腹部损伤英文ppt课件

Abdominal InjuryAbdominal Injury1腹部损伤英文ppt课件2腹部损伤英文ppt课件3the outlinethe incidence of abdominal injuries in peacetime:0.4%-1.8%in wartime :50%the mortality of abdominal injuries is 10%the outlinethe incidence of a4Types of the abdominal injuriesabdominal injuryopen abdominal injuryclosed abdominal injurypenetrating abdominal injurynon-penetrating abdominal injuryIatrogenic injuryTypes of the abdominal injurie5腹部损伤英文ppt课件6Mechanism of closed injuryDirect impactDeceleration and rotational forcesSpleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.Mechanism of closed injuryDire7Mechanism of open injuryStab woundsGunshot woundsLiver,small bowel,stomach and colon are commonly involved in the open abdominal injuries.Mechanism of open injuryStab w8The 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.The severity of the injuries a9clinical manifestationsabdominal painhemorrhagic shockperitonitisclinical manifestationsabdomin10abdominal 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.abdominal organs injuries are 11Hemorrhage and peritonitis can exist simultaneously,when the injuries involve the 2 kinds of abdominal organs.Hemorrhage and peritonitis can12DiagnosisAccurate diagnosis and management requires a thorough history,physical examination,and,when indicated,laboratory tests.DiagnosisAccurate diagnosis an13when we diagnose the injury as the open abdominal injury,we should consider if there is a penetrating injury.when we diagnose the injury as14Diagnosis of the closed abdominal injuryDoes the abdominal organ injury exist?Which organ is injuried?whether multiple organs are involved in the abdominal injuries?Diagnosis of the closed abdomi15when its still difficulty to diagnose,the following measures can be taken.auxiliary examinationdignostic abdominal paracentesis and peritoneal Lavagex-ray UltrasoundAbdominal computed tomographyMRI,angiography,diagnostic laparoscopy when its still difficulty to16 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.observing closely 17 exploratory laparotomy The indications for laparotomyAbdominal pain and peritoneal irritation sign aggravate gradually.Bowel tones becomes more weaker,even disappeared.The erythrocyte number and blood pressure are instability.Gastrointestinal bleedingRefractory shock exploratory laparotomy Th18Management of the abdominal injuryWe should identify and correct any immediate life-threatening conditions and treat with the other anticipate problems.CPR is the most important thing in the critical case.AAirway BBreathing CCirculation with haemorrhage controlManagement of the abdominal in19Dont send the exposed abdominal organs back to the peritoneal cavity.Cover them with warm NS soaked gauze.Dont send the exposed abdomi20Antishock 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.Antishock therapy is a key st21In 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 panceasIn principle,the laparotomy 22Splenic ruptureSplenic rupture23腹部损伤英文ppt课件24腹部损伤英文ppt课件25The spleen remains the most commonly injured organ.in closed injury:20%40%in open injury:10%The spleen remains the most co26The 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.The Magnitude of spleanic rupt27 Now spleen is recognized as an important immunologic factory.The risk of overwhelming postsplenctomy infection(OPSI)is greatest in child less than 2 yrs.Recognition of OPSI has stimulated efforts to Conserve spleen by splenorrhaphy.Now spleen is recognized a28TREATMENTInitial ManagementNon operative approach:widely practiced in pediatric trauma the criteria for nonoperative approachOperative approach:Decision to perform splenctomy or splenorraphy is usually made after assessment&grading the splenic injury.TREATMENTInitial Management29Contraindication for splenic salvage:The patient has protracted hypotension Undue delay is anticipated in attempting repair the spleen The patient has other severe injuryContraindication for splenic s30Liver rupture Liver rupture 31腹部损伤英文ppt课件32腹部损伤英文ppt课件33Operative management-liverGauze packingmay have infective complications(Ivatury RR et al 1986)Omental packingResectional debridementMass liver sutureHepatic artery ligationTotal hepatic isolation-good for retrohepatic venous injuriesAtriocaval shuntOperative management-liverGa34腹部损伤英文ppt课件35腹部损伤英文ppt课件36pancreatic injury pancreatic injury 37Characteracute abdominal pain because of the chemical peritonitis caused by pancreatic juiceAMY in the blood and urine difficult to diagnose before the lapartomyCharacter38Treatmentkposthesispartial excision and drainageTreatment39Gastric injuryGastric injury40CharacterPeritonitispneumoperitoneum TreatmentkposthesisexcisionCharacter41Duodenal injuryDuodenal injury42Character not injuried easily not noticed easilymostly severe Treatmentkposthesisanastomosisdecompression and drainageCharacter43Small intestine ruptureSmall intestine rupture44Character high incidence rate Peritonitis is the main manifest.pneumoperitoneumTreatmentKposthesisPartial excision and anastomosisThe blood vessels of intestinal mesenteric radix should be anastomosed.Character45Colon ruptureColon rupture46Character the thin intestinal wall and the poor vascular supply poor healing function serious infection easy to missing diagnose Treatmentexteriorize the intestinal canalColostomy and Kposthesissometimes primary sutureCharacter47Rectal injuryRectal injury48Characters are similar to the colon rupture.TreatmentsigmoidostomyKposthesis and anastomosesCharacters are similar to the 49Retroperitoneal hematomaRetroperitoneal hematoma50