腹部损伤英文课件

AbdominalInjury腹部损伤英文课件AbdominalInjury腹部损伤英文课件1腹部损伤英文课件腹部损伤英文课件2腹部损伤英文课件腹部损伤英文课件3theoutlinetheincidenceofabdominalinjuriesinpeacetime:0.4%-1.8%inwartime:50%themortalityofabdominalinjuriesis10%腹部损伤英文课件theoutlinetheincidenceofa4Typesoftheabdominalinjuriesabdominalinjuryopenabdominalinjuryclosedabdominalinjurypenetratingabdominalinjurynon-penetratingabdominalinjuryIatrogenicinjury腹部损伤英文课件Typesoftheabdominalinjurie5腹部损伤英文课件腹部损伤英文课件6MechanismofclosedinjuryDirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.腹部损伤英文课件MechanismofclosedinjuryDire7MechanismofopeninjuryStabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.腹部损伤英文课件MechanismofopeninjuryStabw8Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.腹部损伤英文课件Theseverityoftheinjuriesa9clinicalmanifestationsabdominalpainhemorrhagicshockperitonitis腹部损伤英文课件clinicalmanifestationsabdomin10abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.腹部损伤英文课件abdominalorgansinjuriesare11Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.腹部损伤英文课件Hemorrhageandperitonitiscan12DiagnosisAccuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.腹部损伤英文课件DiagnosisAccuratediagnosisan13whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.腹部损伤英文课件whenwediagnosetheinjuryas14DiagnosisoftheclosedabdominalinjuryDoestheabdominalorganinjuryexist?Whichorganisinjuried?whethermultipleorgansareinvolvedintheabdominalinjuries?腹部损伤英文课件Diagnosisoftheclosedabdomi15whenit'sstilldifficultytodiagnose,thefollowingmeasurescanbetaken.auxiliaryexaminationdignosticabdominalparacentesisandperitonealLavagex-ray

UltrasoundAbdominalcomputedtomographyMRI,angiography,diagnosticlaparoscopy★腹部损伤英文课件whenit'sstilldifficultyto16★

observingclosely

①determinethepulserate,respiratoryrate,bloodpressureevery15-30minutes.

②examinetheabdominalsignsevery30minutes.③determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.腹部损伤英文课件★observingclosely腹部损伤英文课件17★

exploratorylaparotomy

TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock腹部损伤英文课件★exploratorylaparotomyTh18ManagementoftheabdominalinjuryWeshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwith

theotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.△

A——Airway△

B——Breathing△

C——Circulationwithhaemorrhagecontrol腹部损伤英文课件Managementoftheabdominalin19Don'tsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.腹部损伤英文课件Don'tsendtheexposedabdomi20Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.腹部损伤英文课件Antishocktherapyisakeyst21Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:thesolidorgans→diaphragma→stomach→duodenum→jejunum→ileum→mesentery→pelvicorgans→posteriorsurfaceofstomach→panceas腹部损伤英文课件Inprinciple,thelaparotomy22Splenicrupture腹部损伤英文课件Splenicrupture腹部损伤英文课件23腹部损伤英文课件腹部损伤英文课件24腹部损伤英文课件腹部损伤英文课件25Thespleenremainsthe

most

commonly

injuredorgan.inclosed

injury:20%~40%inopeninjury:10%腹部损伤英文课件Thespleenremainsthemostco26TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.腹部损伤英文课件TheMagnitudeofspleanicrupt27

♣Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskof

overwhelmingpostsplenctomyinfection(OPSI)isgreatestinchildlessthan2yrs.

♣RecognitionofOPSIhasstimulatedeffortsto

Conservespleen

bysplenorrhaphy.

