Presentation on the management of abdominal injuries including the causes of abdominal injuries; the classification of abdominal injuries; the initial management of patients with abdominal injuries according to the ATLS; trauma laparotomy
This document discusses principles of bowel anastomosis, including types of anastomoses, indications for anastomoses, pre-operative preparation, intra-operative techniques, post-operative care, complications, and controversies. It covers topics such as hand-sewn versus stapled anastomoses, single versus double layer closure, inversion versus eversion of tissue, and use of abdominal drains and NG tubes. The goal of bowel anastomosis is to successfully rejoin bowel segments through meticulous surgical technique and postoperative management in order to restore intestinal continuity.
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document provides an overview of the types, causes, examination, and management of abdominal trauma from blunt forces. It discusses the different regions of the abdomen that can be injured and mechanisms of injury for hollow and solid organs. Specific injuries to the spleen, liver, pancreas, kidneys, diaphragm, stomach, duodenum, intestines, colon, and bladder are reviewed. Management approaches for stable and unstable patients are described, including non-operative management with monitoring versus exploratory surgery depending on injury grade and hemodynamic status. Imaging tools like ultrasound, CT scan, and diagnostic peritoneal lavage are also summarized.
This document discusses safe laparoscopic cholecystectomy and management of bile duct injuries. It begins with an overview of laparoscopic cholecystectomy and the increased risk of bile duct injury compared to open procedures. It then covers bile duct injury mechanisms, classifications, prevention techniques such as obtaining the critical view of safety, and management strategies whether the injury is recognized intraoperatively or postoperatively. The key messages are that obtaining the correct anatomical views and following established safety procedures can help prevent bile duct injuries, and injuries need to be promptly addressed either by repair or biliary reconstruction to reestablish bile flow.
Bile duct injuries are a complex complication seen more frequently with laparoscopic cholecystectomies due to aberrant anatomy and increased procedures. They can involve the cystic duct, gallbladder bed, or major bile ducts. Various classification systems exist to describe the level and extent of injury. Injuries may be detected intraoperatively by cholangiogram abnormalities, bile drainage from unusual locations, or anomalous anatomy. Prevention strategies include proper case selection, opening retroperitoneal folds, dissecting close to the gallbladder, achieving the critical view of safety, and using intraoperative cholangiography.
This document summarizes key information about duodenal injuries:
- The duodenum is 12 inches long and located retroperitoneally behind the liver and pancreas. It has four parts and is vulnerable to trauma due to its location and proximity to other abdominal organs.
- Duodenal injuries can be from penetrating or blunt trauma. Diagnosis involves imaging like CT scans and upper GI series. Management principles involve restoring intestinal continuity, decompressing the duodenum, providing drainage, and nutritional support.
- Treatment options depend on the severity of injury and include primary repair, diversion procedures like gastrojejunostomy, or pancreaticoduodenectomy for severe injuries involving other structures. Complications can include
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
This document discusses principles of bowel anastomosis, including types of anastomoses, indications for anastomoses, pre-operative preparation, intra-operative techniques, post-operative care, complications, and controversies. It covers topics such as hand-sewn versus stapled anastomoses, single versus double layer closure, inversion versus eversion of tissue, and use of abdominal drains and NG tubes. The goal of bowel anastomosis is to successfully rejoin bowel segments through meticulous surgical technique and postoperative management in order to restore intestinal continuity.
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document provides an overview of the types, causes, examination, and management of abdominal trauma from blunt forces. It discusses the different regions of the abdomen that can be injured and mechanisms of injury for hollow and solid organs. Specific injuries to the spleen, liver, pancreas, kidneys, diaphragm, stomach, duodenum, intestines, colon, and bladder are reviewed. Management approaches for stable and unstable patients are described, including non-operative management with monitoring versus exploratory surgery depending on injury grade and hemodynamic status. Imaging tools like ultrasound, CT scan, and diagnostic peritoneal lavage are also summarized.
This document discusses safe laparoscopic cholecystectomy and management of bile duct injuries. It begins with an overview of laparoscopic cholecystectomy and the increased risk of bile duct injury compared to open procedures. It then covers bile duct injury mechanisms, classifications, prevention techniques such as obtaining the critical view of safety, and management strategies whether the injury is recognized intraoperatively or postoperatively. The key messages are that obtaining the correct anatomical views and following established safety procedures can help prevent bile duct injuries, and injuries need to be promptly addressed either by repair or biliary reconstruction to reestablish bile flow.
Bile duct injuries are a complex complication seen more frequently with laparoscopic cholecystectomies due to aberrant anatomy and increased procedures. They can involve the cystic duct, gallbladder bed, or major bile ducts. Various classification systems exist to describe the level and extent of injury. Injuries may be detected intraoperatively by cholangiogram abnormalities, bile drainage from unusual locations, or anomalous anatomy. Prevention strategies include proper case selection, opening retroperitoneal folds, dissecting close to the gallbladder, achieving the critical view of safety, and using intraoperative cholangiography.
This document summarizes key information about duodenal injuries:
- The duodenum is 12 inches long and located retroperitoneally behind the liver and pancreas. It has four parts and is vulnerable to trauma due to its location and proximity to other abdominal organs.
- Duodenal injuries can be from penetrating or blunt trauma. Diagnosis involves imaging like CT scans and upper GI series. Management principles involve restoring intestinal continuity, decompressing the duodenum, providing drainage, and nutritional support.
