The document provides information on the history, anatomy, physiology, assessment, and management of splenic injuries. Some key points:
- The spleen was historically described as "the organ full of mystery" due to lack of understanding of its function. Splenectomy became more successful in the late 19th century.
- The spleen is wedge-shaped and located in the left upper abdominal quadrant. It has important roles in immune function and filtering blood. Injuries are often due to blunt trauma from motor vehicle accidents or direct blows.
- Assessment of splenic injuries involves history, examination, and investigations like ultrasound, CT scan, or diagnostic peritoneal lavage. Injuries are graded based on the Organ
The document discusses splenic injuries, providing details on the surgical anatomy, blood supply, assessment, investigations including FAST scan and CT scan, grading of injuries, and management approaches including conservative management, splenorrhaphy, splenectomy, embolization, and complications like overwhelming post-splenectomy infection. Splenic injuries are most commonly caused by blunt trauma to the abdomen and can range from minor injuries to severe lacerations requiring surgical intervention.
This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
- Complications of splenic injuries and splenectomy include hemorrhage, infection, and post-splenectomy sepsis. Guidelines recommend attempting non-operative management for stable patients
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.
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.
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 provides an overview of the assessment and management of abdominal trauma. It discusses the classification of abdominal trauma as blunt or penetrating, and the classification of patients as hemodynamically normal, stable, or unstable. Absolute indications for an emergency laparotomy are listed. Diagnostic tools like FAST scan, DPL, and CT scan are outlined. Organ-specific injuries and treatments are covered including liver, spleen, small bowel, colon, pancreas, duodenum, kidney, and retroperitoneal hematomas. Damage control surgery principles, abdominal compartment syndrome, and antibiotics for penetrating abdominal trauma are also summarized.
This document provides information on the management of blunt trauma to the abdomen. It begins with an overview of the regional anatomy of the abdomen and mechanisms of injury. It then discusses the initial management, physical examination and investigations for patients with blunt abdominal trauma. Specific imaging studies like abdominal x-ray, FAST, DPL, CT scan and their indications are explained. The document outlines the indications for laparotomy and approaches to managing specific organ injuries like liver and spleen trauma encountered during surgery. Post-operative management and complications are also summarized.
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
The document discusses splenic injuries, providing details on the surgical anatomy, blood supply, assessment, investigations including FAST scan and CT scan, grading of injuries, and management approaches including conservative management, splenorrhaphy, splenectomy, embolization, and complications like overwhelming post-splenectomy infection. Splenic injuries are most commonly caused by blunt trauma to the abdomen and can range from minor injuries to severe lacerations requiring surgical intervention.
This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
- Complications of splenic injuries and splenectomy include hemorrhage, infection, and post-splenectomy sepsis. Guidelines recommend attempting non-operative management for stable patients
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.
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.
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 provides an overview of the assessment and management of abdominal trauma. It discusses the classification of abdominal trauma as blunt or penetrating, and the classification of patients as hemodynamically normal, stable, or unstable. Absolute indications for an emergency laparotomy are listed. Diagnostic tools like FAST scan, DPL, and CT scan are outlined. Organ-specific injuries and treatments are covered including liver, spleen, small bowel, colon, pancreas, duodenum, kidney, and retroperitoneal hematomas. Damage control surgery principles, abdominal compartment syndrome, and antibiotics for penetrating abdominal trauma are also summarized.
This document provides information on the management of blunt trauma to the abdomen. It begins with an overview of the regional anatomy of the abdomen and mechanisms of injury. It then discusses the initial management, physical examination and investigations for patients with blunt abdominal trauma. Specific imaging studies like abdominal x-ray, FAST, DPL, CT scan and their indications are explained. The document outlines the indications for laparotomy and approaches to managing specific organ injuries like liver and spleen trauma encountered during surgery. Post-operative management and complications are also summarized.
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
The document discusses laparoscopic hernia repair, including definitions of hernias, types of hernias, and laparoscopic repair options. It focuses on the transabdominal preperitoneal (TAPP) technique for laparoscopic inguinal hernia repair. The TAPP procedure involves entering the abdominal cavity laparoscopically, incising the peritoneum to access the preperitoneal space, dissecting and removing hernia sacs, placing mesh to reinforce the defect, and closing the peritoneum. Key anatomical structures are identified including the triangles of doom and pain. The steps of TAPP repair and important technical considerations are described in detail.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
1. The document discusses various potential causes of a mass in the right iliac fossa, including appendicitis, appendicular abscess, carcinoid tumors of the appendix, mucoceles, adenocarcinoma, tuberculosis, Crohn's disease, carcinoma of the caecum, actinomycosis, amoebiasis, mesenteric cysts, intussusception, iliopsoas abscess, retroperitoneal tumors, aneurysms, and more rare causes.
