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Splenic Injuries

2. AetiologyRoad traffic accidentsFall from heights left lower chest or left upper quadrant of abdoment hitting some objectAssault by blunt or sharp instrimentsMinor injuries like fall without direct trauma to the spleen if it is diseased or enlarged infectious mononucleosis or malariaFract

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Splenic Injuries

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    1. 1 Splenic Injuries

    2. 2 Aetiology Road traffic accidents Fall from heights – left lower chest or left upper quadrant of abdoment hitting some object Assault by blunt or sharp instriments Minor injuries like fall without direct trauma to the spleen if it is diseased or enlarged – infectious mononucleosis or malaria Fractures of the overlying ribs

    3. 3 Cases of ruptured spleen may be divided into three groups:- 1. Rapid Death from massive haemorrhage 2. Initial shock – recovery – signs of bleeding upper abdominal guarding local bruising and abdominal distension 3. The delayed case Initial signs pass off and the concern about a serious intra-abdominal bleed is postponed - late rupture after 2 to 3 days

    4. 4 Clinical Features History of injury Pain left side of chest or left upper abdomen Faintness bruising Pain referred to the left shoulder known as Kehr’s sign. The sign can be demonstrated 15 minutes after elevation of the foot of the bed – blood under diaphragm. Shifting dullness – PR – fullness in the pelvis

    5. 5 Investigations USGM CAT scan Hb estimation Blood Grouping and Rh typing Reserve four units of blood Monitor the pulse – if the pulse shoots up by more than 20/minute alert the doctor Monitor the BP USGM can be repeated as many times as necessary for monitoring purpose

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    11. 11 Treatment of Rupture of Spleen Spleen preservation especially in countries where malaria is prevalent Vicryl mesh bag and tightening to stop bleeding – especially for children – if by compression bleeding can be stopped. Splenectomy in cases where it is unavoidable. ( long term prophylaxis against streptococcal infections will be needed)

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