Abdominal Trauma

Oleh :

Dr. A. Aziz, Sp.B-KBD

Disajikan pada Pelatihan Penanggulangan Penderita Gawat

Darurat (PPGD) RSD Raden Mattaher Jambi tanggal 28 November

2005 s/d 04 Desember 2005

Objectives

Describe external and internal anatomy

Recognize blunt vs penetrating injury Patterns

Indentify signs different types of injuries

Apply diagnostic and therapeuti

Procedures

Demonstrate and discuss DPL

Abdominal Trauma

Unrecognized injury : Cause of

preventable death

Exam compromised by

• Alcohol, illicit drugs

• Injury to brain, spinal cord

• Injury to ribs, spine, pelvis

Anatomy

External

Anterior abdomen

Flank

Back

Anatomy

Mechanism of injury

Blunt

Spleen, liver, and Hollow viscus

Compression

Crushing

Shearing

Deceleration (fixed organs)

Mechanism of injury

Penetrating

Liver , small bowel, and colon

Laceration / low energy

Kinetic energy / high energy

Assessment : History

Blunt

Speed

Point of impact

Intrusion

Safety devices

Position

Ejection

Penetrating

Weapon

Distance

Assessment : Physical Exam

Inspection

Percussion

Palpation

Auscultation

Assessment : Physical Exam

Local wound exploration by surgeon

Pain over bony pelvis

Genitourinary, perineal, rectal,vaginal

and gluteal

Adjuncts : Intubation

Gastric Tube

Relieves dilatation

Decompresses stomach before DPL

Basilar skull/facial fractures

My induce vomiting/ aspiration

Adjuncts : Intubation

Urinary Catheter

Monitors urinary output

Decompresses bladder before DPL

Diagnostic

Urethral injury

Adjuncts : x – ray Studies

Routine

Blunt : AP chest, pelvis

Penetrating : AP chest, abdomen with

markers (if hemodynamically normal)

Contrast

Urethrogram

Cystogram

GI

IVP

Special Studies in Blunt Trauma

DPL US* CT

Time Rapid Rapid Delayed

Transport No No Required

Sensitivity High High? High

Specificity Low Intermediate High

Eligibility All

patients

All patients Hemodyna

mically normal

Indications for Celiotomy

Blunt

+ DPL or ultrasound

↓BP suspected

visceral injury

Peritonitis

Penetrating

+ DPL or ultrasound

Peritoneal/

retroperitoneal injury

Peritonitis

Hypotension

Evisceration

Indications for Celiotomy

Plain X – ray

Free air

Retroperitoneal air

Ruptured diaphragm

Indications for Celiotomy

Special Studies

CT scan : Free air, visceral injury ? Fluid?

Cystogram : Bladder rupture, intraperitoneal

injury

Arteriogram: Renal pedicle occlusion

Upper GI : Duodenal rupture

Special Problems : Blunt Trauma

Diaphragm :

Duodenum/

small bowel :

Pancreas :

GU :

Abnormal chest x –ray

Retroperitoneal air, contrast

seat belt sign, chance

fracture ,free air

Amylase ?, CT ?

Extravasation of contras

nonfunctioning renal

Pelvic Fractures

Significant force

applied

Associated injuries

Pelvic bleeding

• Ends of bones

• Pelvic muscles

• Veins/arteries

Pelvic Fractures

Mechanism

Ap compression

Lateral

compression

Vertical shear

Classification

Open

Closed

Pelvic Fractures

Assessment

Inspection

Palpate prostate

Pelpiv ring

• Leg-length disrepancy , external rotation

• Pain on palpation of bony pelvic ring

• AP x - ray

Pelvic Fractures : Management

Resuscitate

Transfer as needed with PASG

Determine if intraperitoneal hermorrhage

Operation

Control hemorrhage Fixation device

Possible angiography

Questions

Summary

ABCDEs

Delineate mechanism

Repeated exams

Diagnostics as needed

High index of suspicion

Early recognition /prompt celiotomy