2. Diagnostic tools mentioned include ultrasound, CT, colonoscopy, and biopsy. Treatment depends on the underlying cause but may include antibiotics, surgery, chemotherapy, and ATT.
3
Damage control surgery involves rapidly controlling hemorrhaging and contamination through temporary closure of injuries to stabilize critically injured patients, followed by resuscitation and definitive repair once physiology is restored. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy. The approach has three stages - initial laparotomy and packing, ICU resuscitation, and planned reoperation once metabolic conditions improve. It has been shown to improve survival rates for severely injured trauma patients compared to traditional surgery.
This is a small handbook on individual surgical disease and its management . I have discussed about Acute Appendicitis and then step by step I explain both open and laparoscopic appendicectomy in this book.
The operative surgery part is very useful for surgical trainees.
The document discusses gastric perforation, beginning with the anatomy of the stomach and its layers. It then addresses the epidemiology of gastric perforation, noting that males have higher rates and risk factors include H. pylori infection, NSAID use, smoking, and alcohol consumption. The pathophysiology and signs/symptoms are explained, along with diagnostic tools such as abdominal x-rays and CT scans. Surgical treatments like omental patching, vagotomy, and gastrojejunostomy are covered. Finally, complications and prognosis are summarized.
This document discusses acute peritonitis, including:
- Peritonitis is defined as inflammation of the peritoneum and can be localized or generalized. It is usually caused by bacterial infection entering through the gastrointestinal tract or other sources.
- Symptoms depend on whether it is localized or diffuse. Localized peritonitis causes pain specific to the affected organ, while diffuse peritonitis causes generalized abdominal pain and tenderness.
- Treatment involves antibiotics, fluid resuscitation, and sometimes surgery to address the underlying cause and drain any abscesses. Outcomes depend on several factors but mortality is around 10% with prompt treatment. Complications can include shock, bowel obstruction, and residual infections.
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
The document summarizes the surgical management of pancreatic pseudocysts. It presents a case study of a 40-year-old male with recurrent abdominal pain. Imaging revealed a large fluid collection in the pancreas consistent with a pseudocyst. The document then reviews the relevant anatomy, etiology, classification, pathophysiology, clinical evaluation, differential diagnosis, investigation and treatment options for pancreatic pseudocysts. Key treatment approaches discussed include conservative management, percutaneous drainage, endoscopic drainage, and surgical drainage via cystogastrostomy or cystojejunostomy.
The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
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.
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.
This document provides an overview of benign anorectal diseases. It begins with the anatomy of the anorectum and anal canal, including structures like the anal sphincter. It then discusses conditions like hemorrhoids, anal fissures, anorectal abscesses, and fistulas. For each condition, it covers topics like etiology, classification, clinical presentation, examination findings, and treatment options both non-surgical and surgical. The document provides detailed information on procedures for these various anorectal conditions.
1) Bowel and mesenteric injuries occur in 1-5% of abdominal trauma cases and are difficult to diagnose due to non-specific clinical signs in 40% of cases and complications from polytrauma.
2) CT scanning is the preferred imaging modality for evaluating bowel and mesenteric injuries in hemodynamically stable patients, with a sensitivity of 70-85%. Common CT findings include bowel wall discontinuity, extraluminal air or contrast, and mesenteric stranding or hematoma.
3) The most common sites of bowel injury are the small bowel (jejunum and ileum), followed by the colon (transverse colon). Mesenteric injuries like bleeding require
This document discusses acute abdomen, including causes, symptoms, and examination findings. It notes that acute abdomen involves sudden severe abdominal pain that may be life-threatening. Common intra-abdominal causes include inflammation, perforation, obstruction, and hemorrhage. Examination involves inspection, palpation, percussion, and auscultation of the abdomen, as well as relevant history and lab/imaging tests. Imaging tests like x-ray, ultrasound, and CT scan can help identify conditions like perforation, obstruction, or masses.
The document provides an overview of hemorrhoids including their definition, etiology, classification, clinical presentation, diagnosis, and treatment options. Some key points include:
- Hemorrhoids are symptomatic enlargement of the anal cushions and the most common symptom is rectal bleeding with bowel movements.
- Risk factors include constipation, pregnancy, and increased pelvic pressure. Hemorrhoids are classified based on their location and severity.
