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Abdominal trauma

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Title: Abdominal trauma  
Author: World Heritage Encyclopedia
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Subject: Ballistic trauma, Pulmonary contusion, Head injury, Secondary sclerosing cholangitis, Uterine perforation
Collection: Injuries of Abdomen, Lower Back, Lumbar Spine and Pelvis, Medical Emergencies
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Abdominal trauma

Abdominal trauma
Abdominal trauma resulting in a right kidney contusion (open area) and blood surround the kidney (closed arrow) as seen on CT.
Classification and external resources
ICD-10 S30-S39
ICD-9-CM 868
eMedicine med/2805 emerg/1
MeSH D000007
The abdominal organs

Abdominal trauma is an injury to the abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery.[1] Injury to the lower chest may cause splenic or liver injuries.[2]

Contents

  • Classification 1
  • Signs and symptoms 2
  • Causes 3
  • Pathophysiology 4
    • Liver 4.1
    • Spleen 4.2
    • Pancreas 4.3
    • Kidneys 4.4
    • Bowel 4.5
  • Diagnosis 5
    • CT 5.1
  • Treatment 6
  • Prognosis 7
  • Epidemiology 8
  • References 9
  • Bibliography 10

Classification

Abdominal trauma is divided into blunt and penetrating types. While penetrating abdominal trauma (PAT) is usually diagnosed based on clinical signs, diagnosis of blunt abdominal trauma is more likely to be delayed or altogether missed because clinical signs are less obvious.[1] Blunt injuries predominate in rural areas, while penetrating ones are more frequent in urban settings.[3] Penetrating trauma is further subdivided into stab wounds and gunshot wounds, which require different methods of treatment.[4]

Signs and symptoms

Pneumoperitoneum, seen as an air bubble on the lower left side of the X-ray film

People injured in

Bibliography

  1. ^ a b c d e f g h i j k
  2. ^
  3. ^ a b c d e f g h i j k l m
  4. ^ a b c d e f g h i
  5. ^ a b c d e f g h i j k l m n o p q r s
  6. ^ a b c
  7. ^ Chih, p.343
  8. ^ a b c Hemmila, p. 231
  9. ^ a b Chih, pp. 346–348
  10. ^ a b c d
  11. ^
  12. ^ a b c d e f g h
  13. ^
  14. ^ Demetriades D, Velmahos G, Cornell E 3rd, et al. Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132:178–183
  15. ^ Goodman CS, Hur JY, Adajar MA, Coulam CH., How well does CT predict the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury? A review and meta-analysis., AJR Am J Roentgenol. 2009 Aug;193(2):432-7.
  16. ^
  17. ^
  18. ^

References

Most deaths resulting from abdominal trauma are preventable;[3] abdominal trauma is one of the most common causes of preventable, trauma-related deaths.[4]

Epidemiology

If abdominal injury is not diagnosed promptly, a worse outcome is associated.[1] Delayed treatment is associated with an especially high morbidity and mortality if perforation of the gastrointestinal tract is involved.[12]

Prognosis

Initial treatment involves stabilizing the patient enough to ensure adequate airway, breathing, and circulation, and identifying other injuries.[4] Surgery may be needed to repair injured organs. Surgical exploration is necessary for people with penetrating injuries and signs of peritonitis or shock.[3] Laparotomy is often performed in blunt abdominal trauma,[1] and is urgently required if an abdominal injury causes a large, potentially deadly bleed.[3] The main goal is to stop any sources of bleeding before moving onto any definitive find and repair any injuries that are found.[16] Due to the time sensitive nature, this procedure also emphasizes expedience in terms of gaining access and controlling the bleeding, thus favoring a long midline incession.[17] Intra-abdominal injuries are also frequently successfully treated nonoperatively[4][5] as there is little benefit shown if there is no known active bleeding of potential for infection.[18] The use of CT scanning allows care providers to use less surgery because they can identify injuries that can be managed conservatively and rule out other injuries that would need surgery.[4] Depending on the injuries, a patient may or may not need intensive care.[5]

Treatment

CT is only able to detect 76% of hollow viscous injuries and patients who have negative scans must often be observed and rechecked if they deteriorate.[13] However, CT has been demonstrated to be useful in screening patients with certain forms of abdominal trauma in order to avoid unnecessary laparotomies, which can significantly increase the cost and length of hospitalizations.[14] A meta-analysis of CT use in penetrating abdominal traumas demonstrated sensitivity, specificity and accuracy >= 95%, with a PPV of 85% and an NPV of 98%.[15] This suggests that CT is excellent for avoiding unnecessary laparotomies but must be augmented by other clinical criteria to determine the need for surgical exploration (23.37 positive likelihood ratio, 0.05 negative likelihood ratio).

