abdominal trauma powerpoint explained for medical students

Abdominal trauma explaination

1. Abdominal trauma

2. The primary management of abdominal trauma is determination that an intra abdominal injury EXISTS and operative intervention is required. Types: Blunt abdominal trauma. Penetrating abdominal trauma. The recognition of the mechanism of the injury is a greatest importance for treatment and diagnosis and workup therapy. The liver, spleen and kidneys commonly involved in the blunt abdominal injuries.

3. After initial resuscitation: Haemodynamically ‘normal’ – investigation can be completed before treatment is planned. Haemodynamically ‘stable’ – investigation is more limited and is aimed at establishing: Patient can be managed non-operatively? Angioembolisation ? Surgery? Haemodynamically ‘unstable’ – investigations need to be suspended as immediate surgical correction of the bleeding is required.

4. Clinical features: Abdominal pain Abdominal distention, tenderness and rigidity. Respiratory problems. Signs of trauma on abdominal wall. Signs of shock.

5. Investigations CBC Urea and electrolytes Viral markers(HBS,HCV,HIV). Plain x-ray FAST(Focused abdominal sonar for trauma) CT scan Diagnostic laparoscopy Paracentesis Peritoneal lavage Wound examination and exploration in sharp injuries

6. If Serial physical and radiologic examination can not rule out intraperitoneal bleeding.

7. Contraindications of paracentesis: Previous abdominal surgery. Abdominal distention due to distended bowel loops. Coma due to head trauma . Diagnostic peritoneal lavage: Coma due to head trauma and abdominal blunt trauma. Despite negative Paracentesis, the intra-abdominal injury was suspected. Blunt abdominal trauma with suspected spinal injury. Contraindications of DPL: Pregnancy Positive paracentesis Abdominal distention due to distended bowel loops. Previous abdominal surgery.

8. The cannula is aspirated for blood (>10 mL is deemed as positive). 1000 mL of warmed Ringer’s lactate solution is allowed to run into the abdomen and is then drained out via the same route. The presence of >100,000 red cells/ μL The presence of >500 white cells/ μL is deemed positive (this is equivalent to 20 mL of free blood in the abdominal cavity). As is the presence of vegetable fibre or a raised amylase level.

9. Treatment of abdominal wall trauma Abdominal wall injuries from blunt trauma are most often due to shear forces. The shearing often devitalizes the subcutaneous tissue and skin(necrotizing anaerobic infection) The management of penetrating abdominal wall injuries is usually straightforward. Debridement and irrigation are appropriate surgical treatments. Abdominal wall defects may require insertion of absorbable mesh or coverage with a myocutaneous flap.

10. Liver injury Right upper quadrant pain Hypovolemic shock Blood and bile in peritoneal lavage fluids Abdominal x-ray Ultrasound or CT scan of the abdomen

11. Management Only by drainage Ligature of bleeders Push Pringle Plug Pack Suturing of liver Liver resection

12. Trauma of biliary tract Gall bladder injury(cholecystectomy). Minor injury of right/left hepatic duct or CBD( repair+T-tube ).

13. Spleen trauma Left upper quadrant pain Kehr’s sign Balances sign Absence of gastric fundus on x-ray Blood on DPL CT and MRI Treatment splenectomy

14. Pancreatic trauma Epigastric pain and tenderness Elevated amylase level DPL----(amylase) Ultrasound, CT scan and MRI Management Injuries without duct or capsule disruption Injuries to capsule without duct disruption Distal pancreatic injury Injuries to head of pancreases

15. Gastrointestinal tract injury 1- Stomach

16. 2- Duodenum