abdominal trauma basics, diagnosis, treatment, organ wise classifications

based on surgery books for medstudents.
info based on : medical textbooks as follows.
bailey and love
sabiston
schwartz

1. Abdominal trauma Priya Shailesh Salunke G roup H

2. Introduction Definition : Injury to the area from the nipple line to the inguinal creases as a result of energy transfer from an inflicting source. Sources: chemical, thermal, ionising radiation or mechanical General : reason for largest number of deaths and disability in children and young adults (9% of global deaths) Main reasons : road traffic accidents (RTAs), falls, violence ( eg : gunshot wounds or knife stab) Major cause of death : uncontrolled hemorrhage Types of abdominal trauma: Blunt Penetrating

3. Blunt trauma Definition : nonpenetrating injury to abdomen due to forceful impact, falls or physical attack with dull object. These are more common and more difficult to assess. Appearance : external bruising, disfigured structure, contusions, abrasion, or fractures. Types: Based on injury – solid viscera injury. Eg : liver, pancreas, spleen Hollow viscera injury. Eg : bladder, gut, stomach, GB Based on stability Hemodynamically stable – vitals are normal Hemodynamically unstable- vitals are abnormal S eat syndrome

4. Penetrating trauma Definition : trauma causing external bleeding and tissue damage. Types are: Gunshot wounds : small bowel (50%), colon, liver are most affected Stab wounds : liver (40%) and small bowel (30%) are most affected Wound characteristics : Entrance wounds : bullets, lacerations, burns Exit wounds : appears to be blown outwards, pressure wave Impaled object – don’t remove

5. Management of trauma Primary survey (ATLS protocol) Diagnostics test : ecg , urinary cath , ABG, pulse oximeter, BP, Xray , Initial choice USG –FAST, CT is the gold standard for intra-abdominal dx of injury in stable patient. Secondary survey – AMPLE Physical examination Inspection shows: skin lesions, bruises, wounds, lacerations Assess pelvic stability and penetrating wound 5. Treatment : gold standard is laparotomy

6. FAST - focused assessment sonogram in trauma - USG done in emergency room to check for presence of free fluid

7. Algorithm of suspected blunt abdominal trauma

8. Algorithm for penetrating abdominal trauma

9. Treatment

10. Early total care (ETC) and damage control surgery (DCS) ETC: Management of injuries within 36hrs Patient is stable but needs treatment and monitoring DCS: Is an emergency surgical approach used in trauma cases where a patient is critically unstable. Simultaneous resuscitation with early rapid life and limb saving surgery. Below is the DCS triad Phases (ACS guidelines)

11. Organ wise Splenic trauma: Most common organ injured in blunt and overall and children in abd trauma What to suspect?: fractured of ribs 9-11 th on left side, bruising on left lower chest, kehr sign (pain in left shoulder due to splenic rupture) Treatment : Grade 1 2, 3 (stable) – CECT shows contract blush angioembolization – if fails and unstable vitals laparotomy (splenic preservation) Grade 3,4 and 5 (all unstable) : if FAST is positive laparotomy : splenectomy Complications: Hemorrhage Pancreatic injury

12. 2. Liver trauma Most common organ affected in penetrating trauma Management: Grade 1,2,3 – conservative, monitor and serial CECT If unstable surgery Grade 3 4 5 (unstable) – surgery Surgeries: Pringles maneuver – hepatic pedicle compressed (CBD, portal vein and Hep artery) – bleeding decreased. If not – its hepatic vein Packing – tamponading effect

13. 3. Pancreas Prognostic factor : injury to main pancreatic duct 4. Duodenum Haematoma bowel rest Perforation  seen as peritonitis omental patch repair