- Treatment options depend on the severity of injury and include primary repair, diversion procedures like gastrojejunostomy, or pancreaticoduodenectomy for severe injuries involving other structures. Complications can include
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing mesh to cover the defect, and post-operative care. The laparoscopic approach has advantages over open surgery such as smaller incisions, less tissue disruption, and less post-operative pain, though it requires practice to learn.
This document discusses intestinal anastomosis, which involves creating a connection between intestinal loops or ends. Intestinal anastomosis is commonly performed for elective and emergency cases involving conditions like cancer, infections, or obstructions. The key factors for a successful anastomosis are minimal contamination, good blood supply, and tension-free apposition of the intestinal ends. The document compares hand-sewn and stapled techniques, noting that while staplers are faster, studies have found no difference in outcomes between the two methods. Proper patient factors and surgical technique are more important than the specific method used.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Abdominal surgery and stomas are discussed, including:
- Common abdominal procedures for colorectal cancer like right/left hemicolectomy and anterior resection are described.
- Complications of surgery like anastomotic leaks and paralytic ileus are also covered.
- Stomas, specifically ileostomies and colostomies, are defined as ways to divert feces after removal of part of the colon and rectum. Differences between ileostomies and colostomies and potential complications are outlined.
Splenic trauma - Causes, Complications, ManagementVikas V
The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
This document discusses the management of abdominal vascular injuries. It covers the epidemiology, anatomy, presentation, investigations, surgical approaches, challenges, and complications of abdominal vascular injuries. Resuscitation and damage control techniques are emphasized. Exposure and control of the aorta, inferior vena cava, and iliac vessels are described in detail. Primary repair or ligation are the main repair options, with endovascular techniques also playing a selective role. Mortality rates are high and prompt diagnosis and management are critical due to the risk of exsanguinating hemorrhage.
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. Most liver injuries can be successfully treated without surgery if the patient is hemodynamically stable. Surgical management may involve packing the liver or angiographic embolization of bleeding sites. Following initial resuscitation, imaging can help evaluate the severity and location of liver injuries.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This document discusses various types of stomas including colostomies and ileostomies. It describes their indications, techniques for formation, types like end, loop and continent variations, as well as complications and management strategies. Stomas are surgically created openings of the intestinal or urinary tract onto the abdominal wall to divert feces or urine. Proper technique and siting are important to reduce complications.
1. Abdominal trauma can result from motor vehicle accidents, falls, and other blunt or penetrating injuries. Common organs injured include the liver, spleen, and small intestine.
2. Evaluation involves assessing life threats, performing a physical exam looking for signs of internal bleeding, and obtaining imaging like ultrasound, CT scan, or diagnostic peritoneal lavage to identify injuries.
3. For stable patients, non-operative management is usually attempted first with monitoring and treatment of any bleeding. Unstable or deteriorating patients typically require surgery to repair damaged organs.
Abdominal trauma: diagnosis and managementvinayakas4
1) Abdominal trauma is a major cause of death globally, especially in young adults, due to injuries from motor vehicle accidents. The abdomen has no bony protection and is vulnerable to hemorrhage from solid organs or sepsis from hollow viscus injuries.
2) Evaluation of abdominal trauma involves history, physical exam, focused assessment with sonography for trauma (FAST), and CT scan if stable. Unstable patients may require diagnostic peritoneal lavage or immediate exploratory laparotomy.
3) Management depends on injury type and hemodynamic stability. Nonoperative management is preferred for solid organ injuries while laparotomy is often needed for penetrating injuries or hemodynamically unstable patients to control bleeding.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing mesh to cover the defect, and post-operative care. The laparoscopic approach has advantages over open surgery such as smaller incisions, less tissue disruption, and less post-operative pain, though it requires practice to learn.
This document discusses intestinal anastomosis, which involves creating a connection between intestinal loops or ends. Intestinal anastomosis is commonly performed for elective and emergency cases involving conditions like cancer, infections, or obstructions. The key factors for a successful anastomosis are minimal contamination, good blood supply, and tension-free apposition of the intestinal ends. The document compares hand-sewn and stapled techniques, noting that while staplers are faster, studies have found no difference in outcomes between the two methods. Proper patient factors and surgical technique are more important than the specific method used.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Abdominal surgery and stomas are discussed, including:
- Common abdominal procedures for colorectal cancer like right/left hemicolectomy and anterior resection are described.
- Complications of surgery like anastomotic leaks and paralytic ileus are also covered.
- Stomas, specifically ileostomies and colostomies, are defined as ways to divert feces after removal of part of the colon and rectum. Differences between ileostomies and colostomies and potential complications are outlined.
Splenic trauma - Causes, Complications, ManagementVikas V
The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
This document discusses the management of abdominal vascular injuries. It covers the epidemiology, anatomy, presentation, investigations, surgical approaches, challenges, and complications of abdominal vascular injuries. Resuscitation and damage control techniques are emphasized. Exposure and control of the aorta, inferior vena cava, and iliac vessels are described in detail. Primary repair or ligation are the main repair options, with endovascular techniques also playing a selective role. Mortality rates are high and prompt diagnosis and management are critical due to the risk of exsanguinating hemorrhage.
