal injury
• Crush , Direct blow to abdo & Seat belt
injury
• Associated with abdominal. Duodenal
injury, Vascular injury & liver injury •
Diagnosis – Difficult, High index of suspicion
• CT Scan is helpful
• Serum amylase is a poor
• Usually diagnose on Laparotomy
• Distal Pancreatic injury - Distal resection
• Pancreaticojejunostomy – Injury to Ampulla
of Vater, Head & Body of Pancreas

27. Bladder Injury
• Commonly in BTA
• 70% of bladder Injury are associated with pelvic fracture .
• Hematuria
Type:
1.Extraperitoneal Rupture-by bony fragment
2. Intraperitoneal Rupture: maybe secondary to a blow, kick or fall on a fully distended
bladder
• Diagnosis: 1. Clinical
2. Cystography
Treatement:
1. Intraperitoneal –trans-peritoneal - closure + statistical process control(SPC)
2.Extraperitoneal Rupture : catheter drainage alone (Foley‟s catheter -10 -14 days)

28. Trauma in Pregnancy
• Incidence- 10-20%
• Causes:
1.Domestic violence
2.Sexual Assault
3.Accident
• Third trimester: balance & coordination disturbed
• Multidisciplinary team: Obstetrician, surgeon, and neonatologist
•Peritoneal sign are delayed
• “Supine hypotensive syndrome” > 20 weeks‟ gestation
COMPLICATIONS
• Fetal Injury & Death –fetoplacental injury, maternal shock,
• Placental Abruption
• Rupture of Uterus

29. Penetrating abdominal trauma
management
• Directly to OR:
-Hemodynamic instability
-Peritoneal signs
-Vast majority of gunshot wound or Missel …
Stable patients with stab wounds without peritonitis:
-Observed with frequent exams
-Wound exploration
-DPL
-Laparotomy
Emerging role for CT scan in selected patients with stable VS and no PS

30. Penetrating abdominal trauma

31. Conclusion
• Blunt solid organ injury is common
• CT scan use for diagnosis is nearly universal – beware missed small
bowel injury
• Majority NOM with excellent outcomes
• Death from abdominal injury usually result from hemorrhage and
delayed surgical repair.