This document discusses the evaluation and management of abdominal trauma. It notes that blunt trauma is the most common mechanism of abdominal injury, which can involve the liver, spleen, pancreas, and kidneys. Physical exam alone is often inadequate for diagnosis, as patients may be stable initially despite injuries. Bedside ultrasound and CT scan are recommended for diagnosis as they are sensitive and accurate. Management depends on the severity of injuries, with penetrating injuries typically requiring exploration while blunt injuries can sometimes be observed conservatively.

1. •Uncommon
•Protected
by the ribs
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2. Most
frequent mechanism of
abdominal injury
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3.  Falls
 Assaults
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4.  Spleen
• Mechanism of injury in blunt trauma
 Rapid deceleration
• Risk of injury
 Liver
 Pancreas
 Kidneys
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5.  Inadequate
to identify intra-abdominal
injuries
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6.  May
not have peritoneal signs
 May in a compensated hemodynamic
condition
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7.  Cannot
be ruled out by physical
findings
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8.  May
have very few physical signs initially
 May progress to sepsis
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9.  Bedside
FAST
 Focused abdominal sonography for trauma
 Portable
radiographs of the pelvis and
chest
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10.  Sensitive,
and accurate
• Intra-abdominal injuries
• Retroperitoneal injuries
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11.  Rapid
and accurate
• Identify intra-abdominal injuries after blunt
trauma
 Indicated
in unstable patients
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12. Tachycardia
 Postural fall
 Hypotension
 Low urine output
 Metabolic acidosis
 Thirst

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13.  Peritonitis
 Ongoing
intra-abdominal hemorrhage
 Presence of other injuries known to be
frequently associated with intraabdominal injuries
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14.  Penetrating
injuries to the abdomen with
shock
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15.  Pneumoperitoneum
 Lower
rib fractures
• Increases the probability of splenic and hepatic injury
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16. Abdominal
ultrasound or CT
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17. Significant
morbidity and mortality
Penetrating injuries
• Explored
Blunt
injuries
• May be treated conservatively
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18. Major
early complication
• Coagulopathy
Biliary
fistulae
• Rare
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19. Develop
rapidly
• Lack of fibrinogen and clotting factors
Factors
should be given empirically
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20. Best
diagnostic test for suspected
liver injury
• Parenchymal damage to the liver or
spleen
• Free fluid
Peritoneal
lavage
• Confirm haemoperitoneum
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26. Usually
associated with major
vascular injuries
Mortality rate
• 50% to 80%
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27.  Superior
to open operation.
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28. Most
useful method for hemostasis
• Packed against the natural contour of the
diaphragm
Effective
for the majority of liver
injuries
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29. In
survivors of liver packing
• < 15%
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30. Usually
ineffective
Blood transfusion
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31. No
specific intervention
• Resolve spontaneously
Aspiration
• May result in liver abscess
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32.  Hypotension
that does not respond to
fluid resuscitation
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33.  For
lacerations that continue to bleed
despite attempts at local control
 Open the liver wound
• Bleeding vessels and biliary radicles
 Ligated
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34.  Clamping
of the hepatic pedicle
• When life-threatening hemorrhage is unresponsive to
packing
• Control all hepatic bleeding except that from the
hepatic veins or the intrahepatic vena cava
• Not >1 hour
 Ischemic damage to the liver
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35.  Vascular
clamp or vessel loops
• Around the porta hepatis
 If
the bleeding stops after clamping the portal
triad
• Bleeding from the portal veins or hepatic artery branches
 If
the bleeding continues
• Injury to the hepatic veins or the retrohepatic vena cava
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36. Blunt abdominal trauma – algorithm
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