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. Most liver injuries can be successfully treated without surgery if the patient is hemodynamically stable. Surgical management may involve packing the liver or angiographic embolization of bleeding sites. Following initial resuscitation, imaging can help evaluate the severity and location of liver injuries.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This document discusses various types of stomas including colostomies and ileostomies. It describes their indications, techniques for formation, types like end, loop and continent variations, as well as complications and management strategies. Stomas are surgically created openings of the intestinal or urinary tract onto the abdominal wall to divert feces or urine. Proper technique and siting are important to reduce complications.
1. Abdominal trauma can result from motor vehicle accidents, falls, and other blunt or penetrating injuries. Common organs injured include the liver, spleen, and small intestine.
2. Evaluation involves assessing life threats, performing a physical exam looking for signs of internal bleeding, and obtaining imaging like ultrasound, CT scan, or diagnostic peritoneal lavage to identify injuries.
3. For stable patients, non-operative management is usually attempted first with monitoring and treatment of any bleeding. Unstable or deteriorating patients typically require surgery to repair damaged organs.
Abdominal trauma: diagnosis and managementvinayakas4
1) Abdominal trauma is a major cause of death globally, especially in young adults, due to injuries from motor vehicle accidents. The abdomen has no bony protection and is vulnerable to hemorrhage from solid organs or sepsis from hollow viscus injuries.
2) Evaluation of abdominal trauma involves history, physical exam, focused assessment with sonography for trauma (FAST), and CT scan if stable. Unstable patients may require diagnostic peritoneal lavage or immediate exploratory laparotomy.
3) Management depends on injury type and hemodynamic stability. Nonoperative management is preferred for solid organ injuries while laparotomy is often needed for penetrating injuries or hemodynamically unstable patients to control bleeding.
Permissive hypotension, also known as hypotensive resuscitation, involves allowing trauma patients with penetrating injuries to have a lower blood pressure to avoid disrupting unstable blood clots and worsening bleeding until emergency surgery can control the hemorrhage. The goal is to maintain adequate tissue perfusion while avoiding excessive fluid resuscitation that could lead to rebleeding and complications. Damage control resuscitation aims for a minimal volume, normotensive approach with a target mean arterial pressure of 65 mmHg for penetrating trauma patients without head injuries.
The document provides information on abdominal injuries, including:
1. The abdomen can be injured through penetrating or blunt trauma, involving the abdominal wall, solid organs, hollow viscus, or vasculature.
2. Assessment of abdominal injury focuses on recognizing conditions requiring immediate surgery and avoiding delayed intervention. Investigations include physical exam, paracentesis, diagnostic peritoneal lavage, FAST scan, and imaging.
3. Management depends on injury mechanism and patient stability. Penetrating injuries may require laparotomy for bleeding control or foreign body removal. Indications for laparotomy include bleeding control, injury identification, and contamination protection. Specific organ repairs include splenectomy, tractotomy, and primary suturing
1) Abdominal trauma is a major public health problem worldwide, with blunt trauma making up around 2/3 of cases and road traffic accidents being the most common cause.
2) A thorough history and physical exam are important to evaluate abdominal trauma patients, but diagnostic modalities like FAST ultrasound, CT scan, and DPL may be needed depending on stability.
3) For stable blunt trauma patients, non-operative management is preferred when possible, while unstable patients generally require exploratory laparotomy. Penetrating trauma patients often require laparotomy depending on injury characteristics.
This document provides an overview of abdominal trauma, including blunt and penetrating injuries. It discusses the anatomy, mechanisms of injury, assessment techniques like the FAST scan and CT scan, management principles, and specific injuries to the liver, spleen, diaphragm, and pelvis. Treatment may involve resuscitation, laparotomy, interventional radiology, or observation depending on the stability of the patient and findings on imaging and examination. Unrecognized abdominal injuries can be preventable causes of death, so early recognition and management of intra-abdominal injuries is important for saving lives.
The document discusses the principles of trauma management for abdominal and pelvic injuries, including classifications of injuries, mechanisms of injury, assessment techniques, management approaches like damage control resuscitation and surgery, and guidelines for treatment of specific injuries to the liver, spleen, and other abdominal organs. Case scenarios are presented and management strategies are outlined for various injury patterns and severity.
(1) Perform a primary survey and assess for ABCDE issues.
(2) Consider a seatbelt sign and evaluate for abdominal tenderness or rigidity which suggest occult injury.
(3) Perform a FAST exam to check for hemoperitoneum which, if positive, indicates need for surgical consultation given the mechanism of injury.
(4) If the patient is stable, further evaluation with CT scan would be most accurate to diagnose potential solid organ or retroperitoneal injuries from the handlebar impact.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
This document provides an overview of the evaluation and management of abdominal injuries. It discusses the important differences between penetrating and blunt trauma, key CT findings, and general principles of care. Damage control surgery techniques are described that aim to rapidly control bleeding and limit gastrointestinal spillage to break the lethal triad of hypothermia, acidosis, and coagulopathy in critically injured patients. Post-operative intensive care is focused on resuscitation and monitoring for abdominal compartment syndrome.
This document discusses approaches to managing abdominal trauma in the emergency department. It begins by outlining learning objectives which include identifying abdominal trauma, learning assessment approaches, and trauma management. It then discusses the primary and secondary surveys as well as indications of shock. Specific injuries like solid organ injuries, hollow visceral injuries, retroperitoneal injuries, and diaphragmatic injuries are examined. Mechanisms of injury, physical exam findings, ultrasound, and management are also reviewed to provide emergency physicians with guidance on evaluating and treating abdominal trauma.
