Abdominal Trauma

INTRODUCTION
Abdomina trauma is an injury to the abdomen and is one of the leading
cause of death and disability.
Indentifying serious intra-abdominal pathology can be chellenge, because
pacient whit abdominal trauma require rapid assessment , stabilization, and
early surgical consultation.
Initial management of all trauma patients should be same, assessing the
airway, breathing, circulation, disability and exposures (ABCDEs) of trauma.
While Airway is first in trauma algorithm, Circulation needs to be
simultaneously assessed.
 Types of Injury
There are different types of trauma .
The types are classified according to the mechanism of
trauma.
1.Blunt Trauma
This cand result from either compression( secondary to a direct
blow or against a fixed external objecteg, a seat belt), or from
deceleration forces. The liver and spleen are the most
frequently damaged organs.
 2.Penetrating Injuries:
Penetrating abdominal trauma are most commonly caused
by knife or gun.
a)A gunhot wound is associated whith high energy transfer
and the extent of intra abdominal injuries is difficult to
predict. Are frequently associated with massive tissue
damage.

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Stab wound can be inflicted by many objects other than
knives, including needles, garden forks, wire.
 Pathophysiology
Abdominal trauma can be life-threatening because
abdominal organs, especially those in the retroperitoneal
space, can beed profusely, and the spage cand hold a
great deal of blood.
Solid abdominal organs, such as liver,spleen and kidneys
bleed profusely as do major blood vessel such as the aorta
and vena cava.
Gastrointestinal organs such as the bowel, stomach can
spill theis content into abdominal cavity and can result
serious risk of systemic infection.
Hemorrhage and systemic infection are the main cause of
deaths that result from abdominal trauma.
 Spleen Injuries
Is the most common cause of massive bleeding and the
most commonly injured organ in blunt abdominal trauma to
a solid organ.
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A lacerations of spleen may be associated with hematoma.
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Because of the speen;s ability to profusely, a ruptured
spleen can be life-threatening, resulting in SHOCK.
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Is associated with fractures of the left lower ribs.
 Liver injuries
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Because of its size and location, the liver is the second most
commonly injuured organ in blunt abdominal trauma,
accounting for approximately 8-25% of all intra-abdominal
injuries.
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Liver injuries present a serious risk for shock because the liver
tissue is delicate and has a large blood supply and capacity.
The liver may be lacerated of contused and a hematoma may
develop.
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If severely injured, the liver may cause exanguination(bleeding
to death), requiring emergency surgery to stop the bleeding.
 Renal injuries
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After the spleen and liver, the kidney are the
third most commonly injured solid organ in blunt
abdominal trauma.
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Gross hematuria is tipically indicative of
urologic injury. This could include the kidneys,
ureters, bladder, urethra, or external genitalia.
 Pancreatic injuries
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Uncommon and usually seen after blunt trauma
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Pacients may present with epigastric or back pain
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Serum pacreatic enzyme leves demonstrate only
averange sensitivity and specificity
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It occurs in both penetrating and blunt trauma.
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The pancreas may be lacerated, contused, transected
or comminuted.
 Diaphragmatic injuries
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Rupture may be secondary to blunt or
penetrating forces
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Diaphragmatic ruptures occurs predominantly
on the left side because the right
hemidiaphragm is better protected by the liver
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The delayed diagnosis of diagragmatic injury
can lead to potential herniation and
strangulation of visceral abdominal contents.
 DIAGNOSTIC
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Assessment of hemodynamic stability is the
most important initial concern in the evaluation
of a patient with blunt abdominal trauma.
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In the hemodynamically UNSTABLE patient a
rapid evaluation for hemoperitoneum can be
accomplished be means of diagnostic
peritoneal lavage (DPL) or the focused
assesment with sonography for trauma FAST
 FAST
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Ultrasonography has emerged as the primary initial
diagnostic examination of the abdomen in multisystem
blunt trauma patients .
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The FAST examination has high specificity 99% to
detect hemoperitoneum and can detect as little as 250
ml of blood in the pritoneal cavity
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First the FAST examination evaluates intraperitoneal
blood and poorly visualizes blood in the
retroperitoneum.
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Important if the FAST is negativ does a mean that
there is no bleeding or injuries.
 CT SCAN
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Hemodynamically stable trauma patient,
computer tomography scanning is an execellent
diagnostic modality that is easy to perform.
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Contraindications to CT scanning in trauma
include hemodynamic instability or clear
indication for exploratory laparotomy.
 Laboratory Evaluation
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FBC – haemoglobin and hematocrit result
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Blood type,screen and crossmatch – until
crossmatch is available, use 0 negative or type
– specific blood
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Coagulation profile – obtain prothrombin
time(PT)/activated partial theromboplastin
time(aPTT)
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Arterial blood gass (ABG) – to see acidaemia
result from lactic acidosis that accompanies
shock.
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Abdominal laboratory tests including hepatic
function panel, pancreatic enzimes lipase
amilase .
 Treatment
Abdominal trauma requires urgent medical attention and
hospitalization.
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The initial involves stabilizing the person enough to ensure
adequate airway, breathing and circulation and identifying other
injuries.
 A. Fluid Resuscitation
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Monitoring and addressing hemodynamic instability is
an important part of treating abdominal trauma.
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Currently CRYSTALLOID fluids are recommended as
FIRST line agent for trauma resuscitation
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Blood products – including packed red blood cells
(RBCs), fresh frozen PLASMA(FFP) and plateles may-
may be indicated in pontentially uncontrolabe
hemorrage.
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The use of 1 g of tranexamic acid TXA is
demonstrated an overall reduction in mortality of
1.5%in pacient.
 B. LAPAROTOMY
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Hemodynamically unstable pacients sustaining blunt or
penetrating intra-abdominal trauma with a positive FAST
usually warrant an emergent surgical laparotomy to control
hemorrage and further evaluate for intra-abdominal
injuries.
Cases in Emergency Department
 BIBLIOGRAPHY
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CURRENT Diagnosis and Treatment
Emergency Medicine 8th Edition
Section III Trauma Emercencies
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Tintinalli’s Emergency Medicine a
Comprehensive Study Guide
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European Resuscitation Council
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Advanced Trauma Life Support