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ABDOMINAL TRAUMA L.M NTLHE Department of Surgery SBAH-UP

ABDOMINAL TRAUMA L.M NTLHE Department of Surgery SBAH-UP. ABDOMINAL TRAUMA. Universal precautions against communicable diseases Principles of initial assessment & resuscitation apply May be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock. Mechanism of Injury.

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ABDOMINAL TRAUMA L.M NTLHE Department of Surgery SBAH-UP

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  1. ABDOMINAL TRAUMAL.M NTLHEDepartment of SurgerySBAH-UP

  2. ABDOMINAL TRAUMA Universal precautions against communicable diseases Principles of initial assessment & resuscitation apply May be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock

  3. Mechanism of Injury Penetrating: stab wound gunshot wound 2. Blunt- MVA/blunt assault/fall from heights 3. Blast

  4. PENETRATING ABDO TRAUMA

  5. BLUNT ABDOMINAL TRAUMA (BAT) • SCENARIO

  6. DEFINITION • INJURIES TO MORE THAN ONE ANATOMICAL AREA • INCIDENCE – 10-15% OF TRAUMA PATIENTS

  7. BAT

  8. BAT

  9. BAT

  10. BAT

  11. CLINICAL PRESENTATION GENERAL-Stable or Unstable -Coma or conscious & cooperative -Pale Primary survey done, now secondary survey

  12. ABDOMINAL EXAMINATION Inspection Palpation Percusion Auscaltation Rectal examination

  13. Local-open wound± -bruising -Distension -Tender (peritonitic) -B/S ± absent -PR - ±blood

  14. MANAGEMENT – INVESTIGATIONS: Blood – U + E/FBC Radiology – CXRay/AbdXRay -U/S (FAST), CT Scan, DPL, Laparascopy TREAT MENT : Resuscitation TREAT THE INJURED ORGAN

  15. SOLID VISCERA Spleen: Liver: Pancreatico-Duodenal: Kidneys:

  16. Spleen

  17. Liver

  18. HOLLOW VISCERA Stomach: Penetrating Blunt (rare) Treatment: debride and suture (nonabsorbable sutures, two layers) Corrosive ingestion

  19. Small Bowel: Penetrating – GSW -Stab Blunt Blast Treatment: debride and suture

  20. Duodenal and Pancreatic injuries: 3-5 % Penetrating 75%-GSW 85% Blunt-crushing against vertebral column -shearing forces -duodenal blow out

  21. DIAGNOSIS : History and Examination Duodenal haematoma→copious bilious vomiting AXRay-retroperitoneal air ( air nephrogram) -Scattered air bubbles -Obliterated psoas shadow -Free extra luminal air -Lumber & lower thoracic spine Blood- serum amylase FAST CT

  22. Pancreatico-Duodenal

  23. Treatment – Pancreas: hemorrhage→haemostasis – Major duct :→distal pancreatectomy – Proximal→Whipple procedure(↑mortality) Colon →1⁰ repair Rectum/Anus: Diverting colostomy

  24. Vascular injury- Vascular unit Kidney-urology department

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