新版腹部損傷英文課件-醫(yī)學(xué)課件(精選).ppt

1、Abdominal Injury1。2。3。the outlinethe incidence of abdominal injuries in peacetime: 0.4%-1.8% in wartime : 50%the mortality of abdominal injuries is 10%4。Types of the abdominal injuriesabdominal injuryopen abdominal injuryclosed abdominal injurypenetrating abdominal injurynon-penetrating abdominal in

2、juryIatrogenic injury5。6。Mechanism of closed injuryDirect impactDeceleration and rotational forcesSpleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.7。Mechanism of open injuryStab woundsGunshot woundsLiver, small bowel, stomach and colon are commonly involved

3、in the open abdominal injuries. 8。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. 9。clinical manifestationsabdominal painhemorrhag

4、ic shockperitonitis10。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.11。Hemorrhage and peritonitis can exist simulta

5、neously,when the injuries involve the 2 kinds of abdominal organs.12。DiagnosisAccurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests.13。when we diagnose the injury as the open abdominal injury,we should consider if there is a penetr

6、ating injury.14。Diagnosis of the closed abdominal injuryDoes the abdominal organ injury exist?Which organ is injuried?whether multiple organs are involved in the abdominal injuries?15。when its still difficulty to diagnose, the following measures can be taken.auxiliary examinationdignostic abdominal

7、paracentesis and peritoneal Lavagex-ray UltrasoundAbdominal computed tomographyMRI, angiography, diagnostic laparoscopy 16。 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

8、, hemoglobin, hematocrit every 30-60 minutes.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 bleeding

9、Refractory shock18。Management 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 control19。Dont send the ex

10、posed abdominal organs back to the peritoneal cavity. Cover them with warm NS soaked gauze.20。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 e

11、xploratory laparotomy is necessary.21。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 panceas22。Splenic rupture23。24。25。The spleen remains the mos

12、t commonly injured organ.in closed injury:20%40%in open injury: 10%26。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 .27。 Now sp

13、leen 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. 28。TREATMENTInitial ManagementNon operative approach: widely practice

14、d in pediatric trauma the criteria for nonoperative approachOperative approach: Decision to perform splenctomy or splenorraphy is usually made after assessment & grading the splenic injury.29。Contraindication for splenic salvage: The patient has protracted hypotension Undue delay is anticipated in a

15、ttempting repair the spleen The patient has other severe injury30。Liver rupture 31。32。33。Operative management - liverGauze packingmay have infective complications (Ivatury RR et al 1986)Omental packingResectional debridementMass liver sutureHepatic artery ligationTotal hepatic isolation - good for r

16、etrohepatic venous injuriesAtriocaval shunt34。35。36。pancreatic injury 37。Characteracute abdominal pain because of the chemical peritonitis caused by pancreatic juiceAMY in the blood and urine difficult to diagnose before the lapartomy38。Treatmentkposthesispartial excision and drainage39。Gastric inju

17、ry40。CharacterPeritonitispneumoperitoneum Treatmentkposthesisexcision41。Duodenal injury42。Character not injuried easily not noticed easilymostly severe Treatmentkposthesisanastomosisdecompression and drainage43。Small intestine rupture44。Character high incidence rate Peritonitis is the main manifest.

18、 pneumoperitoneumTreatmentKposthesisPartial excision and anastomosisThe blood vessels of intestinal mesenteric radix should be anastomosed.45。Colon rupture46。Character 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 sutur