1m.a.kubtan. 2 what is torso : the body excluding the head and neck and limbs m.a.kubtan3

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Page 1: 1M.A.Kubtan. 2 What is TORSO : The body excluding the head and neck and limbs M.A.Kubtan3

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What is TORSO :The body excluding the head and neck and

limbs

TORSO TRAUMA

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What is trauma ?

The medical problems associated with physical injury .

Injury is the adverse effect of physical force upon a person .

Forces that can lead to injury include : mechanical , thermal ,ionizing radiation , and chemical .

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The Troso is generally regarded as the area between the neck and the groin ,made up of the thorax and abdomen .

Division of the body into abdomen and thorax is artificial .

Injury to the troso is more appropriate. Our aim is restoration of normal

physiology . Accordingly trauma surgery requires

knowledge of anatomy and physiology .

Introduction

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Between the neck and the thorax . Between the thorax and the abdomen . Between the abdomen and the pelvic

structures and the groin .

This zones represent surgical challenges in terms of diagnosis of the area of injury and surgical approach .

It is related and balanced against the physiological stability of the patient .

Junctional zones

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Patients who have suffered abdominal injury can be generally classified into :

Haemodynamiclly normal . Haemodinamiclly stable . Haemodynamically unstable .

Abdominal Injury

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A B C D E of trauma care

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Cardiovascular status . Radiological imaging . Stable patient may be able to have CT

scan . Evaluation of torso trauma .

Investigation

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CT scan with intravenous contrast most valuable ( however in unstable patient it not always possible ) .

DPL Diagnostic peritoneal lavage . the presence of > 100 000 red cells /micro liter

or > 500 white cells in the peritoneal washout is an indication of intraperitoneal bleeding and this is equivalent to 20 ml of free blood in the abdominal cavity .

Drainage of peritoneal lavage fluids via chest drain is an indication of penetration of diaphragm .

Diagnostic tools

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When positive it means that there is free blood in the peritoneal cavity .

Negativity does not rule out the presence of blood in the peritoneal cavity .

4 quadrant tap

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FAST Focused abdominal sonar for trauma . FAST is a technique whereby US imaging is used

to assess the TORSO for the presence of blood . This technique focuses on four areas : Pericardial, Splenic , Hepatic , Pelvic .FAST is accurate for the detection of < 100 ml of

free blood in the peritoneom .It is extremely dependent on the operator

experience .

FAST

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FAST

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CT is the gold standered for the intra-abdominal diagnosis in the stable patient .

CT is performed using intravenous and often oral contrast as well .

CT has the advantages of sensitivity for the diagnosis of retroperitoneal injury .

CT is usually sufficient to exclude injury .

Computerized Tomography

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DL is valuable screening investigation in penetrating trauma .

DL of course in stable patient s following an abdominal or thoraco-abdominal stab wound .

DL is not appropriate for use in the unstable patient .

DL is difficult to exclude all intra-abdominal injuries laparoscopic ally .

DL is not a substitute for open laparatomy especially in the presence of haemoperitonium or contamination.

DL Diagnostic Laparoscopy

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Liver The majority of livers injuries occur as a result

of blunt injury which may burst liver . The use of CT for the evaluation of trauma

patient ( liver , spleen , kidneys ) . The liver is a solid organ and may be

compressed between the forces and the rib cage or vertebral column.

Penetrating trauma relatively common ( stab wound , bullets cause significant damage ).

Not all penetrating wounds require operative management.

Individual Organ Injury

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Push : direct compression . Pringle : The inflow from the portal triad

is controlled by pringle maneuver . Plug :any holes can be plugged directly . Pack .

Management of liver injury

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Occur mainly from penetrating trauma . Common bile duct injuries often associate

with portal vein injury .

Biliary injuries

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Splenic injury occurs from direct trauma , Overlaying ribs ( ninth to 11th ribs ) . Most isolated splenic injuries espacially in children can

be managed non operatively . In adults in the presence of other injuries laparatomy

may become indicated depending on physiological instability .

At laparatomy direct splenorrhaphy , or packed , repaired or placed in a mesh bag.

Selective embolisation of spleen can play a role . Following splenectomy : changes in blood

physiology ,raised platelets count > 1000000 , and white cell count rises and mimic sepsis.

Spleen

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Due to blunt trauma . CT scan the main test of value . Amylase may be low or normal ( low

amylase in 50% of cases .) . Treatment : conservative , closed suction

drainage , distal pancreatectomy , Wipple,s procedures .

Pancreas

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Renal and urological tract Injury

Major abdominal vessels Injury

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Stomach . Duodenum . Small bowel . Colon . Rectum.

hollow viscus

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