腹部损伤英文课件♣Nowspleenisrecognizeda28TREATMENTInitialManagementNonoperativeapproach:

widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:Decisiontoperform

splenctomyor

splenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.腹部损伤英文课件TREATMENTInitialManagement腹部损29Contraindicationforsplenicsalvage:Thepatienthasprotracted hypotensionUnduedelayisanticipatedin

attempting

repairthespleenThepatienthasothersevereinjury腹部损伤英文课件Contraindicationforsplenics30Liverrupture腹部损伤英文课件Liverrupture腹部损伤英文课件31腹部损伤英文课件腹部损伤英文课件32腹部损伤英文课件腹部损伤英文课件33Operativemanagement-liverGauzepackingmayhaveinfectivecomplications(IvaturyRRetal1986)OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshunt腹部损伤英文课件Operativemanagement-liverGa34腹部损伤英文课件腹部损伤英文课件35腹部损伤英文课件腹部损伤英文课件36pancreaticinjury

腹部损伤英文课件pancreaticinjury腹部损伤英文课件37Character♠acuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuice♠AMYinthebloodandurine↑↑♠difficulttodiagnosebeforethelapartomy腹部损伤英文课件Character腹部损伤英文课件38Treatment☀kposthesis☀partialexcisionanddrainage腹部损伤英文课件Treatment腹部损伤英文课件39Gastricinjury腹部损伤英文课件Gastricinjury腹部损伤英文课件40Character♠Peritonitis♠pneumoperitoneumTreatment☀kposthesis☀excision腹部损伤英文课件Character腹部损伤英文课件41Duodenalinjury腹部损伤英文课件Duodenalinjury腹部损伤英文课件42Character♠notinjuriedeasily♠notnoticedeasily♠mostlysevere

Treatment☀kposthesis☀anastomosis☀decompressionanddrainage腹部损伤英文课件Character腹部损伤英文课件43Smallintestinerupture腹部损伤英文课件Smallintestinerupture腹部损伤英文课44Character♠highincidencerate♠Peritonitisisthemainmanifest.♠pneumoperitoneumTreatment☀Kposthesis☀Partialexcisionandanastomosis☀Thebloodvesselsofintestinalmesentericradixshouldbeanastomosed.腹部损伤英文课件Character腹部损伤英文课件45Colonrupture腹部损伤英文课件Colonrupture腹部损伤英文课件46Character♠thethinintestinalwallandthepoorvascularsupply♠poorhealingfunction♠seriousinfection♠

easytomissingdiagnoseTreatment☀exteriorizetheintestinalcanal☀ColostomyandKposthesis☀sometimesprimarysuture腹部损伤英文课件Character腹部损伤英文课件47Rectalinjury腹部损伤英文课件Rectalinjury腹部损伤英文课件48Charactersaresimilartothecolonrupture.Treatment☀sigmoidostomy☀Kposthesisandanastomoses腹部损伤英文课件Charactersaresimilartothe49Retroperitonealhematoma

腹部损伤英文课件Retroperitonealhematoma

腹部损伤英50Character♠worsecondition♠morecomplicatedinjuries

♠difficultytodiagnoseTreatment☀expectanttreatment☀theexploratorylaparotomy腹部损伤英文课件Character腹部损伤英文课件51AbdominalInjury腹部损伤英文课件AbdominalInjury腹部损伤英文课件52腹部损伤英文课件腹部损伤英文课件53腹部损伤英文课件腹部损伤英文课件54theoutlinetheincidenceofabdominalinjuriesinpeacetime:0.4%-1.8%inwartime:50%themortalityofabdominalinjuriesis10%腹部损伤英文课件theoutlinetheincidenceofa55Typesoftheabdominalinjuriesabdominalinjuryopenabdominalinjuryclosedabdominalinjurypenetratingabdominalinjurynon-penetratingabdominalinjuryIatrogenicinjury腹部损伤英文课件Typesoftheabdominalinjurie56腹部损伤英文课件腹部损伤英文课件57MechanismofclosedinjuryDirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.腹部损伤英文课件MechanismofclosedinjuryDire58MechanismofopeninjuryStabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.腹部损伤英文课件MechanismofopeninjuryStabw59Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.腹部损伤英文课件Theseverityoftheinjuriesa60clinicalmanifestationsabdominalpainhemorrhagicshockperitonitis腹部损伤英文课件clinicalmanifestationsabdomin61abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.腹部损伤英文课件abdominalorgansinjuriesare62Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.腹部损伤英文课件Hemorrhageandperitonitiscan63DiagnosisAccuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.腹部损伤英文课件DiagnosisAccuratediagnosisan64whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.腹部损伤英文课件whenwediagnosetheinjuryas65DiagnosisoftheclosedabdominalinjuryDoestheabdominalorganinjuryexist?Whichorganisinjuried?whethermultipleorgansareinvolvedintheabdominalinjuries?腹部损伤英文课件Diagnosisoftheclosedabdomi66whenit'sstilldifficultytodiagnose,thefollowingmeasurescanbetaken.auxiliaryexaminationdignosticabdominalparacentesisandperitonealLavagex-ray

