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Abdominal Traumaa.ppt
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- 3. ABDOMINAL TRAUMA INTRA THORACIC •LIVER •SPLEEN •STOMACH •TRANSVERSECOLON ABDOMINAL •SI •LI •DISTENDED BLADDER PELVIC •SIGMOID COLON •RECTUM •SI •BLADDER •UTERUS •OVARIES EXTRA- PERITONEAL •KIDNEY & URETERS •DUODENUM •PANCREAS •CAECUM •ASCENDING COLON •2/3 DESCENDING COLON •AORTA & IVC
- 4. History Road traffic accident Falls Assaults Sportinginjuries Gun shot injuries Stabs
- 5. Presentation Signs & Symptoms •Acute& persistent abdominal pain •Abdominal tenderness •Rebound tenderness •Rigidity •Shoulder tip pain •Absent bowel sounds •Signs of shock •Abdominal distension
- 6. •Grey Turner sign-Briusingof the flanks ,the part of the body between the last rib and the top of the hip •Cullen’s sign -Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
- 7. INVESTIGATIONS FBC, LFT,BU/SE CXR – Air under the diapragm AXR- Not much important in detecting organ damage USS – FAST SCAN ( Focused Abdominal Sonography for Trauma ) Detects Perihepatic, Perisplenic, Pelvic & Pericardiac fluid CT scan
- 8. PENETRATING TRAUMA CAUSES- Gun shot injuries Stab injuries THE MOST COMMONLY INJURED ORGANS ARE:- Small intestine Liver
- 9. MANAGEMENT A, B,C Look for evidence of any wounds EX:- Both entry & exit wounds in gun shot wounds (GSW) All penetrating truma secondary to gsw Exploratory laparotomy
- 10. STAB WOUNDS IF, Haemodynamicallystable No signs of peritonism No evisceration No air under the diapragm on CXR CAN Mx Conservatively IF Any of above present/ suspect organ damage EXPLORATORY LAPAROTOMY
- 11. BLUNT TRAUMA CAUSES –Direct injury Deceleration Rotational force COMMONLY INJURED ORGANS ARE :- Spleen Liver
- 12. MANAGEMENT A, B,C Easily missed as it can present without much symptoms or signs Suspect if Skin abrasions Seat belt imprint 10-12 rib # Peritonism Distension (-) Bowel sounds Shock Haematuria
- 13. IF ; Hypotension refractory to resucitation Peritonism Air under the diaphrgm Evisceration (+ ) CT SCAN EXPLORATORY LAPAROTOMY IF ; None of above is (+) in a haemodynamically stable patient , observe closely for deterioration or complications
- 14. SPLEEN MOST COMMONLYINJURED ORGAN IN BLUNT TRAUMA SYMPTOMS/ SIGNS – Left hypochondrial bruisig L/S lower rib # L/ S shoulder tip pain
- 15. MANAGEMENT Non operative– HD stable pt with no evidence of organ injury observe for splenic rupture Radiological – Splenic Angio-Embolization Operative – Urgent laparotomy Packing Diathermy Suturing the laceration Ligate splenic vessels Partial splenectomy
- 16. LIVER SYMPTOMS/ SIGNS, Right hypochondrial bruising Broken R/S 10- 12 ribs R/ Shoulder tip pain
- 17. MANAGEMENT RADIOLOGICAL –Embolization OPERATIVE – Urgent laparotomy Packing liver with gauze Ligation of the feeding artery Suture the laceration Resection of unviable liver fragments
- 18. SMALL BOWEL COMMONLYINJURED IN PENETRATING TRAUMA CAUSES – Deceleration injury (ileocaecal area) Blast injury SYMPTOMS/ SIGNS – Peritonism (-) Bowel sounds
- 19. MANAGEMENT EXPLORATORY LAPAROTOMYRESECTION ANASTOMOSIS
- 20. Kidney Following heavyfall, blow or crushing injury SYMPTOMS/SIGNS – Pain Bruising Swelling in the loin Haematuria Ureteric colic
- 21. Management Non operative– Conservative Management Operative - Partial/ total nephrectomy Suture of lacerations
- 22. Bladder & Urethra SIGNS& SYMPTOMS Abdominal distension Inability to pass urine Haematuria MANAGEMENT Partial rupture of urethra- supra pubic catheterization s