1. Definition and classification
Abdominal trauma is damage to the abdominal wall or abdominal viscera products traumatic agents .
Abdominal trauma can be:
a) bruising when the skin remains intact ;
b ) wound , the skin is broken . Plagues are:
– Non-penetrating , they do not penetrate into the peritoneal cavity ;
– Penetrating the vulnerable agent has penetrated the peritoneal cavity . These are:
• no visceral lesions ;
• visceral lesions , they are interested in parenchymal organs bone crushing a plane or hollow organ explosive or plucking .
Wounds can be caused by projectile weapons or firearms . The arms wounds are characterized by a relatively steady sections of the tissues usually occurs as a result of impact from the front, is located on the left side of the body and are often located in the upper abdomen . Projectile wounds are more complex lesions are pluriviscerale and are usually different .
2. Traumatizatului abdominal examination
Clinical evaluation of abdominal trauma patient has the following steps :
– Investigation of vital functions (pulse , breathing TA) ;
– Complete medical history of the patient is achieved over how the accident and traumatic agent ;
– Inspection abdomen is done : bruises , abrasions or wounds .
– Palpation of the abdomen to sense pain points and areas of bulging , swelling, muscle stiffness ;
– Abdominal Auscultation may indicate the presence or absence of intestinal peristalsis ;
– Rectal and vaginal bleeding to grasp .
Laboratory examination is needed to supplement with important examination . It consists of:
– The collection of blood for blood grouping and Rh , Hb and Ht HLG detection , glucose , urea, creatinine, ionograma (Na + , K + , Cl-) ;
– Abdominal radiograph scoring for the presence or absence of pneumoperitoneum by rupture of a segment of the digestive tract to determine possible rib fractures , hip fractures ;
– Chest radiography for the determination of the fracture of the left costal margin ( ruptured spleen ) or right costal margin ( liver rupture ) ;
– Point peritoneal lavage with 200-300 ml . saline to see the color of the liquid extract in order to determine the presence or absence of blood in the abdomen ;
– Abdominal ultrasound shows splenic capsule or liver damage , kidney damage or pancreas ;
– Complete investigation CT;
– Selective arteriography ;
– Urography .
3 . clinical syndromes
At traumatizaţii abdominal visceral on incentives usually clinical manifestations occur through:
• internal bleeding syndrome ( intraperitoneal or retroperitoneal ) manifested by hypotension , tachycardia , pallor , cold sweat , with or without loss of consciousness. Appears bleeding lesions ;
• peritoneal irritation syndrome occurs when the body is broken into the peritoneal cavity and the contents discharged . Clinically manifested by defense and muscle contraction , pain ;
• Joint Syndrome , in the presence of signs of internal bleeding concomitant with peritonitis ;
• complex syndrome where incentives offered traumatic and other parts of the body which enhances and amplifies the abdominal symptoms .
May cause abdominal trauma and abdominal visceral injuries with late clinical manifestations . These are :
• Two stroke internal bleeding :
1 – it is a large hematoma liver or spleen ;
1. hematoma ruptures causing internal bleeding .
• – two-stroke Peritonitis :
1 – peritoneal necrosis ;
1 – discharging liquid.
• Breaking or dezinserţia mezenteriului , leading to necrosis , perforation and peritonitis two-stroke ;
• Bowel two-stroke , which consists in breaking mezenteriului abdominal herniation interstitial loop , strangulation , bowel obstruction and internal hernias through traumatic eventration ;
• Late intraperitoneal abscess manifested by bleeding small supra- infection , abscess sac of Douglas subfrenic (fever , pain) ;
• traumatic acute pancreatitis , the pancreas is crushed pain the patient has very high bar , nausea , vomiting, muscular defense , increased amylase in blood and urine.
4 . Treatment of abdominal trauma
Abdominal trauma treatment consists of:
⁃ resuscitation fluid infusion and blood ;
⁃ fluid resuscitation ;
⁃ surgical emergency stop bleeding ;
⁃ nasogastric aspiration probe is mounted :
⁃ pain relief ;
⁃ tetanus prophylaxis ;
⁃ if operators indications , surgical treatment consists of high xifoombilicală exploratory incision , intraoperative fluid collection , making definitive surgical hemostasis , abundant lavage of the peritoneal cavity with leaving the drain tubes .