腹部損傷英文課件

1、Abdominal InjuryAbdominal Injury腹部損傷英文課件腹部損傷英文課件the outlinethe incidence of abdominal injuries in peacetime: 0.4%-1.8% in wartime : 50%the mortality of abdominal injuries is 10%the outlinethe incidence of aTypes of the abdominal injuriesabdominal injuryopen abdominal injuryclosed abdominal injurypen

2、etrating abdominal injurynon-penetrating abdominal injuryIatrogenic injuryTypes of the abdominal injurie腹部損傷英文課件Mechanism of closed injuryDirect impactDeceleration and rotational forcesSpleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.Mechanism of closed inju

3、ryDireMechanism of open injuryStab woundsGunshot woundsLiver, small bowel, stomach and colon are commonly involved in the open abdominal injuries. Mechanism of open injuryStab wThe severity of the injuries and involved organs depend on the intensity , velocity, position and direction of the force .A

4、bdominal anatomic features and the functions of the organs are also important to the injuries. The severity of the injuries aclinical manifestationsabdominal painhemorrhagic shockperitonitisclinical manifestationsabdominabdominal organs injuries are divided to solid and hollow organs injuries.the ma

5、in manifestation of the solid organs injuries is hemorrhage that can lead to shock.the main manifestation of the hollow organs injuries is peritonitis.abdominal organs injuries are Hemorrhage and peritonitis can exist simultaneously,when the injuries involve the 2 kinds of abdominal organs.Hemorrhag

6、e and peritonitis canDiagnosisAccurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests.DiagnosisAccurate diagnosis anwhen we diagnose the injury as the open abdominal injury,we should consider if there is a penetrating injury.when we

7、diagnose the injury asDiagnosis of the closed abdominal injuryDoes the abdominal organ injury exist?Which organ is injuried?whether multiple organs are involved in the abdominal injuries?Diagnosis of the closed abdomiwhen its still difficulty to diagnose, the following measures can be taken.auxiliar

8、y examinationdignostic abdominal paracentesis and peritoneal Lavagex-ray UltrasoundAbdominal computed tomographyMRI, angiography, diagnostic laparoscopy when its still difficulty to observing closely determine the pulse rate, respiratory rate, blood pressure every 15-30 minutes. examine the abdomina

9、l signs every 30 minutes. determine the erythrocyte number, hemoglobin, hematocrit every 30-60 minutes. observing closely exploratory laparotomy The indications for laparotomyAbdominal pain and peritoneal irritation sign aggravate gradually.Bowel tones becomes more weaker,even disappeared.The erythr

10、ocyte number and blood pressure are instability.Gastrointestinal bleedingRefractory shock exploratory laparotomy ThManagement of the abdominal injuryWe should identify and correct any immediate life-threatening conditions and treat with the other anticipate problems.CPR is the most important thing i

11、n the critical case. AAirway BBreathing CCirculation with haemorrhage controlManagement of the abdominal inDont send the exposed abdominal organs back to the peritoneal cavity. Cover them with warm NS soaked gauze.Dont send the exposed abdomiAntishock therapy is a key step in the therapeutic procedu

12、re.If given active antishock therapy, the shock still difficulty to correct, it suggests that there is progressive intraperitoneal hemorrhage, the exploratory laparotomy is necessary.Antishock therapy is a key stIn principle, the laparotomy should explore the abdominal organs in order as the followi

13、ng: the solid organs diaphragma stomach duodenum jejunumileummesentery pelvic organs posterior surface of stomach panceasIn principle, the laparotomy Splenic ruptureSplenic rupture腹部損傷英文課件腹部損傷英文課件The spleen remains the most commonly injured organ.in closed injury:20%40%in open injury: 10%The spleen

14、remains the most coThe 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 .The Magnitude of spleanic rupt Now spleen is recognized as an

15、 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. Now spleen is recognized aTREATMENTInitial ManagementNon operative approach: widely practiced

16、 in pediatric trauma the criteria for nonoperative approachOperative approach: Decision to perform splenctomy or splenorraphy is usually made after assessment & grading the splenic injury.TREATMENTInitial ManagementContraindication for splenic salvage: The patient has protracted hypotension Undue de

17、lay is anticipated in attempting repair the spleen The patient has other severe injuryContraindication for splenic sLiver rupture Liver rupture 腹部損傷英文課件腹部損傷英文課件Operative management - liverGauze packingmay have infective complications (Ivatury RR et al 1986)Omental packingResectional debridementMass

18、liver sutureHepatic artery ligationTotal hepatic isolation - good for retrohepatic venous injuriesAtriocaval shuntOperative management - liverGa腹部損傷英文課件腹部損傷英文課件pancreatic injury pancreatic injury Characteracute abdominal pain because of the chemical peritonitis caused by pancreatic juiceAMY in the b

19、lood and urine difficult to diagnose before the lapartomyCharacterTreatmentkposthesispartial excision and drainageTreatmentGastric injuryGastric injuryCharacterPeritonitispneumoperitoneum TreatmentkposthesisexcisionCharacterDuodenal injuryDuodenal injuryCharacter not injuried easily not noticed easilymostly severe Treatmentkposthesisanastomosisdecompression and drainageCharacterSmall intestine ruptureSmall intestine ruptureCharacter hig