- Clinical evaluation involves physical examination and anoscopy. Treatment depends on severity but includes dietary and lifestyle changes, minimally invasive procedures like rubber band ligation, and surgery for advanced cases. Surgical recovery involves pain management and preventing complications.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document discusses different types of intestinal stomas. It begins by defining a stoma as an opening of the intestinal tract onto the abdominal wall, which can be temporary or permanent. It describes factors to consider when selecting a stoma site, such as avoiding deep folds of fat or scars. The document then covers various types of stomas including colostomies and ileostomies. It provides details on their construction and functions, whether they serve to decompress or divert intestinal contents. Complications that can arise are also mentioned.
This document discusses pneumomediastinum, beginning with its epidemiology and anatomy. It describes spontaneous pneumomediastinum, which is usually managed conservatively, as well as secondary causes like trauma. A rare form called tension pneumomediastinum requires urgent chest drain placement. The document presents a case of an elderly man with Boerhaave's syndrome who underwent multiple surgeries but ultimately passed away.
The document discusses disorders of the spleen including splenic abscess, splenomegaly (enlarged spleen), ruptured spleen, and splenectomy (surgical removal of the spleen). The spleen acts as an immune and blood filtering organ located in the left upper abdomen. Disorders can be caused by infection, injury, blood disorders, or cancer. Symptoms may include fever, pain, or enlarged spleen. Treatment depends on the underlying cause but may involve antibiotics, drainage, or splenectomy. Post-splenectomy patients are at risk for life-threatening infection and require vaccinations and antibiotic prophylaxis.
The document discusses laparoscopic hernia repair, including definitions of hernias, types of hernias, and laparoscopic repair options. It focuses on the transabdominal preperitoneal (TAPP) technique for laparoscopic inguinal hernia repair. The TAPP procedure involves entering the abdominal cavity laparoscopically, incising the peritoneum to access the preperitoneal space, dissecting and removing hernia sacs, placing mesh to reinforce the defect, and closing the peritoneum. Key anatomical structures are identified including the triangles of doom and pain. The steps of TAPP repair and important technical considerations are described in detail.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
1. The document discusses various potential causes of a mass in the right iliac fossa, including appendicitis, appendicular abscess, carcinoid tumors of the appendix, mucoceles, adenocarcinoma, tuberculosis, Crohn's disease, carcinoma of the caecum, actinomycosis, amoebiasis, mesenteric cysts, intussusception, iliopsoas abscess, retroperitoneal tumors, aneurysms, and more rare causes.
2. Diagnostic tools mentioned include ultrasound, CT, colonoscopy, and biopsy. Treatment depends on the underlying cause but may include antibiotics, surgery, chemotherapy, and ATT.
3
Damage control surgery involves rapidly controlling hemorrhaging and contamination through temporary closure of injuries to stabilize critically injured patients, followed by resuscitation and definitive repair once physiology is restored. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy. The approach has three stages - initial laparotomy and packing, ICU resuscitation, and planned reoperation once metabolic conditions improve. It has been shown to improve survival rates for severely injured trauma patients compared to traditional surgery.
This is a small handbook on individual surgical disease and its management . I have discussed about Acute Appendicitis and then step by step I explain both open and laparoscopic appendicectomy in this book.
The operative surgery part is very useful for surgical trainees.
The document discusses gastric perforation, beginning with the anatomy of the stomach and its layers. It then addresses the epidemiology of gastric perforation, noting that males have higher rates and risk factors include H. pylori infection, NSAID use, smoking, and alcohol consumption. The pathophysiology and signs/symptoms are explained, along with diagnostic tools such as abdominal x-rays and CT scans. Surgical treatments like omental patching, vagotomy, and gastrojejunostomy are covered. Finally, complications and prognosis are summarized.
This document discusses acute peritonitis, including:
- Peritonitis is defined as inflammation of the peritoneum and can be localized or generalized. It is usually caused by bacterial infection entering through the gastrointestinal tract or other sources.
- Symptoms depend on whether it is localized or diffuse. Localized peritonitis causes pain specific to the affected organ, while diffuse peritonitis causes generalized abdominal pain and tenderness.
- Treatment involves antibiotics, fluid resuscitation, and sometimes surgery to address the underlying cause and drain any abscesses. Outcomes depend on several factors but mortality is around 10% with prompt treatment. Complications can include shock, bowel obstruction, and residual infections.
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
The document summarizes the surgical management of pancreatic pseudocysts. It presents a case study of a 40-year-old male with recurrent abdominal pain. Imaging revealed a large fluid collection in the pancreas consistent with a pseudocyst. The document then reviews the relevant anatomy, etiology, classification, pathophysiology, clinical evaluation, differential diagnosis, investigation and treatment options for pancreatic pseudocysts. Key treatment approaches discussed include conservative management, percutaneous drainage, endoscopic drainage, and surgical drainage via cystogastrostomy or cystojejunostomy.
The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
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.
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.
