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
- 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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