1) Abdominal trauma is commonly encountered and can be life-threatening. Identification of serious intra-abdominal injuries can be challenging.
2) Motor vehicle accidents account for 60% of abdominal trauma, with blunt trauma more common than penetrating injuries.
3) Injuries to solid organs like the spleen, liver, and kidneys require careful assessment and may be graded based on severity. Conservative management is often attempted initially if the patient is stable.
4) Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy can help identify injuries, but repeated examinations are often necessary. Management may involve surgery or conservative approaches depending on injury severity and patient stability.
Management of injuries to the specific organs in the abdomen. The clincal presentation of each organ injury, the diagnostic investigations to use and how to treat it definitively and in a damage control setting.
This document provides information on trauma to the abdomen, including penetrating and blunt abdominal injuries. It discusses the initial management, investigations, and operative vs non-operative management for various organ injuries involving the liver, spleen, diaphragm, stomach, bowel, pancreas, and more. It also covers genitourinary trauma to organs like the kidneys, ureters, bladder, and urethra. Specific considerations for pediatric and geriatric trauma patients are discussed as well.
This document summarizes the assessment and management of abdominal trauma. It discusses the anatomy most commonly injured by blunt or penetrating trauma, including the spleen, liver, and small bowel. The physical exam involves inspection, auscultation, percussion, and palpation of the abdomen and pelvis. Adjunct studies include x-rays, FAST scan, diagnostic peritoneal lavage, and CT scan to identify internal injuries. Management may involve gastric/urinary decompression or surgery depending on the severity of injuries found.
This document provides guidance on the initial assessment and management of abdominal trauma. It discusses:
- Recognizing abdominal injuries through physical exam, ultrasound, CT, and diagnostic tools.
- Managing hemorrhage from abdominal injuries through damage control resuscitation including permissive hypotension, blood product transfusion, and early surgery to control bleeding.
- Evaluating different areas of the abdomen that could be injured, including the intraperitoneal cavity, retroperitoneum, thorax, heart, and diaphragm.
This document discusses abdominal trauma, providing classifications and management strategies. It divides the abdomen into 4 internal sections and classifies trauma as blunt or penetrating. Factors influencing blunt trauma severity are outlined. Diagnosis involves history, exam, and special tests like ultrasound, CT, DPL. Management depends on stability, with laparotomy indicated for instability or clear injuries. Specific organ injuries from spleen to urethra are addressed, noting diagnostic criteria and treatment options like repair versus resection.
Pelvic Fracture managemnt- Case based discussion .pptxKTD Priyadarshani
A case based approach on the management of a pelvic fracture. it is based on ATLS guideline. A brief account on anaesthetic and orthopedic point of view also included.
Gastric cancer is the sixth most common cancer and third leading cause of cancer death worldwide. Risk factors include infection with H. pylori bacteria and low fruit/vegetable intake. Precancerous conditions include atrophic gastritis and intestinal metaplasia. Diagnosis involves endoscopy with biopsy. Treatment options include surgery to remove all or part of the stomach, chemotherapy, and radiation therapy. Post-operative care focuses on managing complications and preventing issues like dumping syndrome.
This document discusses abdominal trauma, including its causes, signs and symptoms, diagnostic tests, and management. It notes that abdominal trauma peaks among 15-30 year olds and is most often caused by motor vehicle accidents or falls. Diagnostic tests include FAST scan, CT scan, DPL, and laparoscopy. Treatment depends on whether the trauma is blunt or penetrating and involves stabilizing the patient, identifying internal injuries, and treating those injuries either operatively or non-operatively. Nursing management focuses on monitoring for shock, sepsis, and other complications.
This presentation is a general overview of the various drains used in surgery.
It entails the history of drains, rationale of drains, indications of drains, the factors that affect flowrate, classification of drains and the care of drains.
1. Opioid overdose can occur from both prescription and illicit opioid use. Common opioids involved include morphine, heroin, fentanyl, oxycodone, and hydrocodone.
2. Symptoms of opioid overdose include respiratory depression, sedation, small pupils, nausea, vomiting, and decreased heart rate. Naloxone is used as an antidote to reverse the effects of opioid overdose.
3. Treatment of opioid overdose focuses on supporting breathing, administering naloxone, monitoring for complications, and managing withdrawal symptoms which can include restlessness, nausea, and drug craving. Prevention strategies aim to reduce opioid misuse and increase access to treatment.
A brief overview of syphilis and an outlook on the frequently requested VDRL test.
An insight into other investigative modalities for the diagnosis of syphilis.
A power point on the various types of flaps and their respective indications. This presentation briefly describes the various flaps and how to care for flaps.
A presentation
a. The anatomy of the skin
b. The types of skin grafts
c. Indications of a skin graft
d. Mechanism of a graft take
e. Causes of graft failure
f. How to perform skin grafting
This document provides information on principles of gastrectomy, including:
- A brief history of gastrectomy procedures from the early 19th century to modern developments.
- Details on the anatomy, blood supply, lymph drainage of the stomach as relevant to gastrectomy.
- Descriptions of different types and techniques of gastrectomy for treating conditions like cancer, ulcers, and obesity.
