ABDOMINAL TRAUMA Flashcards
What are the two major types of abdominal trauma?
The two types of injury are blunt and penetrating. The
abdomen may be considered as being composed of five parts:
Abdominal wall: front and back
Subcostal portion: containing the stomach, liver, spleen and
lesser sac
Pelvic portion: containing the rectum, internal genitalia and
iliac vessels
Intraperitoneal portion in between the above: containing
the small and large bowel
Retroperitoneum: containing the kidneys, urinary tract,
great vessels, pancreas and the rest of the colon
Which abdominal organs are most commonly
injured?
The three most commonly injured organs are the liver, spleen
and kidneys.
How may suspected injuries be investigated?
The initial investigations performed to assess the abdomen as
a whole are
Plain radiography: also assesses the bony pelvis
Ultrasound: particularly good for the presence of free
f luid in the abdomen, or haematoma around solid organs.
There is a 10% risk of missing a significant injury
Diagnostic peritoneal lavage (DPL): this is 98% sensitive
for intra-peritoneal bleeding
CT scanning: this can be used if the results of the DPL are
equivocal, and may also be performed at the same time as
a brain scan. Very good for retroperitoneal injury, less so
for hollow viscus injury such as the bowel
Under which circumstances would you perform a
diagnostic peritoneal lavage (DPL)?
Some of the indications are
A suspicion of abdominal trauma on clinical examination
Unexplained hypotension: with the abdomen being the
source of occult haemorrhage
Equivocal abdominal examination because of head injury
and reduced level of consciousness
The presence of a wound that has traversed the
abdominal wall, but there is no indication for immediate
laparotomy, e.g. a stab wound in a stable patient
When is DPL contraindicated?
The most important contraindication for DPL is in the
situation which calls for mandatory laparotomy, e.g. frank
peritonitis following trauma, abdominal gunshot injury or a
hypotensive patient with abdominal distension.
How is DPL most commonly performed?
Performance of a DPL by the open method
Requires an aseptic technique
The abdomen is decompressed by insertion of a urinary
catheter and nasogastric tube
Local anaesthetic is administered to the subumbilical area
in the mid-line
An incision is made over this point. If a pelvic fracture is
suspected, then a supraumbilical incision is made to
prevent haematoma disruption
Dissection is performed down to the peritoneum and the
cannula is inserted under direct vision, guiding it towards
the pelvis
One litre of warmed saline is infused. Tilting and gently
rolling the patient helps distribution
The bag of saline can be left on the f loor to siphon off
the sample f luid from the abdomen
What are the positive criteria with DPL?
Lavage fluid appears in the chest drain or urinary catheter Frank blood on entering the abdomen Presence of bile or faeces Red cell count of 100,000/l White cell count of 500/l Amylase of 175 U/ml
