Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes...

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Abdominal Trauma Begashaw M (MD)

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Transcript of Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes...

Page 1: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Abdominal Trauma

Begashaw M (MD)

Page 2: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Anatomy

Page 3: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Abdominal Trauma

Two mechanisms

_Bluntusually causes solid organ injury (spleen injury is most common)

_Penetratingusually causes hollow organ injury or liver injury (most common)

Page 4: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Mechanism of Injury

Blunt Force Trauma Penetrating Trauma

Page 5: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Mechanism of Injury Africa style

Page 6: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Mechanism of Injury

Blunt– Speed– Nature of Impact– Position in vehicle– Ejection– Intrusion– Seatbelt– Airbag

Penetrating– Type of weapon– Distance – Number and

location of wounds– Trajectory– Energy– Blast effect

Page 7: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

BLUNT TRAUMA

results in two types of hemorrhage

- intra-abdominal bleeding

- retroperitoneal bleedingadopt high clinical suspicion of bleeding in

multi-system trauma

Page 8: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Examination

Abdomen

Inspect: contusions, abrasions, seatbelt sign, distention

Auscultate: bruits,bowel sounds

Palpate: tenderness, rebound tenderness, rigidity, guarding

DRE: rectal tone, blood, bone fragments,prostate location

Placement - NG, foley catheter

Page 9: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Commonly injured organs

SpleenLiverSmall Bowel

Page 10: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Assessment of abdominal trauma

Difficult due to:

_Altered sensorium (head injury, alcohol)

_Altered sensation (spinal cord injury)

_Injury to adjacent structures (pelvis, chest)

Page 11: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Investigations

Labs: CBC, electrolytes,cross & type, glucose, creatinine, amylase, liver enzymes

Imaging

Page 12: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Imaging

Imaging strengths limitations

X-ray Erect CXR Soft tissue not visualized

CT scan Most specific test Radiation,cannot use if hemodynamic instability

Diagnostic peritoneal Lavage

Most sensitive testTest for intra abdominal bleeding

Retroperitoneal hemorrhage, diaphragmatic rupture

Ultrasound FAST Free fluid, Rapid, pericardium, plura

Specific organ injury

Page 13: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

FAST

Focused assessment for the sonographic assessment of trauma

Assess for intraperitoneal fluid

o Right upper quadrant

o Left upper quadrant

o Suprapubic region Fluid in subphrenic, subhepatic spaces or Pouch of

Douglas in hypotensive patient Confirms likely need for emergency laparotomy

Page 14: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

FAST

Page 15: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Criteria for positive DPL

>10 cc gross bloodBile, bacteria. foreign materialRBC count >I 00,000 WBC >500 Amylase > 1751U

Page 16: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Imaging

Equivocal abdominal examination, suspected intra-abdominal injury

Multiple trauma Unexplained shock/hypotensionFractures of lower ribs, pelvis, spinepositive FAST

Page 17: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Management

General: ABCs, fluid resuscitation and stabilization Surgical: watchful wait vs laparotomy Solid organ injuries: decision based on

hemodynamic stability, not the specific injuries Hemodynamically unstable or persistently high

transfusion requirements: laparotomy Hollow organ injuries: laparotomy Even if low suspicion on injury: admit and observe

for 24 hours

Page 18: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)
Page 19: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Indications for Laparotomy

Free Fluid on FASTUnstable patient with suspected abdominal

injuryFree AirDiaphragm RupturePeritonitisPositive findings on CT Scan

Page 20: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

PENETRATING TRAUMA

High risk of gastrointestinal perforation and sepsis History: size of blade, calibre/distance from gun,

route of entry Local wound exploration under direct vision may

determine lack of peritoneal penetration (not reliable in inexperienced hands) with the following exceptions:

-thoracoabdominal region (may cause pneumothorax)

-back or flanks (muscles too thick)

Page 21: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Penetrating Trauma

Overall condition of the patient

Local wound exploration

DPL?

Page 22: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Penetrating abdominal trauma

Page 23: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Laparomy in penetrating injury

ShockPeitonitisEviserationFree air in abdomenBlood in NG tube, Foley catheter, or on

rectal exam

Page 24: Abdominal Trauma Begashaw M (MD). Anatomy Abdominal Trauma Two mechanisms _Blunt usually causes solid organ injury (spleen injury is most common)

Management

General: ABCs, fluid resuscitation and stabilization

Gunshot wounds-always require laparotomy


Blunt Abdominal Trauma: Injury to the Epigastrium

Blunt Abdominal Trauma: Injury to the Epigastrium

Trauma– Blunt Abdominal Trauma

Trauma– Blunt Abdominal Trauma

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