- Information on pre-operative preparation, surgical techniques for different procedures like Billroth I and II reconstructions, and post-operative care and complications.
Malignant pleural effusion (MPE) is an abnormal collection of fluid in the pleural space caused by the presence of malignant cells. It commonly occurs in advanced cancer and indicates poor prognosis. Treatment of MPE is palliative and aims to drain pleural fluid and prevent recurrence through pleurodesis. Chest tube drainage with chemical sclerosing agents like talc is the standard treatment and achieves a high rate of pleurodesis success. Thoracoscopy with talc poudrage is also effective at draining fluid and achieving pleurodesis. Treatment goals are to relieve symptoms and improve quality of life.
This document discusses the management of hand injuries and associated infections. Some key points:
- Hand injuries are common, usually affecting young males, and are often caused by domestic or work-related accidents. Proper treatment is important to prevent stiffness.
- Evaluation of hand injuries involves assessing wound characteristics, neurovascular status, and underlying bone or tendon injuries. Management principles aim to preserve the hand and restore function.
- Treatment depends on wound type but typically involves debridement, irrigation, splinting, antibiotics, and reconstruction of tendons, nerves or bone as needed. Complications can include infection, stiffness if not managed properly.
- Specific injuries like bites, foreign bodies, fingertip injuries
This document discusses urethral strictures, which are narrowings of the urethra caused by scarring. It covers the anatomy and epidemiology of urethral strictures and their various causes including iatrogenic, traumatic, inflammatory, and idiopathic factors. Diagnostic tests like retrograde urethrography and treatments options are outlined, including dilation, direct vision internal urethrotomy, and urethroplasty surgery. Urethroplasty is considered the gold standard treatment but has the highest success rate for short, simple strictures.
The document shows the relationship between prostate-specific antigen (PSA) levels and findings from digital rectal exams (DRE) for men being tested for prostate cancer. Men with higher PSA levels were more likely to have abnormal DRE findings, with over 75% of men with a PSA over 10ng/ml found to have an abnormal DRE.
Posterior urethral valves is a congenital condition caused by abnormal membranes in the proximal urethra that obstruct the flow of urine. It most commonly presents in infancy with failure to pass urine and is diagnosed using imaging like ultrasound and voiding cystourethrography. Treatment involves surgical ablation of the valves via cystoscopy to restore urinary flow and halt renal damage. Prognosis depends on factors like age at diagnosis and degree of renal dysfunction, as patients may develop lifelong complications due to the original renal insults.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Introduction
• Trauma is the leading cause of death between ages 1 and
44
• The abdomen is third most injured region of the body.
• Abdominal injuries accounts for 15 - 20% of all trauma
deaths
• Abdominal trauma is traditionally classified as either
blunt or penetrating.
• Morbidity and mortality from abdominal injuries are due
haemorrhage and sepsis
• It is usually associated with injuries of other regions
of the body.
• Missed or delayed diagnoses are the most common cause
of death from these injuries
3. Epidemiology
• Epidemiology of abdominal injuries varies across the continent
• In Egypt it account for 82.7% of all trauma cases (Gad et al 2012)
• 14.2% of all trauma cases in Mbarara hospital in Uganda (Ruhinda et
al 2008)
• Ghana
• Ghana Medical Journal– 234 abdominal injuries were seen between
1983 and 1989 (Naaedar 1990)
• 411 patients were seen with penetrating injuries in KBTH and KATH
between 1998 to 2008
(Dakubo et al 2010)
• KBTH – General Surgery Logs
• 1772 cases in total were done between August and December
• 5 Trauma laparotomies
• Spleen was the most injured viscus – 3 cases
• Small bowel and mesenteric injuries – 2 cases
6. Classification of Abdominal
Injuries
• Non-penetrating abdominal Injuries
• Damage to the abdomen and/or abdominal organs
secondary to the impact of blunt forces applied
across an abdominal region.
• Forces can be localised to one region of the body or
across a wide area.
• Penetrating abdominal Injuries
• Occurs when there is a full thickness violation of
the abdominal wall which may or may not be
associated with visceral injuries.
• Visceral injury is more likely when the fascia is
breached.
7. Blunt Injuries
• Automobile accidents
• Fall from heights
• Impalement of blunt
objects
• Assaults – kicks and
blows
• Blast injuries
• Sports injury
Penetrating
Injuries
• Stab wound
• Gunshot wound
• RTA
• Impalement of sharp
objects
• Flying objects
• Falls from height
9. Mechanisms of Abdominal
Injuries
1. Blunt Abdominal Injuries
• Deceleration forces – generates shearing forces that avulse
structure near fix points
• Crushing forces – compression of visceral between abdominal
wall and vertebrae
• Blow-out forces – sudden increase in intra-luminal pressures
cause hollow viscus to rupture
2. Penetrating Abdominal Injuries
• Construction of injuring agent – e.g., length of knife,
calibre of bullet.
• Energy behind injury – e.g., stabbing forces vs
10. Pathophysiology
• Haemorrhage
• Injury to solid viscera – early death if not managed
efficiently
• Injury to major abdominal vessel – immediate death
• Sepsis
• Spillage hollow viscus contents - chemical and
bacterial peritonitis.
• Death is usually slow.
