Understanding Abdominal Trauma: Epidemiology, Mechanism, Evaluation & Management

Abdominal trauma is a significant concern, notably in road traffic accidents. Blunt abdominal trauma (BAT) accounts for a majority of cases, with injuries commonly affecting the spleen and liver. Various mechanisms of injury and evaluation techniques, including examination signs and lab tests, aid in diagnosing and managing these injuries effectively. Imaging modalities like CT scans play a crucial role in determining the extent of injury and the need for surgical intervention.

• Abdominal Trauma
• Epidemiology
• Mechanism of Injury
• Evaluation
• Management

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Uploaded on Sep 12, 2024 | 0 Views

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1. BAT 1

2. Epidemiology BAT accounts for 80% of the abdominal trauma 75% related to RTC Blows to abdomen and falls - 15% & 6-9% Prevalence is 13% Spleen & Liver most commonly injured

3. Mechanism of Injury Intra-abdominal pressure outward can rupture a hollow vis Lap belt without a shoulder attachment compresses the abd Force against the anterior abd wall can lead to vertebral injury Deceleration injuries can cause hollow Vis, tear vascular pedicle - kidney commonly injured Fracture of ribs or pelvic bone can lacerate intra-abdominal tissues

4. History Fatality at scene Vehicle type & speed Vehicle rolled over (seat position of impact ) Extent of intrusion ( >6 inches ass with increased injury) Extent of damage to the vehicle Steering wheel deformity Seat belt used if so what type Airbags

5. Examination Seat Belt sign (LR 5.6-9.9) Rebound tenderness ( LR 6.5) Hypotension (LR 5.2) Abdominal distension (LR 3.8) Abdominal Guarding ( LR 3.7) Femur fracture (LR 2.9) 10% with isolated HI may have abdominal injury 7% with no pain or tenderness but has distracting injury may have AT

6. Examination Pain in the left costal margin is associated with splenic injury in 5.6% 90% of Patients with visceral injury with no distracting injuries will present with pain and tenderness Awake, no distracting injury no findings on abdominal examination very unlikely to have any abdominal injuries Think about referred pain Seat belt sign - 1/3 will have abdominal injury

7. Lab test Haematocrit - <30% increase Likely hood (LR 3.3) Leucocyte count Pancreatic enzyme LFT - Raised LT (LR 2.5-5.2) Urine analysis - Microscopic H (LR 3.4-7.4) Base deficit & lactate - BE of -6 was ass with intra-intra- abd injury & need for laparotomy & transfusion

8. CT Sensitivity & Specificity- 97-98% & 97-99% Pt with BAT & negative MDCT - chances of injury low (0.06%) LR 0.034 In a study of 5000 pts only 5% had injury which needed surgery

9. US/Angio/DPL

10. Management Haemodynamically unstable patient Hamedynamically Stable patient

11. Indication for Laparotomy Unexplained blood loss or hypotension who cannot be stabilised Persistent signs of irritation Evidence of pneumoperitoneum consistent with viscus rupture Diaphragmatic rupture GI bleed which is persistent

12. Special Consideration Pelvic Fracture Multiple system injury Closed Head Injury Transfers Pregnant patient Geriatric Patient