This document provides an overview of benign anorectal diseases. It begins with the anatomy of the anorectum and anal canal, including structures like the anal sphincter. It then discusses conditions like hemorrhoids, anal fissures, anorectal abscesses, and fistulas. For each condition, it covers topics like etiology, classification, clinical presentation, examination findings, and treatment options both non-surgical and surgical. The document provides detailed information on procedures for these various anorectal conditions.
1) Bowel and mesenteric injuries occur in 1-5% of abdominal trauma cases and are difficult to diagnose due to non-specific clinical signs in 40% of cases and complications from polytrauma.
2) CT scanning is the preferred imaging modality for evaluating bowel and mesenteric injuries in hemodynamically stable patients, with a sensitivity of 70-85%. Common CT findings include bowel wall discontinuity, extraluminal air or contrast, and mesenteric stranding or hematoma.
3) The most common sites of bowel injury are the small bowel (jejunum and ileum), followed by the colon (transverse colon). Mesenteric injuries like bleeding require
This document discusses acute abdomen, including causes, symptoms, and examination findings. It notes that acute abdomen involves sudden severe abdominal pain that may be life-threatening. Common intra-abdominal causes include inflammation, perforation, obstruction, and hemorrhage. Examination involves inspection, palpation, percussion, and auscultation of the abdomen, as well as relevant history and lab/imaging tests. Imaging tests like x-ray, ultrasound, and CT scan can help identify conditions like perforation, obstruction, or masses.
The document provides an overview of hemorrhoids including their definition, etiology, classification, clinical presentation, diagnosis, and treatment options. Some key points include:
- Hemorrhoids are symptomatic enlargement of the anal cushions and the most common symptom is rectal bleeding with bowel movements.
- Risk factors include constipation, pregnancy, and increased pelvic pressure. Hemorrhoids are classified based on their location and severity.
- Clinical evaluation involves physical examination and anoscopy. Treatment depends on severity but includes dietary and lifestyle changes, minimally invasive procedures like rubber band ligation, and surgery for advanced cases. Surgical recovery involves pain management and preventing complications.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document discusses different types of intestinal stomas. It begins by defining a stoma as an opening of the intestinal tract onto the abdominal wall, which can be temporary or permanent. It describes factors to consider when selecting a stoma site, such as avoiding deep folds of fat or scars. The document then covers various types of stomas including colostomies and ileostomies. It provides details on their construction and functions, whether they serve to decompress or divert intestinal contents. Complications that can arise are also mentioned.
This document discusses pneumomediastinum, beginning with its epidemiology and anatomy. It describes spontaneous pneumomediastinum, which is usually managed conservatively, as well as secondary causes like trauma. A rare form called tension pneumomediastinum requires urgent chest drain placement. The document presents a case of an elderly man with Boerhaave's syndrome who underwent multiple surgeries but ultimately passed away.
The document discusses disorders of the spleen including splenic abscess, splenomegaly (enlarged spleen), ruptured spleen, and splenectomy (surgical removal of the spleen). The spleen acts as an immune and blood filtering organ located in the left upper abdomen. Disorders can be caused by infection, injury, blood disorders, or cancer. Symptoms may include fever, pain, or enlarged spleen. Treatment depends on the underlying cause but may involve antibiotics, drainage, or splenectomy. Post-splenectomy patients are at risk for life-threatening infection and require vaccinations and antibiotic prophylaxis.
Chyle leakage occurs when the thoracic duct or lymphatic vessels are damaged, resulting in the leakage of milky fluid called chyle. It can lead to fluid and nutritional depletion if not properly managed. Treatment involves initially managing it conservatively with wound drainage, pressure dressings, and a low-fat diet. For higher output leaks, surgical exploration may be needed to locate and ligate the leak. Rarely, thoracoscopic ligation of the thoracic duct or percutaneous embolization of the duct may be required if conservative and surgical treatments are unsuccessful. Proper management is important to avoid serious complications like chylothorax.
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.
Content will be helpful for B.Sc. and M.Sc. nursing students as it describes causes, signs and symptoms, diagnosis,emergency mangement , medical and nursing management.
The document provides guidance on the assessment and management of trauma patients. It describes the golden hour period following trauma where rapid assessment is critical. The primary and secondary surveys are outlined, with the primary focusing on stabilizing vital functions like airway, breathing, circulation, disability and exposure. Specific injuries and treatments are discussed for areas like head trauma, spinal trauma, chest trauma, abdominal trauma and genitourinary trauma. Throughout, the emphasis is on stabilizing life-threatening injuries and rapidly diagnosing and treating problems that could impair ventilation or circulation.
