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Abdominal Trauma

Learn about diagnostic methods, physical examination, classification, and mandatory exploration for assessing abdominal trauma. Understand the importance of serial observation, surgeon's expertise, and specific organ injuries like liver, spleen, and more.

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Abdominal Trauma

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  1. Abdominal Trauma

  2. Diagnostic MethodsAbdominal Trauma • Physical examination • Bruises, abrasion over the abdomen • Abdominal pain or tenderness • Absent bowel sounds • Unexplained hypotension • P/E equivocal or misleading.!!! • Peritoneal sign falsely negative in 40% • Peritoneal sign falsely positive in 20% • 10% of all injuries are initially overlook WHY?

  3. PHYSICAL EXAMINATIONAbdominal Trauma • Physical examination unreliable • Head trauma • Spinal cord injuries • Alcohol intoxication • Use of illicit drugs • Injuries to adjacent structure • Significant amount of blood present • Analgesia

  4. CLASSIFICATIONAbdominal Trauma • Penetrating • High velocity (85% penetrate peritoneum) • Low velocity (95% need surgery) • Stab(1/3 do not penetrate the peritoneum, of those 50% need Sx) • Blunt trauma • High energy transfer (car accident) • Low energy transfer (fall, fight)

  5. Mandatory ExplorationAbdominal Trauma Anterior abdominal gunshot Stab Local exploration • Penetration of the fascia?? • DPL • Laparoscopy • Laparotomy Serial observation Surgeon’s expertise

  6. Blunt Injuries • Physical examination • Investigation • Specific organ injuries • Liver • Spleen • Small bowel

  7. Spleen 25% Liver 15% Hollow viscus 15% Ileum Sigmoid Kidney 12% Retroperitoneal 13% Mesentery 5% Compression Crushing Shearing Avulsion Blunt InjuryAbdominal Trauma

  8. Physical ExaminationAbdominal Trauma Evaluation • Vital signs • Inspection • Seat belt mark • Skin lacerations • Previous surgery scar

  9. Physical ExaminationAbdominal Trauma Evaluation • Auscultation • Palpation • Rebound tenderness • Guarding • Pregnancy • Pelvic instability

  10. Physical ExaminationAbdominal Trauma Evaluation • Rectal examination • Prostate • Rectal tone • Vaginal examination • Gluteal fold • Penetrating injuries = abdominal injuries

  11. Tube InsertionAbdominal Trauma Evaluation 4- Gastric tube • Relives distention • Decrease risk of unattended vomiting • But can induce it , risk of aspiration !!! Caution Facial fracture/basilar skull fracture

  12. Tube InsertionAbdominal Trauma Evaluation • Urinary catheter • Monitor urinary output Caution • Inability to void retrograde • Pelvic fracture urethrogram • Blood at the meatus U/S • Scrotal Ecchymoses • High riding prostate

  13. Special Diagnostic Studies Abdominal Trauma Evaluation • DPL • U/S • Ct abdomen & pelvis

  14. X-RayAbdominal Trauma Evaluation • C-spine • Chest AP • High association of chest injuries and abdominal injuries • Free air? • Pelvis

  15. Others X-RayAbdominal Trauma Evaluation • Urethrography 5. ? IVP for hematuria • IV contrast Keep good urinary output • Better CT scan 6. Spine fracture • Chance Fracture 20% small bowel injuries

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