APPROACH TO ABDOMINAL TRAUMA DR.MOHAMMADZADEH

TRAUMA Trauma is the most common cause of death for ages of 1 & 44 years

MECHANISMS OF INJURY BLUNT TRAUMA PENETRATING TRAUMA

BLUNT TRAUMA Low - energy transfer : High-energy transfer : struck with a club falling from a bicycle falls from short height High-energy transfer : auto-pedstrain accident motor vehicle accident motor-cycle accident falls from heights greater than 20 feet

PENETRATING TRAUMA Stab wound Gunshot wounds Shotgun wounds high-velocity injury(bullet speed > 2000 ft/s ) low-velocity injury Shotgun wounds close-range (< 7meters ) long-range ( > 7 meters )

DIAGNOSTIC PERITONEAL LAVAGE DPL The most sensitive test for determining of intraabdominal injury POSITIVE TEST Aspiration of more than 10 ml of free blood RBC greater than 100,000/ml Detection of bile, vegetable or fecal materia ALK.PH>3IU/L & Amylase> 20 IU/L Effluent draining from a chest tube,NGT,Fo

INDICATION OF DPL Equivocal physical exam Unexplained shock or hypotention Altered sensorium(e.g closed-head injury) General anesthesia for extra abdominal proc Cord injury

CONTRAINDICATION OF DPL Absolute: clear indication for laparotomy Relative : previous exploratory laparotomy pregnancy massive obesity

ADVANTAGES OF ULTRASOUND Noninvasive Dose not require radiation Useful in the resucitation room or emergency department Can be repeated Used during initial evaluation Low cost

DISADVANTAGES OF ULTRASOUND Examiner dependent Obesity Gas interposition Lower sensitivity for the fluid <500 ml False-negative retroperitoneal and hollow viscus injuries

ADVANTAGES OF CT-SCAN Adequate assesment of the retroperitoneum Nonoperative measurment of solid organ injuries Assesment of renal perfusion Noninvasive High specifity

DISADVENTAGES OF CT-SCAN Specialized personnel Hardware Duration: helical versus conventional Hollow viscus injuries Cost

INDICATION OF CT-SCAN Blunt trauma Hemodynamic stability Normal or unreliable physical examination Mechanism : duodenal and pancreatic trauma

CONTRAINDICATION OF CT-SCAN Clear indication for exploratory laparotomy Hemodynamic instability Agitation Allergy to cotrast media

DECISION MAKING FOR BLUNT ABDOMINAL TRAUMA Overt peritonitis Hemoperitoneum LAPARATOMY

HIGH-ENERGY TRANSFER DPL POSITIVE NEGATIVE LAPAROTOMY OBSERVE

LOW-ENERGY TRANSFER DPL stable v/s Unstable v/s CT-SCAN Major solid organ Hollow viscus Minor solid organ LAPAROTOMY OBSERVE

STAB WOUND TO LOWER CHEST AREA Exploration of wound for diaphragmatic - injury DPL - Thoracoscopy -

STAB WOUND TO ANTERIOR ABDOMEN Fascia intact D/C HOME Local wound exploration Negative Observation Fascia violated DPL Positive Laparotomy

STAB WOUND TO BACK AND FLANK Frequent examination DPL Triple contrast CT -scan

GUNSHOT WOUNDS Peritoneal violation Laparotomy Positive Gunshot wounds Equivocal DPL Negative Superficial Observe

SHOTGUN WOUND Close-range Similar to gunshot Shotgun wound Long-range Abdominal X-ray AP and lateral