Lower gastrointestinal bleeding (LGIB) refers to blood loss originating from a site distal to the ligament of Treitz. Common causes of LGIB include hemorrhoids, diverticulosis, angiodysplasia, and anal cancers. Hematochezia is the typical presentation of LGIB. Initial workup includes examination, blood tests to check for anemia and coagulopathy, and colonoscopy for diagnosis and potential therapeutic intervention to stop bleeding. Management depends on the cause but may include conservative measures, nonsurgical options like banding or surgical procedures like hemorrhoidectomy.
This document discusses esophageal trauma, including:
1) Esophageal injuries can occur from trauma or medical procedures and allow stomach contents to leak into surrounding tissues, potentially causing infection.
2) The esophagus has four layers and passes behind the heart and lungs before connecting to the stomach. Injuries can occur in the cervical, thoracic, or abdominal sections.
3) Symptoms of esophageal trauma include chest pain, vomiting, difficulty swallowing, and shortness of breath. Diagnosis involves imaging tests and ruling out other potential causes of symptoms. Treatment may involve antibiotics, draining fluids, and surgery depending on the severity of the injury.
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
Rupture of the spleen can occur due to penetrating trauma, blunt force trauma, operative injury, or spontaneously if the spleen is enlarged. The most common cause is blunt trauma. Symptoms range from mild pain to hypovolemic shock and include pain in the left upper quadrant, referred shoulder pain (Kehr's sign), and tenderness. Diagnosis can be supported by imaging findings on ultrasound, CT scan, or X-ray of splenic injury or blood in the abdomen. Treatment is usually emergency splenectomy to control bleeding.
1. Acute appendicitis is caused by obstruction of the appendix lumen, usually by a fecalith, leading to bacterial proliferation and inflammation.
2. Clinical features include abdominal pain shifting to the right lower quadrant, anorexia, nausea, and tenderness over McBurney's point.
3. Investigations include blood tests showing elevated white cell count and abdominal ultrasound or CT scan.
4. Treatment is usually antibiotic therapy and appendectomy to remove the inflamed appendix. Complications can include perforation, abscess, and peritonitis if not treated promptly.
This document provides an overview of appendicitis, including its definition, causes, clinical manifestations, diagnosis, and management. Appendicitis is defined as acute inflammation of the vermiform appendix, a small finger-like structure attached to the cecum. Common causes include obstruction by fecal material or ulceration by pathogens. Patients typically present with abdominal pain localized to the right lower quadrant along with nausea, vomiting, and fever. Diagnosis is based on assessment findings and tests like bloodwork and imaging. Surgical removal of the appendix (appendectomy) is the primary treatment approach. Nursing care focuses on pain relief, infection prevention, and supporting the patient's recovery before and after surgery.
The document discusses acute abdomen, defined as sudden abdominal pain lasting less than 24-72 hours. It summarizes the key points as:
1) Abdominal pain is the primary symptom and can be visceral, parietal, or referred pain.
2) Causes are divided into surgical (such as inflammation, perforation, obstruction), gynecological/obstetrical, medical, and non-specific.
3) Diagnosis involves history, physical exam focusing on abdominal tenderness and guarding, basic labs, and imaging like ultrasound or CT scan to identify potential causes like appendicitis or bowel obstruction.
A 19-year-old female presented with a rapidly enlarging neck mass. Imaging revealed multiple enlarged cervical and mediastinal lymph nodes compressing the superior vena cava. Due to the risk of airway compromise, the anesthetic plan included difficult airway equipment and careful induction to avoid further compression. The mass was biopsied under general anesthesia without complications. Mediastinal masses can compress vital structures, so thorough preoperative evaluation is needed to identify high-risk patients and plan a safe anesthetic approach.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. 2) Presentation can vary widely from hemodynamic stability with minimal signs to complete shock. Common injuries include injuries to solid organs like the spleen and liver as well as hollow organs. 3) Initial assessment focuses on the ABCDEs with attention to potential for internal bleeding and hemorrhagic shock. History and physical exam aim to identify any signs of intra-abdominal injury.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. Symptoms can range from minimal signs to cardiovascular collapse.
2) The spleen, liver, and kidneys are most commonly injured in blunt trauma due to their solid nature. Injuries to hollow organs like the stomach and intestines also occur from shearing forces.
3) Initial assessment focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Patients are fully evaluated and stabilized, with two IV lines placed and fluid resuscitation started if indicated. Ongoing monitoring of vitals and input/output is important
Acute appendicitis is caused by obstruction of the appendix lumen, usually by a fecalith, leading to infection. It presents with migratory abdominal pain that localizes to the right lower quadrant, along with anorexia, nausea, and sometimes vomiting. On examination, tenderness is maximal near McBurney's point. Imaging such as ultrasound or CT can identify a swollen appendix. Treatment is appendectomy, either open or laparoscopically. Prognosis is generally good due to advances in care, but complications from perforation or infection can still arise.
