abdominal trauma
DESCRIPTION
Abdominal Trauma. Abdominal Trauma. Etiology: Blunt injuries: 90% Automobile injuries - 60 % ≥90% = survive 22% = death Penetrating abdominal trauma : 10 % G unshot or stab wound. Pediatric Trauma Pathophysiology , Diagnosis, and Treatment edited by DAVID E. WESSON. - PowerPoint PPT PresentationTRANSCRIPT
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Abdominal Trauma
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Abdominal Trauma
Etiology:– Blunt injuries: 90%• Automobile injuries - 60%• ≥90% = survive• 22% = death
– Penetrating abdominal trauma: 10% • Gunshot or stab wound
Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON
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Factors that make children vulnerable to abdominal injury:
• Abdominal wall and lower rib cage are thin in children
• Liver and kidneys lie relatively lower in the abdomen
• Kidneys and pancreas lie only a short distance away from the abdominal wall in thin children
• Liver occupies a large percentage of the abdominal cavity
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Key Components of Abdominal Assessment
• INSPECTION
• AUSCULTATION
• PALPATION
• PAIN ASSESSMENT
• RESPIRATION
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Diagnostic Procedures
• Laboratory Tests:– CBC• Hemoglobin and hematocrit• maintain Hct >30%
– Serum Amylase– Urinalysis– Transaminase– Blood typing and crossmatching– Peritoneal Lavage
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Radiological Studies
• Supine and Upright abdominal films (Upright CXR)– free air in the abdomen (pneumoperitoneum)– extent of injury in penetrating trauma
• CT Scan– diagnostic test of choice – solid organ injuries– grade of injury
Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON
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Conservative Approach
• Assessment should include determination:– level of consciousness (GCS) – Vital signs– palpation and auscultation of the abdomen – accurate intake and output measurement
• Patient Stabilization: aggressive volume expansion
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Surgical Intervention
• Indications for surgery:– blood transfusions of 40 ml/kg or 50% of
circulating blood volume is required– most penetrating injuries– inability to achieve hemodynamic stability even
after aggressive fluid and blood replacement – severe abdominal distention accompanied by
hypotension
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Types of Abdominal Injuries
1. Solid Organ Injury• Liver• Spleen
2. Pancreatic Injury3. Stomach and Intestinal Injury
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LIVER INJURY
• Most fatal due to the potential for massive hemorrhage
• Signs and Symptoms:– Pain in right upper shoulder– Pain and tenderness in right upper quadrant of
abdomen– Bruising, abrasions and seatbelt marks– Vital Signs: hypotension with major bleeding
Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON
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• Conservative – Standard practice for stable pediatric patients– monitored for at least 48 hours– Strict bedrest for 7 days with serial H and H– Limit activity for 2-3 months after discharge
• Surgical– control of massive bleeding or liver resection– Indications:
• Child continues to deteriorate • more than 50% of the circulating blood volume requires replacement
within 24 hours
Pediatric Trauma Pathophysiology, Diagnosis, and Treatment edited by DAVID E. WESSON
Management
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SPLENIC INJURY
• Blow to the LUQ/epigastric region of the abdomen
• Signs and Symptom:• Abdominal tenderness and pain • Kehr’s Sign (pain in the left shoulder)• Pain in left part of chest with respirations• Decreased breath sounds• Turner sign (ecchymoses in the left flank)• Cullen sign (ecchymoses around the umbilicus)
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Management• Preservation of the spleen to prevent the occurrence of
postsplenectomy sepsis
• Conservative– Standard practice for stable pediatric patients– Receives ≤ 50% blood volume replacement– Monitored in the ICU for at least 48 hours
• Surgical (splenorrhaphy or splenectomy)– Hemodynamic instability after aggressive fluid resuscitation– Continued blood loss– Separation of the spleen from its blood supply– Severe head injury that cannot tolerate volume resuscitation
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The decision to operate for spleen or liver injury, which should always be made by a surgeon, is best based on clinical signs of continued blood loss such as:– low blood pressure, – elevated heart rate, – decreased urine output, and – falling hematocrit
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PANCREATIC INJURY
• uncommon in children• difficult to diagnose
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• Conservative– complete gastrointestinal rest
• Surgery– pancreatic duct is transected requiring a partial or
total pancreatectomy
Management
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STOMACH AND INTESTINAL TRAUMA
• contusions, lacerations, hematomas or perforation
• Signs of hollow organ injury:– abdominal tenderness, ecchymosis of the upper
and lower abdomen, bloody gastric drainage
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Management
• Surgery