11. ATLS Protocol
• Primary survey
• Airway and Cervical spine control
• Breathing
• Circulation and Control of Haemorrhage
• Assessment of level of consciousness, Pulse rate and Volume,
BP, Skin perfusion
• Identify any source of external or internal bleeding
• Venous access with 2 wide bore cannulae
• Samples for baseline investigations – FBC, GXM, Clotting
profile, Serum Lactate, Serum Amylase,
• Administration of warmed crystalloids, blood and plasma
• Disability – assessing level of consciousness,
• Exposure and Environmental Control
• Adjuncts of Primary Survey
• ECG, Pulse Oximetry, ABG, NG tube, Urinary Catheter,
• Chest X-ray, Cervical and Pelvic X-ray
• FAST, eFAST, DPL
12. Categorization of Patients
• Haemodynamically ‘normal’
• investigation can be completed before treatment is
planned;
• Haemodynamically ‘stable’ –
• Investigation is more limited.
• It is aimed at establishing whether the patient can be
managed non-operatively, whether angioembolization can be
used or whether surgery is required;
• Haemodynamically ‘unstable’ –
• Investigations need to be suspended as immediate surgical
correction of the bleeding is required.
13. ATLS Protocol
• Secondary Survey
• Short Concise Relevant History (AMPLE)
• Allergies
• Medications currently used
• Past illnesses/Pregnancy
• Last meal
• Events/Environment related to the injury
• Speed and Type of collision (frontal, lateral, sideswipe, rear,
rollover)
• Types of restraints
• Patient's position in vehicle
• Fatalities at scene
• Height of fall
• Type of gun or knife used
• Physical Examination
• Head to toe
14. Evidence of Abdominal Injuries
• Obvious penetrating instrument
• Evisceration of bowel, omentum etc.
• Ecchymosis on abdominal wall: Grey-Turner sign, Cullen sign,
Seatbelt sign
• Peritonism
• Tenderness, guarding and Rebound tenderness
• BS may be abolished
• Tenderness on DRE
• Balance sign – Dull percussion in the LUQ (Blood in
subcapsular or extracapsular spleen)
• Kehr sign - Left shoulder pain while supine; caused by
diaphragmatic irritation
16. Investigations
• Baseline labs
• FBC
• Grouping and Cross matching.
• Coagulation profile, ß-HCG,
• Amylase
• X-rays - Chest, Cervical and Pelvic x-ray
• It should not delay in resuscitation
• Chest x-rays can show potentially life-threatening injuries
• Pelvic X-ray – fracture responsible for haemoperitoneum
• Abdominal X-ray –
• Has been superseded by FAST
• Can demonstrate trajectory of penetrating agent
17. FAST
• Focused Assessment with Sonography for Trauma
• Blood in the pericardial sac, hepatorenal fossa, splenorenal and
POD.
• Not to assess visceral injury
• A positive FAST and Haemodynamically unstable patient is an
indication for Exploratory Laparotomy
18. Diagnostic
Peritoneal
Lavage
To detect haemorrhage, bowel
and biliary contents in
unstable patients
Abdominal evaluation in
stable patients in settings
where FAST and CT are not
available.
• Relative contraindications
• previous abdominal
operations,
• morbid obesity,
• advanced cirrhosis
19. Positive DPL
• Aspiration of 10ml or more
of free blood.
• RBC of >100000/ml.
• Aspiration of GIT contents, vegetable
fibers, or bile.
• WBC >500/ml
• Amylase > 19 IU/L
• Alkaline phosphatase > 12IU/L
• Bilirubin level - > 0.01mg/dL
20. CT Scan
• Gold standard for evaluating solid organ blunt abdominal injury.
• It is however time-consuming and requires a co-operative patient.
• Used only in hemodynamically normal patients in whom there is no
apparent indication for an emergency laparotomy
• Can be used to used to detect and grade solid organ injuries
(Based on the AAST)
• Help quantify the volume of intra-peritoneal haemorrhage
• Used to assess retroperitoneal and pelvic organ injuries
22. Laparoscopy
To be done in stable patients
only
Applications
• Screening: to exclude a
penetrating injury with
breach of the peritoneum.
• Diagnostic: finding evidence
of injury to viscera.
• Therapeutic: used to repair
the injury
Still not fully developed
23. Indications for Exploratory
Laparotomy
1. Blunt abdominal trauma with hypotension with
• positive FAST or
• clinical evidence of intraperitoneal bleeding, or
• without another source of bleeding
2. Hypotension with an abdominal wound that penetrates
the anterior fascia
3. Gunshot wounds that traverse the peritoneal cavity
4. Evisceration
5. Peritonitis
6. Free air, retroperitoneal air, or rupture of the
hemidiaphragm
7. Contrast-enhanced CT that demonstrates
• Ruptured gastrointestinal tract, renal pedicle injury, or
• Severe visceral parenchymal injury after blunt or penetrating
trauma
24. Trauma Laparotomy
• Team Preparation
1. Assemble and coordinate the operating team:
• Notify the emergency scrub team to create theatre space, prepare equipment
and call other colleagues.
• Inform the anesthetic team
• Ensures there is an understanding of the available equipment and
definition of role
• Discussion of injury burden, time frame if getting knife to skin and agree
on definitive vs DCS goals.
• Request for likely equipment one will need
• An open vascular set with vascular clamps
• Multiple large abdominal swabs
• Bowel stapler
• Self-retainer retractors if the patient is obese
• Long needle holders with desired sutures
• Cell saver suction device
• An energy device such as a Harmonic scalpel or LigaSureTM.