01.Acute appendicitis and chronic appendicitis.pdfravananusmf
1. Acute appendicitis is an inflammation of the appendix that can range from mild to severe. It is most commonly caused by an obstruction in the appendix, often by a fecalith.
2. The symptoms of acute appendicitis include sudden onset of abdominal pain localized to the right lower quadrant, nausea, vomiting, and low-grade fever. On examination, tenderness may be found at McBurney's point.
3. Diagnosis is usually made clinically but can be supported by blood tests, ultrasound, or CT scan. Treatment involves surgical removal of the appendix (appendectomy) to prevent complications like perforation and peritonitis. Differential diagnoses include other abdominal conditions presenting with similar symptoms
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• 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
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Cell Therapy Expansion and Challenges in Autoimmune Disease
Splenic trauma
1.
2. HISTORY
• Claudius Galen (129-216 AD) described the spleen as “PLENUM
MYSTERII ORGANUM” or “the organ full of mystery”
• In 1893, Reigner published the first documented successful
splenectomy in the German Literature.
• Operative mortality rates remained high until the 1950s
• In modern English, “to vent one's spleen” means one's anger, eg
by shouting (BAD TEMPER).
3. ANATOMY
• Wedge shaped, Purplish, Plulpy mass.
• Development : dorsal mesogastrium.
• Largest Lymphoid organ.
• Completely encircled by peritonium except at hilum.
• It is most commonly injured solid organ in blunt injury
abdomen.
• Protected by lower thoracic cage.
7. LIGAMENTS
• Gastrosplenic: Short gastric &
Left gastro omental vessels
• Splenorenal: Splenic vessels &
tail of pancreas.
• Splenocolic: In contact with
lower pole of spleen, at danger
during splenectomy
8. ANATOMICAL VARIATIONS
Accessory Spleens: Splenenculi
• MC congential anamoly
• 20-30% incidence
• Found near the hilum >80%
• other sites: Gastrocolic lig, Tail of
pancreas, Greater omentum, etc.
9. PHYSIOLOGY
• Acts as filter of Reticulo-endothelial
system
• Humoral immunity: Produces Ig M,
Opsonis, properidin.
• Activation of complement system
• Source of extramedullary
hematopoiesis
10. INITIAL ASSESSEMENT
• History: Victims sitting in the Left Side of the car.
• Type & nature of the weapon.
• If weapon is gun: Caliber of the gun
is important
11. MODES OF INJURY
• Blunt trauma:
Rapid decelaration (MVA), Direct blow to abdomen ( Domestic
voilence, activities such as bicylcling, rowing of boat, etc)
• Penetrating trauma:
Voilence, Gun shot injuries, etc.
• Iatrogenic: Post procedures.
• Spontaneous rupture: Malaria, Infectious mononucleosis
12. ASSOCIATED INJURIES
• Fracture of left lower ribs.
• Left lung/diaphragm injury.
• Left sided hemothorax
• Tail of pancreas injury
• Left kidney injury
• Left colonic injury
15. PER ABDOMEN EXAMINATION
• External bruise may be seen in the left upper
quadrant.
• Abdominal distension
• Decreased movment of left upper quadrant.(LUQ)
• Tenderness in LUQ/ all over the abdomen.
16. SIGNS
KEHR SIGN: Hans kehr,
Germany
• Clot collected under left
diaphragm irritates it &
the phrenic nerve,
causing reffered pain in
left shoulder after foot
end elevation.
17. SIGNS
• SEAT BELT SIGN:
Abdominal wall contusion or hematoma in site of seat belt
18. SIGNS
BALLANCE SIGN: Charles Alfred Ballance, UK.
• Persistent dullness to percussion in the left
flank due to coagulated blood.
• Shifting dullness to percussion in the right
flank due to fluid/blood
19. INVESTIGATIONS
• In unstable patients : Hemoglobin, Blood grouping &
arranging blood.
• No specific lab studies specific to splenic injuries.
20. FAST
ADVANTAGES:
• Non invasive
• Quickily asseses visceral
injuries, intra/retro peritoneal
fluid collections
DISADVANTAGES:
• Not reliable if blood <100ml
• Not identify injuried hollow
viscus
21. PLAIN CHEST X-RAY.
• Left lower rib fracture.
• Left hemidiaphragm
elevation, left lower lobe
atelectasis & pleural
effusion.
22. DIAGNOSTIC PERITONEAL LAVAGE
• Main diagnostic tool for
abdominal trauma in past.
