diagnostic peritoneal lavage (DPL)

there is the introduction part of the torso trauma,
check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
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1. Investigation of abdominal injuries-DPL NAME - DEEPTI MALA PANNA DEPARTMENT OF SURGERY BATCH - 2018 LBRK GMC JAGDALPUR ROLL NO. - 29 MBBS FINAL YEAR PART ll

2. Contents Investigation for abdominal injuries Diagnostic peritoneal lavage (DPL) Introduction Types Indications and contraindications Procedure Interpretation Complications

3. Introduction Abdominal trauma is a major surgical emergency. It is associated with other systemic injuries . Although the more importance is given to other system injuries like head, thorax and bones whereas, abdominal injury is not addressed properly causing life -theatening consequences.

4. Patient who have suffered abdominal injuries can classified into following categories : Haemodynamically ‘normal’- investigation can be completed before treatment is planned. Haemodynamically ‘stable’- investigation is more limited.it is aimed at establishing the patient by non - operative,angioembolisation or whether surgery. Haemodynamically ‘unstable’- investigation need to be suspended as immediate surgical correction of the bleeding is required.

5. Investigation Investigation are driven by the cardiovascular status of the patient. Ultrasound abdomen (FAST) - it is rapid,non invasive, portable bedside method of investigation ,focusing on pericardium, splenic, hepatic and pelvic areas. It is not reliable for bowel or penetrating injuries. Diagnostic peritoneal lavage - it is done in case of physiologically unstable patient with blunt abdominal injury (like with spinal injury, unconscious patient).

6. Computed tomography scan - CT scan has become the ‘gold standard’ for the intra- abdominal diagnosis of injury in the stable patient. CT Scan is sensitive for blood and individual organ injury as well as for retroperitoneal injury .

7. Diagnostic laparoscopy Diagnostic Laparoscopy- It is valuable in stable patient with penetrating trauma. Laparoscopy may be divided into : Screening: used to exclude a penetrating injury with breach of the peritoneum. Diagnostic: finding evidence of injury to viscera Therapeutic: used to repair the injury.

8. Complete blood count: Coagulation studies, grouping, cross matching. fall in Hb is an indication of on- going haemorrhage. Serum amylase/lipase: May be elevated because of pancreatic ishaemia due to hypotension Persistent elevation may be indication of pancreatic injury.

9. Diagnostic peritoneal lavage Introduction Diagnostic peritoneal lavage (DPL) is a test used to assess the presence of blood, cells, WBC,bile, bacteria, amylase,or contaminated gastrointestinal contents in the abdominal. It is done when FAST is not available.

10. Types of DPL Open technique (mini-laparotomy) - infraumbilical skin incision and open peritoneum cavity to directly visualize the peritoneum and incise it to insert catheter. Semi- open - Dissection down to the rectus fascia followed by needle and catheter-over-wire technique into the peritoneum cavity. Closed technique-technique- percutaneous needle insertion into the peritoneum cavity followed by catheter-over-wire.

11. (DPL) cont. Indications: Unconscious trauma patient with signs of abdominal injury. Patient with suspected intra- abdominal injury and equivocal physical findings. Patients with multiple injuries and unexplained shock. Patients with spinal cord injury. Intoxicated patients in whome abdominal injury is suspected.

12. Contraindications for DPL Absolute Contraindications Obvious clinical indication for laparotomy ( eg.gunshot injury, penetrating injury with shock, evisceration) Relative Contraindications Availability of appropriate imaging(eg. E- FAST,CT). Pelvic fracture Inability to place a urethral catheter Pregnancy Previous abdominal surgery Obesity

13. Procedure Prepare the patient: Insert the nasogastric tube. Insert a urinary catheter. A cannula is inserted midline of the abdomen 2cm below the umbilicus angled 45° to the skin and directly inferoposteriorly towards the pelvis. The cannula is aspirated for blood ( ≥ 10ml is +ve) and , following 1000 ml of warmed Ringer's lactate solution is allowed to run into the abdomen and is drained out via the same route.

14. Interpretation One of the criterias signifies positive lavage: 10 ml or more of gross blood RBC count more than 1,00,000/cumm WBC count more than 500/cumm Amylase level in the fluid more than 175 IU/dL Presence of bile , bacteria , food particles or foreign body

15. Complications of DPL Infection. Injury to organs and/or blood vessels by needle or catheter. Cutaneous bleeding and /or hematoma. Herniation of bowel through the incision.