腹部損傷英文課件

AbdominalInjuryAbdominalInjury1腹部損傷英文課件2腹部損傷英文課件3theoutlinetheincidenceofabdominalinjuriesinpeacetime:0.4%-1.8%inwartime:50%themortalityofabdominalinjuriesis10%theoutlinetheincidenceofa4Typesoftheabdominalinjuriesabdominalinjuryopenabdominalinjuryclosedabdominalinjurypenetratingabdominalinjurynon-penetratingabdominalinjuryIatrogenicinjuryTypesoftheabdominalinjurie5腹部損傷英文課件6MechanismofclosedinjuryDirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.MechanismofclosedinjuryDire7MechanismofopeninjuryStabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.MechanismofopeninjuryStabw8Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.Theseverityoftheinjuriesa9clinicalmanifestationsabdominalpainhemorrhagicshockperitonitisclinicalmanifestationsabdomin10abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.abdominalorgansinjuriesare11Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.Hemorrhageandperitonitiscan12DiagnosisAccuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.DiagnosisAccuratediagnosisan13whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.whenwediagnosetheinjuryas14DiagnosisoftheclosedabdominalinjuryDoestheabdominalorganinjuryexist?Whichorganisinjuried?whethermultipleorgansareinvolvedintheabdominalinjuries?Diagnosisoftheclosedabdomi15whenit'sstilldifficultytodiagnose,thefollowingmeasurescanbetaken.auxiliaryexaminationdignosticabdominalparacentesisandperitonealLavagex-rayUltrasoundAbdominalcomputedtomographyMRI,angiography,diagnosticlaparoscopy★whenit'sstilldifficultyto16★observingclosely

①determinethepulserate,respiratoryrate,bloodpressureevery15-30minutes.

②examinetheabdominalsignsevery30minutes.③determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.★observingclosely17★exploratorylaparotomy

TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock★exploratorylaparotomyTh18ManagementoftheabdominalinjuryWeshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwiththeotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.△

A——Airway△

B——Breathing△

C——CirculationwithhaemorrhagecontrolManagementoftheabdominalin19Don'tsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.Don'tsendtheexposedabdomi20Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.Antishocktherapyisakeyst21Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:thesolidorgans→diaphragma→stomach→duodenum→jejunum→ileum→mesentery→pelvicorgans→posteriorsurfaceofstomach→panceasInprinciple,thelaparotomy22SplenicruptureSplenicrupture23腹部損傷英文課件24腹部損傷英文課件25Thespleenremainsthe

most

commonly

injuredorgan.inclosed

injury:20%~40%inopeninjury:10%Thespleenremainsthemostco26TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupt27

?Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskof

overwhelmingpostsplenctomyinfection(OPSI)isgreatestinchildlessthan2yrs.

?RecognitionofOPSIhasstimulatedeffortsto

Conservespleen

bysplenorrhaphy.

?Nowspleenisrecognizeda28TREATMENTInitialManagementNonoperativeapproach:

widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:Decisiontoperform

splenctomyor

splenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.TREATMENTInitialManagement29Contraindicationforsplenicsalvage:Thepatienthasprotracted hypotensionUnduedelayisanticipatedin

attempting

repairthespleenThepatienthasothersevereinjuryContraindicationforsplenics30LiverruptureLiverrupture31腹部損傷英文課件32腹部損傷英文課件33Operativemanagement-liverGauzepackingmayhaveinfectivecomplications(IvaturyRRetal1986)OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshuntOperativemanagement-liverGa34腹部損傷英文課件35腹部損傷英文課件36pancreaticinjury

pancreaticinjury37Character?acuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuice?AMYinthebloodandurine↑↑?difficulttodiagnosebeforethelapartomyCharacter38Treatment?kposthesis?partialexcisionanddrainageTreatment39GastricinjuryGastricinjury40Character?Peritonitis?pneumoperitoneumTreatment?kposthesis?excisionCharacter41DuodenalinjuryDuodenalinjury42Character?notinjuriedeasily?notnoticedeasily?mostlysevere

Treatment?kposthesis?anastomosis?decompressionanddrainageCharacter43SmallintestineruptureSmallintestinerupture44Character?highincidencerate?Peritonitisisthemainmanifest.?pneumoperitoneumTreatment?Kposthesis?Partialexcisionandanastomosis?Thebloodvesselsofintest