• 10ml (blood/stool) +DPL
• Senistivity: 97-98%
• Complication rate: 1%
23. CECT SCAN
• Hemoperitoneum
• Blood density fluid throughout abdomen
• Hypodense regions in region of spleen
• Contrast BLUSH
34. ADJUNCTS TO SPLENOPRRHAPHY
• Hemostatic agents afforded
by temporary packs.
• Argon lasers for lager
splenic tear.
• Stapling devices (quicker
but cause ischemia or
tearing)
• Absorbale meshes around
the badly injured spleen.
35. SPLENECTOMY
• Position: Supine.
• General Anesthesia.
• Incisons: Midline, Left subcostal.
• Usually midline laprotomy incision is preffered.
36. ...CONTINUED
• Incision deepend to access
peritoneal cavity
• Pack 4 quadrants of peritoneal
cavity
• Suck out all the free blood and
clots
• Remove the packs starting from
least area of bleeding.
• Use your fingers to temporarily
sucure hemostasis at the hilum.
41. PARTIAL SPLENECTOMY
• During Partial splenectomy for
extensive injury to splenic
segment, transverse
intraparenchymal arteries may
continue to bleed.
• Some transverse spurting vssels
can be made hemostatic using
electrocoagulation.
• Where as other bleeding vessels
require 4-0 silk suture placed in a
figure-eight manner.
42. EMBOLISATION
• Tc99/ colloid labeled contrast
angiogram.
• Presence of blush /Pseudo
aneurysm pattern
• Transarterial embolisation
using polyvinly
alcohol/silicone/acrylic embolic
spheres.
• Reduce post operative
hemorrhage
47. OVERWHELMING POSTSPLENECTOMY INFECTION
• A rapidly fatal infection following removal of spleen.
• Mostly occurs during first 2years post splenectomy.
• Common Organisms:
1. S.pneumonia (50-90%)
2. H.influeza
3. N.meningitis.
Mortality :50-70%
48. OPSI
• Mechanism: organism with polysaccharide capsules
need opsonization with IgG3 or C3b which attaches to
special macrophages found in spleen.
• Post splenectomy patients have lack of macrophages.
• Flu like symptoms, Meningitis or sepsis.
• Rapidly progressive in 12-48hrs post onset.
49. OPSI
• Other organisms include: Streptococcus species,
salmonella, Babesiosis.
High risks:
• Children <5yrs/ >50yrs old.
• Splenectomty for haemoglobinopathies (Thalasemeia,
Sickle cell), Myelodysplasia, malignancies.
52. TAKE HOME MESSAGE
• Spleen is an important organ, we must try to conserve it.
• Clinical examination has vital role in diagnosing & treating
splenic injuries
• CECT is the Investigation of choice
• Hemodynamically unstable patients: directly to be taken
to Operation theatre.
53. TAKE HOME MESSAGE
• Splenic artery embolisation has got definitive role.
• Enlarged spleens are more susceptible to injury.
• OPSI is devastating sequelae of splenectomy.
• Prophylaxis against OPSI is must (in case it is elective).
or even if the lovers are good match, their love might be ruined by war, death or sickness, so tht the affair lasts on instant. Their time together might be as fleeting as a shadow or as short as any dream, lasting only long as it takes a lightning bolt to flash across the sky. before you can say look, its gone. that's how intense thing like love are quickly destroyed.
It is the most common cause of massive bleeding in blunt abdominal trauma to a solid organ.
pediatric spleen: implies reduced need of operative intervention.
adult: -100-250gms.
two ends
ANTERIOR of LATERAL END is expanded and us more like a border • POSTERIOR OF MEDIAL END is rounded I rests on upper pole of left kidney
Three borders
SUPERIOR BORDER us notched near the anterior vend
INFERIOR BORDER is rounded INTERMEDIATE BORDER is also rounded and directed to the right
T20 swyaces
· DIAPHRAGMATIC SURFACE us convex and smooth
VISCERAL SURFACE is concave and werequlor
Two angles
• ANTE ROBASAL ANGLE - It is the junction of superior border with LATERAL Or ANT - It us the most forward projeding part of spleen
• POSTEROBASPL ANGLE - junction of inferior borde with lateral or ant end of spleen
ARTERIAL SUPPLY
The spleen us supplied by SPLENIC ARTERY which us the largest branch
of the COELIAC TRUNK.