25. Trauma
Laparotomy
• Perioperative preparation
• 2 large bore venous access
• Foleys catheter and an NG tube passed
• Blood products should be obtained
• Temperature control of the room and the
patient
• Administration of perioperative
antibiotics
• Positioning and skin preparation
• Supine position with arms fully abducted
at 90o
• Skin is prepared from the chin to the
knees and between the posterior axillary
lines
• Draped from chine to above the knee (risk
of hypothermia)
27. Trauma Laparotomy
• Abdominal access
• Bold midline incision from xiphisternum to pubis.
• Use the scalpel (diathermy is time consuming)
• Divide the falciform ligament if necessary.
• Use a virgin territory if there are previous scars
• Complete evisceration of small bowel
• Securing haemostasis
• Evacuate the liquid and clotted blood from all 4 quadrants
• Deliver the small bowel in two large abdominal packs to the patients
right
• Systematically empirical pack the abdomen –
• Liver, Right Paracolic gutter, Spleen and Left paracolic gutters
and pelvis
• Inspection and clamping of any bleeding mesenteric vessels.
• Aortic clamping – in rapidly exsanguinating patients
29. Trauma Laparotomy
• Exploring the abdomen
• Run the gut from the ligament of Treitz to the rectum
• Systematically remove the pack around the liver and asses its
injuries.
• Assess the gallbladder and the biliary tree
• Palpate the right kidney
• Carefully Inspect the spleen after removing the pack
• Palpate the left kidney
• Inspect the hemi-diaphragms
• Enter and inspect the lesser sac through the left side of the
greater omentum.
• Mattox manoeuvre or Cattell–Braasch maneuver
31. Trauma Laparotomy
• Choosing an operative profile
a. Definitive repair of the injuries with formal abdominal closure
b. Damage Control techniques and temporary abdominal closure
• Factors to consider
a. Pattern of injury – e.g., major vascular injury – definitive
repair but a hollow viscus injury – DCS
b. Overall trauma burden e.g., serious injury to another region (head
injury)
c. Operating room system and circumstances - small rural facility,
limited trauma experience etc.
d. Physiological insult
a. Duration of hypotension, Realistic estimate of blood loss and
transfusion requirements
b. Onset of metabolic acidosis (pH< 7.3) and hypothermia – late
indicators
32. Damage Control Surgery
• Principles of DCS
• Control of bleeding
• Identification of injury
• Control of contamination
• Protection from further injury e.g., abdominal
compartment syndrome
33. Trauma Laparotomy
• Abdominal Wound Closure
• Definitive Repair – Standard closure as with
Laparotomy
• Dictated by level of contamination of wound
• Damage Control Surgery (DCS) – Closure is temporary
with 4 objective
• Containment of viscera,
• Control of abdominal secretion,
• Maintenance of pressure on tamponaded areas, and
• Optimization of the likelihood of eventual closure
• Techniques – Running sutures, Bogota bag, towel
clips, Ioban, Vacuum closures
34.
35. Management after DCS
• Continued resuscitation and restoration of normal
physiology
• Reversal of Hypothermia
• Nurse patient in a warm room,
• Administer warm intravenous fluid and blood products,
• Application of external warming devices (Bair Hugger).
• Reversal of acidosis
• Correction of shock will correct metabolic acidosis
• Patient’s ability to normalize lactate is strongly correlated with
survival
• Correction of Coagulopathy
• Correction of acidosis and hypothermia corrects it
• Replacement of blood products
• Recent – use of recombinant factor VIIa
36. Abdominal Compartment Syndrome
• Causes
• bowel wall oedema
• Third space fluid loss
• Intra-abdominal packing
• Diagnosis
• Intra-vesical pressure with foleys catheter connected to a
transducer or manometer
• Treatment
• Management is dependent of pressure levels
• 10-15cm/H2O Maintain euvolaemia
• 16-25cm/ H2O Hypervolaemic resuscitation
• 26-35cm/H2O Decompress
• > 35cm/ H2O Decompress/re-explore abdomen looking for bleeding
37. Reoperation after DCS
• Should be done within 48 – 72hrs before the
onset of SIRS
• It involves
• Removal of abdominal packs
• Confirming haemostasis
• Inspection of abdomen for any missed injuries
• Restoration of intestinal integrity and abdominal
wound closure.
The abdomen w part of the trunk between the thorax and the pelvis.
Broad spectrum of abdominal injuries considering the numerous viscera that can injures.
In sub-Saharan Africa, the risk of death from trauma is highest in those aged 15 to 60 years
This risk is higher than in any other region of the world.
Naaedar – 65.9%
Abdomen – Flexible dynamic container
Anterior aspect– nipple line to the groin crease and pubis and AAL laterally
Lateral aspect – from ALL to PAL and 6th ICS to Iliac Crest
Posterior – PAL to PAL and from Tip of Scapulae to Iliac Crest
Organs can be classified as being solid or hollow
Upper - Liver and Spleen, Stomach and Transverse colon
Lower - Jejunum and ileum, ascending, descending and sigmoid colon, reproductive organs
Pelvis - Rectum, bladder iliac vessels and internal reproductive organs
Retroperitoneum - duodenum, pancreas posterior part of asc and desc colon, abdominal aorta, IVC, kidneys and ureter
Blunt Abdominal Trauma – poorer prognosis due to the concealed nature
Multiple organs may be injured
The damage may be concealed due to the subtle clinical features
Unrecognized, abdominal trauma is a frequent cause of preventable death
Deceleration - solid visceral organs and vascular pedicles at relatively fixed points of attachment.
