1. APPROACH TO ABDOMINAL TRAUMA
DR.MOHAMMADZADEH

2. TRAUMA
Trauma is the most common cause of death for ages of 1 & 44 years

3. MECHANISMS OF INJURY
BLUNT TRAUMA
PENETRATING TRAUMA

4. BLUNT TRAUMA Low - energy transfer : High-energy transfer :
struck with a club
falling from a bicycle
falls from short height
High-energy transfer :
auto-pedstrain accident
motor vehicle accident
motor-cycle accident
falls from heights greater than 20 feet

5. PENETRATING TRAUMA Stab wound Gunshot wounds Shotgun wounds
high-velocity injury(bullet speed > 2000 ft/s )
low-velocity injury
Shotgun wounds
close-range (< 7meters )
long-range ( > 7 meters )

8. DIAGNOSTIC PERITONEAL LAVAGE DPL
The most sensitive test for determining of intraabdominal injury
POSITIVE TEST
Aspiration of more than 10 ml of free blood
RBC greater than 100,000/ml
Detection of bile, vegetable or fecal materia
ALK.PH>3IU/L & Amylase> 20 IU/L
Effluent draining from a chest tube,NGT,Fo

9. INDICATION OF DPL Equivocal physical exam
Unexplained shock or hypotention
Altered sensorium(e.g closed-head injury)
General anesthesia for extra abdominal proc
Cord injury

10. CONTRAINDICATION OF DPL
Absolute:
clear indication for laparotomy
Relative :
previous exploratory laparotomy
pregnancy
massive obesity

11. ADVANTAGES OF ULTRASOUND
Noninvasive
Dose not require radiation
Useful in the resucitation room or emergency department
Can be repeated
Used during initial evaluation
Low cost

12. DISADVANTAGES OF ULTRASOUND
Examiner dependent
Obesity
Gas interposition
Lower sensitivity for the fluid <500 ml
False-negative retroperitoneal and hollow viscus injuries

13. ADVANTAGES OF CT-SCAN Adequate assesment of the retroperitoneum
Nonoperative measurment of solid organ injuries
Assesment of renal perfusion
Noninvasive
High specifity

14. DISADVENTAGES OF CT-SCAN
Specialized personnel
Hardware
Duration: helical versus conventional
Hollow viscus injuries
Cost

15. INDICATION OF CT-SCAN Blunt trauma Hemodynamic stability
Normal or unreliable physical examination
Mechanism : duodenal and pancreatic trauma

16. CONTRAINDICATION OF CT-SCAN
Clear indication for exploratory laparotomy
Hemodynamic instability
Agitation
Allergy to cotrast media

17. DECISION MAKING FOR BLUNT ABDOMINAL TRAUMA
Overt peritonitis
Hemoperitoneum
LAPARATOMY

18. HIGH-ENERGY TRANSFER
DPL
POSITIVE
NEGATIVE
LAPAROTOMY
OBSERVE

19. LOW-ENERGY TRANSFER DPL stable v/s Unstable v/s CT-SCAN Major solid
organ
Hollow viscus
Minor solid
organ
LAPAROTOMY
OBSERVE

21. STAB WOUND TO LOWER CHEST AREA
Exploration of wound for diaphragmatic - injury
DPL -
Thoracoscopy -

22. STAB WOUND TO ANTERIOR ABDOMEN
Fascia
intact
D/C HOME
Local wound
exploration
Negative
Observation
Fascia
violated
DPL
Positive
Laparotomy

23. STAB WOUND TO BACK AND FLANK
Frequent examination
DPL
Triple contrast CT -scan

24. GUNSHOT WOUNDS Peritoneal violation Laparotomy Positive Gunshot wounds
Equivocal
DPL
Negative
Superficial
Observe

25. SHOTGUN WOUND Close-range Similar to gunshot Shotgun wound Long-range
Abdominal X-ray
AP and lateral