腹部损伤英文

1、腹部损伤英文 腹部损伤英文 腹部损伤英文 腹部损伤英文 the outline the incidence of abdominal injuries in peacetime: 0.4%-1.8% in wartime : 50% the mortality of abdominal injuries is 10% 腹部损伤英文 Types of the abdominal injuries abdominal injury open abdominal injury closed abdominal injury penetrating abdominal injury non-penet

2、rating abdominal injury Iatrogenic injury 腹部损伤英文 腹部损伤英文 Mechanism of closed injury Direct impact Deceleration and rotational forces Spleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs. 腹部损伤英文 Mechanism of open injury Stab wounds Gunshot wounds Liver, small bowe

3、l, stomach and colon are commonly involved in the open abdominal injuries. 腹部损伤英文 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.

4、 腹部损伤英文 clinical manifestations abdominal pain hemorrhagic shock peritonitis 腹部损伤英文 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 injurie

5、s is peritonitis. 腹部损伤英文 Hemorrhage and peritonitis can exist simultaneously,when the injuries involve the 2 kinds of abdominal organs. 腹部损伤英文 Diagnosis Accurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests. 腹部损伤英文 when we diagnose

6、 the injury as the open abdominal injury,we should consider if there is a penetrating injury. 腹部损伤英文 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? 腹部损伤英文 when its still difficul

7、ty 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 腹部损伤英文 observing closely determine the pulse rate, respiratory rate, blood pressur

8、e every 15-30 minutes. examine the abdominal signs every 30 minutes. determine the erythrocyte number, hemoglobin, hematocrit every 30-60 minutes. 腹部损伤英文 exploratory laparotomy The indications for laparotomy Abdominal pain and peritoneal irritation sign aggravate gradually. Bowel tones becomes more

9、weaker,even disappeared. The erythrocyte number and blood pressure are instability. Gastrointestinal bleeding Refractory shock 腹部损伤英文 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 m

10、ost important thing in the critical case. AAirway BBreathing CCirculation with haemorrhage control 腹部损伤英文 Dont send the exposed abdominal organs back to the peritoneal cavity. Cover them with warm NS soaked gauze. 腹部损伤英文 Antishock therapy is a key step in the therapeutic procedure. If given active a

11、ntishock therapy, the shock still difficulty to correct, it suggests that there is progressive intraperitoneal hemorrhage, the exploratory laparotomy is necessary. 腹部损伤英文 In principle, the laparotomy should explore the abdominal organs in order as the following: the solid organs diaphragma stomach d

12、uodenum jejunumileummesentery pelvic organs posterior surface of stomach panceas 腹部损伤英文 Splenic rupture 腹部损伤英文 腹部损伤英文 腹部损伤英文 The spleen remains the most commonly injured organ. in closed injury:20%40% in open injury: 10% 腹部损伤英文 The Magnitude of spleanic rupture depend on patient age, injury mechanis

13、m and presence of underlying disease . The Magnitude of spleanic rupture depend on patient age, injury mechanism and presence of underlying disease . 腹部损伤英文 Now spleen is recognized as an important immunologic factory. The risk of overwhelming postsplenctomy infection (OPSI) is greatest in child les

14、s than 2 yrs. Recognition of OPSI has stimulated efforts to Conserve spleen by splenorrhaphy. 腹部损伤英文 TREATMENT Initial ManagementInitial Management Non operative approachNon operative approach: widely practiced in pediatric trauma the criteria for nonoperative approach Operative approach: Operative

15、approach: Decision to perform splenctomy or splenorraphy is usually made after assessment & grading the splenic injury. 腹部损伤英文 Contraindication for splenic salvage:Contraindication for splenic salvage: The patient has protracted hypotension Undue delay is anticipated in attempting repair the spleen

16、The patient has other severe injury 腹部损伤英文 Liver rupture 腹部损伤英文 腹部损伤英文 腹部损伤英文 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 retro

17、hepatic venous injuries Atriocaval shunt 腹部损伤英文 腹部损伤英文 腹部损伤英文 pancreatic injury 腹部损伤英文 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 腹部损伤英文 Treatment kposthesis partial excision and

18、drainage 腹部损伤英文 Gastric injury 腹部损伤英文 Character Peritonitis pneumoperitoneum Treatment kposthesis excision 腹部损伤英文 Duodenal injury 腹部损伤英文 Character not injuried easily not noticed easily mostly severe Treatment kposthesis anastomosis decompression and drainage 腹部损伤英文 Small intestine rupture 腹部损伤英文 Character hi