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Abdominal Trauma

Abdominal Trauma. Diagnostic Methods Abdominal 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%

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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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