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Abdominal Trauma


Signs

  • Skin bruising
  • Clothing imprints
  • Hypotension
  • Abdominal tenderness & distension
  • Fractures lower left ribs suggest ruptured spleen
  • Pelvic fractures may be associated with bladder and urethral injuries
  • Haematuria suggests injury to urinary tract

Blunt

  • Suspect injury to an abdominal viscus in any blunt injury to thorax or abdomen
  • Physical signs difficult to interpret because of abdominal wall tenderness

Penetrating

  • Suspect injury to an abdominal organ in penetrating injuries between nipple and perineum
  • Look carefully for entry and exit wounds
  • Size of skin wound no guide to internal damage
  • High velocity bullets injury widely and deeply, low velocity confined to track
  • All penetrating abdominal wounds should be explored under local anaesthesia

Investigations

  • Plain radiographs
    • Free gas
    • Fractures of pelvis, rib
    • Obliteration of psoas shadows
  • Chest X-ray
    • Rib fractures
    • Pneumothorax
    • haemothorax
  • Peritoneal lavage
    • heavy blood-staining suggests intra-abdominal injury
    • bile-staining, cloudiness or particulate suggests ruptured viscus
  • USS
    • Useful for liver, kidney, spleen
  • IVU
    • if haematuria
  • Urethrography

Treatment

  • Resuscitate
  • Abx, tetanus prophylaxis
  • Explore
    • all penetrating
    • blunt if evidence of rupture/bleeding
  • Laparotomy

Specific Organs

  • Spleen
  • Liver
  • Pancreas
  • Stomach, duodenum, small bowel
  • Large Bowel
 

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