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

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ABDOMINAL TRAUMAL.M NTLHEDepartment of
SurgerySBAH-UP
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ABDOMINAL TRAUMA

• Universal precautions against communicable
  diseases
• Principles of initial assessment resuscitation
  apply
• May be on 2 survey of your ABCs of resusc or 1
  survey treatment of shock

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(No Transcript)
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Mechanism of Injury

• Penetrating stab wound
• gunshot wound
• 2. Blunt- MVA/blunt assault/fall from heights
• 3. Blast

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PENETRATING ABDO TRAUMA
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BLUNT ABDOMINAL TRAUMA (BAT)

• SCENARIO

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DEFINITION

• INJURIES TO MORE THAN ONE ANATOMICAL AREA
• INCIDENCE 10-15 OF TRAUMA PATIENTS

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BAT
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BAT
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BAT
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BAT
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• CLINICAL PRESENTATION
• GENERAL-Stable or Unstable
• -Coma or conscious cooperative
• -Pale
• Primary survey done, now secondary survey

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• ABDOMINAL EXAMINATION
• Inspection
• Palpation
• Percusion
• Auscaltation
• Rectal examination

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

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

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• SOLID VISCERA
• Spleen
• Liver
• Pancreatico-Duodenal
• Kidneys

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Spleen
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Liver
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• HOLLOW VISCERA
• Stomach
• Penetrating
• Blunt (rare)
• Treatment debride and suture (nonabsorbable
  sutures, two layers)
• Corrosive ingestion

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• Small Bowel
• Penetrating GSW
• -Stab
• Blunt
• Blast
• Treatment debride and suture

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

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• 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

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Pancreatico-Duodenal
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• Treatment Pancreas hemorrhage?haemostasis
• Major duct ?distal
  pancreatectomy
• Proximal?Whipple
  procedure(?mortality)
• Colon ?1 repair
• Rectum/Anus Diverting colostomy

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• Vascular injury- Vascular unit
• Kidney-urology department