《腹部损伤英》PPT课件.ppt

Abdominal Injury,the outline,the incidence of abdominal injuries in peacetime: 0.4%-1.8% in wartime : 50% the mortality of abdominal injuries is 10%,Types of the abdominal injuries,abdominal injury,open abdominal injury,closed abdominal injury,penetrating abdominal injury,non-penetrating abdominal injury,Iatrogenic injury,Mechanism of closed injury,Direct impact Deceleration and rotational forces Spleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.,Mechanism of open injury,Stab wounds Gunshot wounds Liver, small bowel, stomach and colon are commonly involved in the open abdominal injuries.,The severity of the injuries and involved organs depend on the intensity , velocity, position and direction of the force . Abdominal anatomic features and the functions of the organs are also important to the injuries.,clinical manifestations,abdominal pain hemorrhagic shock peritonitis,abdominal organs injuries are divided to solid and hollow organs injuries. the main manifestation of the solid organs injuries is hemorrhage that can lead to shock. the main manifestation of the hollow organs injuries is peritonitis.,Hemorrhage and peritonitis can exist simultaneously,when the injuries involve the 2 kinds of abdominal organs.,Diagnosis,Accurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests.,when we diagnose the injury as the open abdominal injury,we should consider if there is a penetrating injury.,Diagnosis of the closed abdominal injury,Does the abdominal organ injury exist? Which organ is injuried? whether multiple organs are involved in the abdominal injuries?,when its still difficulty to diagnose, the following measures can be taken.,auxiliary examination,dignostic abdominal paracentesis and peritoneal Lavage,x-ray,Ultrasound,Abdominal computed tomography,MRI, angiography, diagnostic laparoscopy, observing closely determine the pulse rate, respiratory rate, blood pressure every 15-30 minutes. examine the abdominal signs every 30 minutes. determine the erythrocyte number, hemoglobin, hematocrit every 30-60 minutes., exploratory laparotomy,The indications for laparotomy Abdominal pain and peritoneal irritation sign aggravate gradually. Bowel tones becomes more weaker,even disappeared. The erythrocyte number and blood pressure are instability. Gastrointestinal bleeding Refractory shock,Management of the abdominal injury,We should identify and correct any immediate life-threatening conditions and treat with the other anticipate problems. CPR is the most important thing in the critical case. AAirway BBreathing CCirculation with haemorrhage control,Dont send the exposed abdominal organs back to the peritoneal cavity. Cover them with warm NS soaked gauze.,Antishock therapy is a key step in the therapeutic procedure. If given active antishock therapy, the shock still difficulty to correct, it suggests that there is progressive intraperitoneal hemorrhage, the exploratory laparotomy is necessary.,In principle, the laparotomy should explore the abdominal organs in order as the following: the solid organs diaphragma stomach duodenum jejunumileummesentery pelvic organs posterior surface of stomach panceas,Splenic rupture,The spleen remains the most commonly injured organ. in closed injury:20%40% in open injury: 10%,The Magnitude of spleanic rupture depend on patient age, injury mechanism and presence of underlying disease . The Magnitude of spleanic rupture depend on patient age, injury mechanism and presence of underlying disease .,Now spleen is recognized as an important immunologic factory. The risk of overwhelming postsplenctomy infection (OPSI) is greatest in child less than 2 yrs. Recognition of OPSI has stimulated efforts to Conserve spleen by splenorrhaphy.,TREATMENT,Initial Management Non operative approach: widely practiced in pediatric trauma the criteria for nonoperative approach Operative approach: Decision to perform splenctomy or splenorraphy is usually made after assessment & grading the splenic injury.,Contraindication for splenic salvage:, The patient has protracted hypotension Undue delay is anticipated in attempting repair the spleen The patient has other severe injury,Liver rupture,Operative management - liver,Gauze packing may have infective complications (Ivatury RR et al 1986) Omental packing Resectional debridement Mass liver suture Hepatic artery ligation Total hepatic isolation - good for retrohepatic venous injuries Atriocaval shunt,pancreatic injury,Character acute abdominal pain because of the chemical peritonitis caused by pancreatic juice AMY in the blood and urine difficult to diagnose before the lapartomy,Treatment kposthesis partial excision and drainage,Gastric injury,Character Peritonitis pneumoperitoneum Treatment kposthesis excision,Duodenal injury,Character not injuried easily not noticed easily mostly severe Treatment kposthesis anastomosis decompression and drainage,Small intestine rupture,Character high incidence rate Peritonitis is the main manifest. pneumoperitoneum Treatment Kposthesis Partial excision and anastomosis The blood vessels of intestinal mesenteric radix should be anastomosed.,Colon rupture,Character the thin intestinal wall and the poor vascular supply poor healing function serious infection easy to missing diagnose Treatment exteriorize the intestinal canal Colostomy and Kposthesis sometimes primary