UltrasoundAbdominalcomputedtomographyMRI,angiography,diagnosticlaparoscopy★腹部损伤英文课件whenit'sstilldifficultyto67★

observingclosely

①determinethepulserate,respiratoryrate,bloodpressureevery15-30minutes.

②examinetheabdominalsignsevery30minutes.③determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.腹部损伤英文课件★observingclosely腹部损伤英文课件68★

exploratorylaparotomy

TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock腹部损伤英文课件★exploratorylaparotomyTh69ManagementoftheabdominalinjuryWeshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwith

theotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.△

A——Airway△

B——Breathing△

C——Circulationwithhaemorrhagecontrol腹部损伤英文课件Managementoftheabdominalin70Don'tsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.腹部损伤英文课件Don'tsendtheexposedabdomi71Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.腹部损伤英文课件Antishocktherapyisakeyst72Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:thesolidorgans→diaphragma→stomach→duodenum→jejunum→ileum→mesentery→pelvicorgans→posteriorsurfaceofstomach→panceas腹部损伤英文课件Inprinciple,thelaparotomy73Splenicrupture腹部损伤英文课件Splenicrupture腹部损伤英文课件74腹部损伤英文课件腹部损伤英文课件75腹部损伤英文课件腹部损伤英文课件76Thespleenremainsthe

most

commonly

injuredorgan.inclosed

injury:20%~40%inopeninjury:10%腹部损伤英文课件Thespleenremainsthemostco77TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.腹部损伤英文课件TheMagnitudeofspleanicrupt78

♣Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskof

overwhelmingpostsplenctomyinfection(OPSI)isgreatestinchildlessthan2yrs.

♣RecognitionofOPSIhasstimulatedeffortsto

Conservespleen

bysplenorrhaphy.

腹部损伤英文课件♣Nowspleenisrecognizeda79TREATMENTInitialManagementNonoperativeapproach:

widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:Decisiontoperform

splenctomyor

splenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.腹部损伤英文课件TREATMENTInitialManagement腹部损80Contraindicationforsplenicsalvage:Thepatienthasprotracted hypotensionUnduedelayisanticipatedin

attempting

repairthespleenThepatienthasothersevereinjury腹部损伤英文课件Contraindicationforsplenics81Liverrupture腹部损伤英文课件Liverrupture腹部损伤英文课件82腹部损伤英文课件腹部损伤英文课件83腹部损伤英文课件腹部损伤英文课件84Operativemanagement-liverGauzepackingmayhaveinfectivecomplications(IvaturyRRetal1986)OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshunt腹部损伤英文课件Operativemanagement-liverGa85腹部损伤英文课件腹部损伤英文课件86腹部损伤英文课件腹部损伤英文课件87pancreaticinjury

腹部损伤英文课件pancreaticinjury腹部损伤英文课件88Character♠acuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuice♠AMYinthebloodandurine↑↑♠d