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Abdominal Trauma

Abdominal Trauma

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Abdominal Trauma

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  1. Abdominal Trauma

  2. Abdominal Trauma Etiology: • Blunt injuries: 90% • Automobile injuries - 60% • ≥90% = survive • 22% = death • Penetrating abdominal trauma: 10% • Gunshot or stab wound Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON

  3. Factors that make children vulnerable to abdominal injury: • Abdominal wall and lower rib cage are thinin children • Liver and kidneys lie relatively lower in the abdomen • Kidneys and pancreas lie only a short distance away from the abdominal wall in thin children • Liver occupies a large percentage of the abdominal cavity

  4. Key Components of Abdominal Assessment • Inspection • Auscultation • Palpation • Pain assessment • Respiration

  5. Diagnostic Procedures • Laboratory Tests: • CBC • Hemoglobin and hematocrit • maintain Hct >30% • Serum Amylase • Urinalysis • Transaminase • Blood typing and crossmatching • Peritoneal Lavage

  6. Radiological Studies • Supine and Upright abdominal films (Upright CXR) • free air in the abdomen (pneumoperitoneum) • extent of injury in penetrating trauma • CT Scan • diagnostic test of choice • solid organ injuries • grade of injury Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON

  7. Conservative Approach • Assessment should include determination: • level of consciousness (GCS) • Vital signs • palpation and auscultation of the abdomen • accurate intake and output measurement • Patient Stabilization: aggressive volume expansion

  8. Surgical Intervention • Indications for surgery: • blood transfusions of 40 ml/kg or 50% of circulating blood volume is required • most penetrating injuries • inability to achieve hemodynamic stability even after aggressive fluid and blood replacement • severe abdominal distention accompanied by hypotension

  9. Types of Abdominal Injuries • Solid Organ Injury • Liver • Spleen • Pancreatic Injury • Stomach and Intestinal Injury

  10. Liver Injury • Most fatal due to the potential for massive hemorrhage • Signs and Symptoms: • Pain in right upper shoulder • Pain and tenderness in right upper quadrant of abdomen • Bruising, abrasions and seatbelt marks • Vital Signs: hypotension with major bleeding Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON

  11. Management • Conservative • Standard practice for stable pediatric patients • monitored for at least 48 hours • Strict bedrest for 7 days with serial H and H • Limit activity for 2-3 months after discharge • Surgical • control of massive bleeding or liver resection • Indications: • Child continues to deteriorate • more than 50% of the circulating blood volume requires replacement within 24 hours Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON

  12. Splenic Injury • Blow to the LUQ/epigastric region of the abdomen • Signs and Symptom: • Abdominal tenderness and pain • Kehr’s Sign (pain in the left shoulder) • Pain in left part of chest with respirations • Decreased breath sounds • Turner sign (ecchymoses in the left flank) • Cullen sign (ecchymoses around the umbilicus)

  13. Management • Preservation of the spleen to prevent the occurrence of postsplenectomy sepsis • Conservative • Standard practice for stable pediatric patients • Receives ≤ 50% blood volume replacement • Monitored in the ICU for at least 48 hours • Surgical (splenorrhaphy or splenectomy) • Hemodynamic instability after aggressive fluid resuscitation • Continued blood loss • Separation of the spleen from its blood supply • Severe head injury that cannot tolerate volume resuscitation

  14. The decision to operate for spleen or liver injury, which should always be made by a surgeon, is best based on clinical signs of continued blood loss such as: • low blood pressure, • elevated heart rate, • decreased urine output, and • falling hematocrit

  15. Pancreatic Injury • uncommon in children • difficult to diagnose

  16. Management • Conservative • complete gastrointestinal rest • Surgery • pancreatic duct is transected requiring a partial or total pancreatectomy

  17. Stomach and Intestinal Trauma • contusions, lacerations, hematomas or perforation • Signs of hollow organ injury: • abdominal tenderness, ecchymosis of the upper and lower abdomen, bloody gastric drainage

  18. Management • Surgery