腹部损伤英文课件.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Abdominal Injury,the outline,the incidence of abdominal injuries in peacetime:0.4%-1.8%,in wartime :50%,the mortality of abdominal injuries is 10%,Types of the abdominal injuries,abdominal injury,open abdominal,injury,closed abdominal injury,p,enetrating abdominal,injury,non-penetrating abdominal injury,Iatrogenic injur,y,Mechanism of,closed,injury,Direct impact,Deceleration and rotational forces,S,pleen,kidney,small bowel and liver,are the most commonly,closed abdominal,injur,i,ed organs,.,Mechanism of,open,injury,Stab wounds,Gunshot wounds,Liver,small bowel,stomach and colon are,commonly involved in the,open,abdominal injuries.,The severity of the injuries and involved organs depend on the intensity,velocity,position and direction of the force.,Abdominal anatomic features and the functions of the organs are also important to the injuries.,clinical manifestation,s,abdominal pain,hemorrhagic shock,peritonitis,abdominal organs injuries are divided to solid and hollow organs injuries.,the main manifestation of the solid organs injuries is hemorrhage that can lead to shock.,the main manifestation of the hollow organs injuries is peritonitis.Hemorrhage and peritonitis can,exist simultaneously,when the injuries involve the 2 kinds of abdominal organs.,Diagnosis,Accurate diagnosis and management requires a thorough history,physical examination,and,when indicated,laboratory tests,.,when we diagnose the injury as the open abdominal injury,we should consider if there is a,p,enetrating,injury.,Diagnosis of the closed abdominal injury,Does the abdominal organ injury exist?,Which organ is injuried?,whether multiple organs are involved in the abdominal injuries?,when,its still difficulty to diagnose,the following measures can be taken.,auxiliary exami,n,ation,dignostic abdominal paracentesis and peritoneal Lavage,x-ray,Ultrasound,Abdominal computed tomography,MRI,angiography,d,iagnostic laparoscopy,observing closely,determine the pulse rate,respiratory rate,blood pressure every 15-30 minutes.,examine the abdominal signs every 30 minutes.,determine the erythrocyte number,hemoglobin,hematocrit every 30-60 minutes.,exploratory laparotomy,The indications for laparotomy,Abdominal pain and peritoneal irritation sign aggravate gradually.,Bowel tones becomes more weaker,even disappeared.,The erythrocyte number and blood pressure are instability.,Gastrointestinal bleeding,Refractory shock,Management of the abdominal injury,We should,identify and correct any immediate life-threatening condition,s and treat with,the other,anticipate problems,.,CPR is the most important thing in the critical case.,A,Airway,B,Breathing,C,Circulation with haemorrhage control,Dont send the exposed abdominal organs back to the peritoneal cavity.,Cover,them,with warm NS soaked gauze,.,Antishock therapy is a key step in the therapeutic procedure.,If given active antishock therapy,the shock still difficulty to correct,it suggests that there is progressive intraperitoneal hemorrhage,the,exploratory laparotomy,is necessary.,In principle,the,laparotomy,should explore the abdominal organs in order as the following:,the solid organs diaphragma stomach duodenum jejunumileummesentery pelvic organs posterior surface of stomach,panceas,Splenic rupture,The spleen remains the,most,commonly,injured organ,.,in,closed,injury:20%40%,i,n open injury:10%,The 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,.,Now,spleen is,recognized as an important immunologic factory,.T,he risk of,overwhelming,postsplenctomy,infection,(OPS,I,)is greatest in child less than 2 yrs,.,R,ecognition,of OPS,I,has stimulated efforts to,Conserve spleen,by,splenorrhaphy,.,TREATMENT,Initial Management,Non operative approach,:,w,idely,practiced in pediatric trauma the criteria for,nonoperative,approach,Operative approach:,Decision to perform,splenctomy,or,splenorraphy,is usually made after assessment&grading the,splenic,injury,.,Contraindication for,splenic,salvage:,The patient has protracted hypotension,Undue delay is anticipated in,attempting,repair the spleen,The patient has other severe injury,Liver rupture,Operative management-liver,Gauze packing,may have infective complications,(,Ivatury,RR et al 1986),Omental,packing,Resectional,debridement,Mass liver suture,Hepatic artery ligation,Total hepatic isolation,-good for,retrohepatic,venous injuries,Atriocaval,shunt,pancreatic injury,C,haracter,acute abdominal pain because of the chemical peritonitis caused by pancreatic juice,AMY in the blood and urine,difficult to diagnose before the lapartomy,Treatment,kposthesis,partial excision and drainage,Gastric injury,C,haracter,Peritonitis,pneumoperitoneum,Treatment,kposthesis,excision,Duodenal injury,C,haracter,not injuried easily,not noticed easily,mostly severe,Treatment,kposthesis,anastomosis,decompression and drainage,Small intestine rupture,C,haracter,high,incidence rate,Peritonitis,is the main manifest.,pneumoperitoneum,Treatment,Kposthesis,Partial excision and anastomosis,The blood vessels of intestinal mesenteric radix should be anastomosed.,Colon rupture,C,haracter,the thin intestinal wall and the poor vascular supply,poor healing function,serious infection,easy to,miss,ing,diagnose,Treatment,exteriorize the intestinal canal,Colostomy and Kposthesis,sometimes primary suture,Rectal injury,C,haracter,s are similar to the colon rupture.,Treatment,sigmoidostomy,Kposthesis and anastomoses,R,etroperitoneal hematoma,C,haracter,worse condition,more complicated injuries,difficulty to diagnose,Treatment,expectant treatment,the,exploratory laparotomy,THANK YOU!,