Crushing - Intra-abdominal contents can be crushed between the anterior abdominal wall and the vertebral columns. Solid viscera are more vulnerable to crush injuries.
Blowout injuries There is an increase in intraluminal pressure of a segment of a hollow viscera causing it to rupture.
Internal haemorrhage are often identified by physical examination and imaging (FAST, Pelvic, CXR) or DPL
Primary survey is directed at identifying major intra-abdominal haemorrhage
Secondary survey is essential to pick up further bleeding following the restoration of a normal blood pressure.
Abdominal Injuries are often associated with other injuries – Injuries to the airways, intra-thoracic structures generally take precedence over abdominal.
Never pull out a knife wound
The conscious state of the patient is a way of assessing the circulatory function and its important for obtaining further information from the patient.
Identify any source of external or internal bleeding
Physical examination
Imaging – X-ray, FAST
Diagnostic Peritoneal Lavage
Overzealous fluid resuscitation cannot replace
Secondary survey is essential to pick up further bleeding following the restoration of a normal blood pressure.
It does not begin until
the primary survey (ABCDE) is completed,
resuscitative efforts are under way, and
improvement of the patient’s vital functions has been demonstrated.
If there are more personnel, the secondary survey can be started whiles the rest continue with the resuscitation.
Patient may be unconscious, intoxicated or shock – history from ER team, by standers etc.
For both primary and secondary survey
Never pull out the instruments (avoid unnecessary movements)
Peritonism – intoxicated, head injuries, retroperitoneal injuries
Elevated levels points to possibility of pancreatic injury
Also elevated in traumatic rupture of the stomach, duodenum or small bowel.
Chest x-rays can show
potentially life-threatening injuries that require
treatment or further investigation, and pelvic films
can show fractures of the pelvis that may indicate the
need for early blood transfusion. These films can be
taken in the resuscitation area with a portable x-ray
unit, but not when they will interrupt the resuscitation
process (n FIGURE 1-5). Do obtain essential diagnostic
x-rays, even in pregnant patients
It can be done at the bedside whiles being resuscitated
It can be repeated to detect progressive hemoperitoneum
Disadvantage
About 250ml of fluid is needed to detect
Cannot reliably grade solid organ or hollow viscus injuries
Operator dependent
Cannot assess retroperitoneal structures well.
Prerequisite - Gastric and Urinary Decompression to avoid complications.
An open, semi-open, or closed (Seldinger technique)
An infra-umbilical approach is used
Supra-umbilical approach is used cases of pelvic fractures and
Applications
It used to be the gold standard
Now been superseded by FAST and CT Scan
CT is a time-consuming.
That are difficult to assess with a physical examination, FAST, and DPL
It is used as the basis for managing a patient non-operatively
Selective digital subtraction angiogram of the celiac axis showing the intra-peritoneal contrast 'blush' in the spleen, confirming active bleeding.
Selective splenic angiogram immediately post proximal embolization demonstrating perfusion defects.
Contrast extravasation is no longer present.
Drawback – high false negative with small bowel injuries
Bleeding from the stomach, rectum, or genitourinary tract following penetrating trauma
Core Mission – Stop the bleeding
If patient is not bleeding – then identify and repair
Prepare for the worst case scenario: unplanned thoracotomy or required access to the groin.
Preventing hypothermia – Bair Hugger and warm the NS
This sequence reflects the underlying logic and priorities of the procedure.
Modified according to clinical circumstances
IF there is no significant bleeding there is no need to pack .
If there is major blood vessel bleed – then temporary haemostasis merges with definitive repair
Don’t waste time chasing incisional bleeder
tly pack the abdomen without attempting to precisely identify the injuries (hence the term “empirical” packing).
It is worth mentioning that ongoing surgical bleeding will not be amenable to packing and must be addressed at the time of the initial laparotomy.
If the general picture is of overwhelming bleeding and there is simply no means of getting other temporary control or immediate access to the specific bleeding, then we advocate aortic control.
Mattox - suprarenal aortic segment in the presence of a central retroperitoneal hematoma
Cattel-Brasch manoeuvre
Zones of the retroperitoneum visualized at the time of laparotomy.
Zone 1 - central vascular structures, such as the aorta and vena cava.
Zone 2 includes the kidneys and adjacent adrenal glands.
Zone 3 describes the retroperitoneum associated with the pelvic vasculature
even the clinical suspicion of such trauma (e.g., unequal pupils)
“forced” bailout actually means that the surgeon is trying to correct a previous error in judgment and should have bailed out long ago.
It is a resuscitative procedure
with perforated, nonadherent plastic drape over viscera, followed by moistened towel or dressing, on top of which are laid two closed-suction drains (Jackson–Pratt) that are tunneled subcutaneously and brought out through separate stab incisions. A large adherent drape is lastly used to create an air-tight seal and relatively sterile environment. W
The goal of the immediate post-damage-control laparotomy period is correction of the abnormal physiology.
The goal of the immediate post-damage-control laparotomy period is correction of the abnormal physiology.
[ Is this the definitive procedure ]
[ Where will colostomies be placed ]