TH6 ABDOMINAL TRAUMA Flashcards
PENETRATING ABDOMINAL TRAUMA
INJURY WHEN OBJECT PIERCES PARIETAL PERITONEUM + ENTERS PERITONEAL CAVITY
CAUSE:
> laceration of solid organs
> perforate hollow organs > must be discovered + repaired in laparotomy
BLUNT ABDOMINAL TRAUMA
TRAUMATIC OBJECT DOESN’T PIERCE PARIETAL PERITONEUM + SKIN IS NOT BROKEN
CAN CAUSE:
laceration of solid organs + bleeding
hemorrhagic shock + perforation
MANAGEMENT OF BLUNT TRAUMA WHO ARE UNSTABLE TO SEE W/ INTRABDOMINAL FLUID ON FAST?
LAPARATOMY
WHAT IS FAST?
FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA
- rapid bedside ultrasound examination
- test for blood around heart (pericardial effusion)
- blood around abdominal organs (hemoperitoneum)
- after trauma
EVLUATION METHOD FOR PX WITH BLUNT TRAUMA + MENTAL STATUS + CONCOMITANT INJURIES + NO AVAILABLE FAST?
PERITONEAL LAVAGE
MANAGEMENT OF ANTERIOR ABDOMINAL WALL GUNSHOT?
LAPARATOMY
MANAGEMENT OF STAB WOUNDS WITH PERITONITIS, EVISCERATION/ UNSTABLE HEMODYNAMICS?
LAPARATOMY
PRINCIPLE OF EMERGENT LAPARATOMY IN ABDOMINAL TRAUMA?
SYSTEMIC EXPLORATION
- so all areas of abdomen is assessed + injuries not missed
STANDARD TECHNIQUE FOR OPENING ABDOMEN IN EMERGENCY LAPARATOMY?
Abdomen opened from xiphoid process > pubic symphysis to provide adequate exposure of all abdominal structures
MC SOLID ORGAN INJURIED IN BLUNT TRAUMA?
SPLEEN
MC CAUSE OF SPLEEN INJURY?
ROAD + SPORT ACCIDENT
DEFINE DELAYED RUPUTRE OF SPLEEN?
OCCURS WHEN CLINICAL SIGNS OCCUR AFTER 48hrs FROM INITIAL INJURY
DUE: tearing of capsule due to expansion of sub capsular hematoma
KEHRS SIGN?
PAIN IN TIP OF LEFT SHOULDER
DUE: irritation of undersurface of diaphragm by blood in peritoneal cavity (leak by injured spleen)
> STIMUALTE PHRENIC NERVE - C4 dermatome
IN WHAT INJURY IS KEHRS SIGN POSITIVE?
INJURY + RUPTURE TO SPLEEN
> leak of blood into peritoneal cavity + stimulating phrenic nerve + irritation of undersurface of diaphragm
WHY IS LIVER INVOLVED IN ABDOMINAL TRAUMA?
> LIVE SIZE
ANATOMICAL LOCATION
directly under right costal margin
frequently involved penetrating trauma
PRESENTATION OF INTRA ABDOMINAL BLEEDING?
ABDOMINAL PAIN
TENDERNESS
GUARDING
RIGIDITY
HEMOBILLIA?
GI haemorrhage caused by bleeding into billiary tree
sign of extensive liver haemorrhage
TYPE OF ABDOMINAL TRAUMA AFFECTING STOMACH MOST?
PENETRATING TRAUMA
> full thickness perforation > resulting in spillage of gastric contents > peritonitis
PRESENTATION OF GASTRIC INJURIES WITH FULL THICKNESS PERFORMATION OF STOMACH PERITONTIS?
PERITONITIS
> due to peritoneal irritation from intra peritoneal leakage of low pH content of stomach (acidic)
WHY ARE PHYSICAL FINDING LIMITED IN DUODENAL INJURY?
DUE: RETROPERITONEAL LOCATION OF SIGNIFICANT PORTION OF DUODENUM
WHY IS DUODENAL INJURY OFTEN ASSOCIATED WITH PANCREATIC INJURY?
ADJACENT LOCATION
WHY DOES PANCREAS INJURY HAVE HIGH MORTALITY?
DELAY IN DIAGNOSIS + TX
CAUSTIC NATURE OF PANCREATIC ENZYMES
DELAY IN DX > results in massive systemic inflammation > leading to poor outcome
MOST COMMON MECHANISM FOR PANCREATIC TRAUMA?
CRUSHING BODY BETWEEN RIGID STRUCTURE ( STEERING WHEEL, SEATBELT) + VERTEBRAL COLUMN
cause injury to pancreas > ranging from mild contusion to complete transection with ductal disruption
TYPE OF TRAUM SMALL INTESTINE ASSOCIATED WITH?
PENETRATING ABDOMINAL TRAUMA
PRESENTATION OF SMALL INTESTINE INJURY WITH PERFORATION?
SMALL INTESTINE TRAUMA WITH FULL THICKNESS PERFORATION: > signs of peritoneal irritation > abdominal pain > tenderness > guarding + rigidity
TYPE OF TRAUMA COLON/ RECTAL INJURY ASSOCIATED WITH?
PENETRATING ABDOMINAL TRAUMA
RARELY > BLUNT TRAUMA
WHAT DOES BLOOD ON RECTAL EXAMINATION MEAN?
RECTAL INVOLVEMENT + REQUIRES FURTHER EVALUATION
