Abdominal Trauma by DR CHARLES MBEWE - Surgery-unza

ABDOMINAL TRAUMA 7TH YEARS LECTURE DR CHARLES MBEWE Definition Abdominal trauma is a major cause of morbidity and mortality. The vast majority of abd trauma cases can be salvageable as long as they are identified early Classification The mechanism of abd trauma can be classified as either Penetrating or Blunt. Penetrating- low energy such as a knife wound or high energy Blunt abd trauma- compression such as a seat belt and trauma caused by rapid deceleration such as a fall or road traffic collision Assessing a patient to determine the presence of intra abd injury Posses the following challenges They may have altered mentation as a result of HI of from alcohol consumption Altered abd sensation from the spinal cord injury Or destruction injuries from the thorax, pelvis or long bones Clinical Picture Generally look out for signs of shock I.e. tachycardia, increase RR, altered celebration, Hypotetion and decreased urine output Per abdominal exam, one has to look for signs of injury such as bruising, distension or penetrating wounds Bruising of the flanks may indicate retroperitoneal haemorrhage Clinical Picture Signs of peritonism include guarding, regidity, rebound tenderness and absence of bowel sounds Investiagations Simple radiological investigations such as CXR can help by revealing the presence of pneumoperitoneum or abd contents in the chest . Ctscan of abdimiopelvis In a haemodynaemically stable patient Very good for solid organs and can indicate the presence of free gas and fluid Investigation In a hemodynamically unstable patient a FAST scan is used. The US probe is used to identify the presence of free fluid in the sub hepatic, perirenal and peri splenic, pelvis and the pericardium. DPL is rarely used now. It can be used when the abd examination and the vitals are un equivocal, no CT or US DPL To perform the test pt must be catheterised and with NGT. Via a sub umbilical incision under LA, the linear alba divided under dir vision. A peritoneal dialysis catheter is then inserted and aspirated for the presence of blood or enteric contents. If negative, infusion of 1L warm NS is done, the drainage bag is then placed on the floor to allow for the fluid to siphon back into it. Positive DPL The drain fluid is sent for microscopy, and RBCs and WCC A positive DPL= RBCs > 1000 /mm3 or WCC > 500/mm3. Also recorded if presence of bile, or faeculant mater or evidence of lavaged fluid in the catheter of NGT, or chest tube COMMONLY INJURED ORGANS Splenic injury is the most common abd injury in blunt trauma It should be considered where there is evidence of rib fracture on the left side. Rupture can be delayed if there is a subcapsular haematoma. Pts may present with a severe LUQ pain, or peritonism Splenic injuries are graded I to IV Splenic Rupture Grade 1 and II in a stable pt can be managed conservatively. Grade III and IV operative management Splenorrhaphy or splenectomy Vaccines and antibiotics against encapsulated organisms. Hepatic trauma The next most commonly injured organ in blunt abd trauma and the most commonly injured in penetrating abd trauma is the LIVER Like the spleen because of its ligamental attachments it is prone to suffer from the shearing forces involved in accel/deceration accidents Liver injury is graded I to VI. Hepatic trauma Management can be conservatively or operative. Another abd organ to consider esp in blunt abd trauma is the kidney. May present as loin pain or bruising or as micro or macro haematuria. Graded 1 to V Vast maj of grade I to II can be managed conservately Bladder Rupture A well recognised injury in the intoxicated patient is the rupture urinary bladder These injuries occur as a result of steering wheel collision or assault when a patient has a full bladder. A clue to this injury may be a marked raised creatinine. Delayed CT views can show extravasation of urine Urethral Trauma Urethral injury must be considered esp in the presence of pelvic fractures If suspected catheterisation should only be done by the urologist Pancreatic Trauma Pancreatic trauma can occur in both blunt and penetrating abd trauma. It is difficult to diagnose and it is often found incidentally during …