- It passes through the leinorenal ligament to reach the hilum where it divides into FIVE OR MORE BRANCHES
- These branches enter the spleen to supply it within the spleen, et diuder vrepeatedly eto forn straight Vessels called PENICILi, which further divide into ELLIPSOIDS and arterial CAPILLARIES
according to CLOSED THEORY OF SPLENIC CIRWLATION, capillaus are continuous with the venous vaunusoids that lie in the RED PULP
• According to OPEN THEORY OF SPLENIC CIRCULATION, capillaris cend by opening unto the red pulp prom where brood envers sinusoids Through uau
Others before un a com PROMISE THEORY, Where circulation us open un distendid spleen and closed un contracted spleen
SPLENIC VEIN is formed at the hilum of the Spleen
- It joins the SUPERIDR MESENTERIC VEIN to form the PORTAL VEIN behind the neck of the pancreas
Its tributaries are the SHORT GASTRIC, LEFT CASTROEPIPLOIC, PANCREATIC and
INFERIOR MESENTERIC VEINS
LYMPHATIC DRAINAGE
- splenic lissue has no lymphatics,
few lymphatics arise from connective di sues of capsule ancd drain
undo PANCREATICOSPLENIC LYMPH NODES Situated along the splenic artery
NERVE SUPPLY
- Sympathetic fibres are derived from the coeliac plexux: They areVASOMOTOR in nature.
They also supply some smooth muscles in the capsule
type & nature of weapon is important in penetrating injuries.
1lakh RBC/mm3, 500wbc/mm3, 175IU amylase,bile, bacteria or food.
Hemoperitoneum – Localized fluid collections around the spleen (especially those with an elevated HU measurement) are highly suggestive of hemoperitoneum.
• Briskly bleeding splenic lacerations may establish blood density fluid throughout the abdomen.
Hypodensity – Hypodense regions represent areas of Parenchymal disruption, intraparenchymal hematoma or Subcapsular hematoma.
Contrast blush or extravasation – Contrast blush describes hyperdense areas within the splenic parenchyma that represent traumatic disruption or pseudoaneurysm of the splenic vasculature. Active extravasation of contrast implies ongoing bleeding and the need for urgent intervention
tunical media & adventetia
cardiac catheterisation.
trauma.
Once spleen is fully mobilised.
For large deep injuries: 2-0 chromic sutures swedged on blunt tip needle. placed 1-2cm from torn margin & passed deep into the wound crevice.
Equal tension is achieved on both sides of crevices is obtained with two handed ties.
Minor oozing through needle holes are treated by placing dry sponge over spleen & returning the spleen to LUQ for 10mins, while other organs are assessed.
If hemostasis appears good when pack is removed, no touch technique applies.
• Use your fingers to temporarily secure hemostasis at the hilum(to prevent
clamping of the tail of pancreas) • Place the left hand on the spleen and draw it down to divide the lieno renal ligament lying posteriorly
• Deliver the spleen into the abdominal incision Then a non-crushing clamp is applied at the hilum safeguarding the
pancreas • Examine the spleen for grade of injury
Ligate and divide; the short gastric arteries, left gastro-epiploic arteries away from the stomach with non absorbable suture.
elective: lesser sac
emergency: leinorenal ligament.
• Use your fingers to temporarily secure hemostasis at the hilum(to prevent
clamping of the tail of pancreas) • Place the left hand on the spleen and draw it down to divide the lieno renal ligament lying posteriorly
• Deliver the spleen into the abdominal incision Then a non-crushing clamp is applied at the hilum safeguarding the
pancreas • Examine the spleen for grade of injury
Ligate and divide; the short gastric arteries, left gastro-epiploic arteries away from the stomach with non absorbable suture.
• Use your fingers to temporarily secure hemostasis at the hilum(to prevent
clamping of the tail of pancreas) • Place the left hand on the spleen and draw it down to divide the lieno renal ligament lying posteriorly
• Deliver the spleen into the abdominal incision Then a non-crushing clamp is applied at the hilum safeguarding the
pancreas • Examine the spleen for grade of injury
Ligate and divide; the short gastric arteries, left gastro-epiploic arteries away from the stomach with non absorbable suture.
Gently separate the tail of the pancreas from the splenic
Vessels Separately divide and double ligate the splenic artery and Then the vein.
• Beware ; tail of the pancreas, splenic flexure of the colon, left kidney and adrenal gland.
Complete the splenectomy by dividing the splenocolic liagament
• Complete exploratory laparotomy
• Meticulous hemostasis
• Peritoneal saline lavage
Suction drain on splenic bed- to drain the tail of pancreas Closure; abdomen is closed in layers
Gently separate the tail of the pancreas from the splenic
Vessels Separately divide and double ligate the splenic artery and Then the vein.
• Beware ; tail of the pancreas, splenic flexure of the colon, left kidney and adrenal gland.
Complete the splenectomy by dividing the splenocolic liagament
• Complete exploratory laparotomy
• Meticulous hemostasis
• Peritoneal saline lavage
Suction drain on splenic bed- to drain the tail of pancreas Closure; abdomen is closed in layers