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TRAUMA TO THE ABDOMEN lec 3

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الكلية كلية الطب     القسم  الجراحة     المرحلة 5
أستاذ المادة مهند عباس نوري الشلاه       15/04/2018 18:27:13
The abdomen can be arbitrarily divided into 4 areas.
The first is the intrathoracic abdomen, which is the portion of the upper abdomen that lies beneath the rib cage. Its contents include the diaphragm, liver, spleen, and stomach. The rib cage makes this area inaccessible to palpation and complete examination. The second is the pelvic abdomen, which is defined by the bony pelvis. Its contents include the urinary bladder, urethra, rectum, small intestine, and, in females, ovaries, fallopian tubes, and uterus. Injury to these structures may be extraperitoneal in nature and therefore difficult to diagnose. The third is the retroperitoneal abdomen, which contains the kidneys, ureters, pancreas, aorta, and vena cava. Injuries to these structures are very difficult to diagnose on the basis of physical examination findings. Evaluation of the structures in this region may require computed tomography (CT) scanning, angiography, and intravenous pyelography (IVP). The fourth is the true abdomen, which contains the small and large intestines, the uterus (if gravid), and the bladder (when distended). Perforation of these organs is associated with significant physical findings and usually manifests with pain and tenderness from peritonitis.

Resuscitation of all injuries to the abdomen should follow traditional ATLS principles.

Important factors relevant to the care of a patient with blunt abdominal trauma, specifically those involving motor vehicles, include the following:
• The extent of vehicular damage
• Whether prolonged extrication was required
• Whether the passenger space was intruded
• Whether a passenger died
• Whether the person was ejected from the vehicle
• The role of safety devices such as seat belts and airbags
• The presence of alcohol or drug use
• The presence of a head or spinal cord injury
• Whether psychiatric problems were evident

On physical examination, the following injury patterns predict the potential for intra-abdominal trauma:
• Lap belt marks: Correlate with small intestine rupture
• Steering wheel–shaped contusions
• Ecchymosis involving the flanks (Grey Turner sign) or the umbilicus (Cullen sign): Indicates retroperitoneal hemorrhage, but is usually delayed for several hours to days.
• Abdominal distention
• Auscultation of bowel sounds in the thorax: May indicate a diaphragmatic injury
• Abdominal bruit: May indicate underlying vascular disease or traumatic arteriovenous fistula
• Local or generalized tenderness, guarding, rigidity, or rebound tenderness: Suggests peritoneal injury
• Fullness and doughy consistency on palpation: May indicate intra-abdominal hemorrhage
• Crepitation or instability of the lower thoracic cage: Indicates the potential for splenic or hepatic injuries


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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