CT

[3] may also be performed if other diagnostic methods do not yield conclusive results.laparotomy or exploratory laparoscopy Diagnostic [5] However, people with abdominal trauma frequently need CT scans for other trauma (for example, head or chest CT); in these cases abdominal CT can be performed at the same time without wasting time in patient care.[1] CT scanning is the preferred technique for people who are not at immediate risk of shock, but since ultrasound can be performed right in an emergency room, the latter is recommended for people who are not stable enough to move to CT scanning.[5] and relatively safe for the patient.procedure and it is a noninvasive [1] Ultrasound can detect fluid such as blood or gastrointestinal contents in the abdominal cavity,[1] One study found that ten percent of

CT scan showing the liver and a kidney

Diagnosis

The small intestine takes up a large part of the abdomen and is likely to be damaged in penetrating injury.[3] The bowel may be perforated.[5] Gas within the abdominal cavity seen on CT is understood to be a diagnostic sign of bowel perforation; however intra-abdominal air can also be caused by pneumothorax (air in the pleural cavity outside the lungs that has escaped from the respiratory system) or pneumomediastinum (air in the mediastinum, the center of the chest cavity).[5] The injury may not be detected on CT.[5] Bowel injury may be associated with complications such as infection, abscess, bowel obstruction, and the formation of a fistula.[5] Bowel perforation requires surgery.[5]

Bowel

The kidneys may also be injured; they are somewhat but not completely protected by the ribs.[6] Kidney lacerations and contusions may also occur.[12] Kidney injury, a common finding in children with blunt abdominal trauma, may be associated with bloody urine.[12] Kidney lacerations may be associated with urinoma or leakage of urine into the abdomen.[5] A shattered kidney is one with multiple lacerations and an associated fragmentation of the kidney tissue.[5]

A large hematoma (closed arrow) of the left kidney (open arrow)

Kidneys

The pancreas may be injured in abdominal trauma, for example by laceration or contusion.[5] Pancreatic injuries, most commonly caused by bicycle accidents (especially by impact with the handlebars) in children and vehicular accidents in adults, usually occur in isolation in children and accompanied by other injuries in adults.[5] Indications that the pancreas is injured include enlargement and the presence of fluid around the pancreas.[5]

Pancreas

Spleen is the most common damaged organ in blunt abdominal trauma. The renal artery.[3] Fractures of the left lower ribs are associated with spleen lacerations in 20 percent of cases.[8]

Spleen

[8] to stop the bleeding.emergency surgery (bleeding to death), requiring exsanguination If severely injured, the liver may cause [12], usually without serious consequences.bile It may leak [12], and a hematoma may develop.contused or lacerated The liver may be [12] The

Liver

One or more of the intra-abdominal organs may be injured in abdominal trauma. The characteristics of the injury are determined in part by which organ or organs are injured.

[3] and systemic infection are the main causes of deaths that result from abdominal trauma.Hemorrhage [3] Abdominal trauma can be life-threatening because abdominal organs, especially those in the

Pathophysiology

Gunshot wounds, which are higher energy than stab wounds, are usually more damaging than the latter.[9] Gunshot wounds that penetrate the peritoneum result in significant damage to major intra-abdominal structures in some 90 percent of cases.[9]

[6].traumatic brain injury and is the second leading cause of child abuse-related death, after child abuse Abdominal injury may result from [5] Falls and sports are also frequent mechanisms of abdominal injury in children.[4] Seat belts reduce the incidence of injuries such as [3] Motor vehicle collisions are a common source of blunt abdominal trauma.

Causes

Injuries associated with intra-abdominal trauma include rib fractures, vertebral fractures, pelvic fractures, and injuries to the abdominal wall.[8]

[7]

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