新版腹部损伤英文课件-医学课件(精选).ppt.ppt

新版腹部损伤英文课件-医学课件(精选).ppt.ppt

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AbdominalInjury,1,。

2,。

3,。

theoutline,theincidenceofabdominalinjuriesinpeacetime:

0.4%-1.8%inwartime:

50%themortalityofabdominalinjuriesis10%,4,。

Typesoftheabdominalinjuries,abdominalinjury,openabdominalinjury,closedabdominalinjury,penetratingabdominalinjury,non-penetratingabdominalinjury,Iatrogenicinjury,5,。

6,。

Mechanismofclosedinjury,DirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.,7,。

Mechanismofopeninjury,StabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.,8,。

Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.,9,。

clinicalmanifestations,abdominalpainhemorrhagicshockperitonitis,10,。

abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.,11,。

Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.,12,。

Diagnosis,Accuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.,13,。

whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.,14,。

Diagnosisoftheclosedabdominalinjury,Doestheabdominalorganinjuryexist?

Whichorganisinjuried?

whethermultipleorgansareinvolvedintheabdominalinjuries?

15,。

whenitsstilldifficultytodiagnose,thefollowingmeasurescanbetaken.,auxiliaryexamination,dignosticabdominalparacentesisandperitonealLavage,x-ray,Ultrasound,Abdominalcomputedtomography,MRI,angiography,diagnosticlaparoscopy,16,。

observingcloselydeterminethepulserate,respiratoryrate,bloodpressureevery15-30minutes.examinetheabdominalsignsevery30minutes.determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.,17,。

exploratorylaparotomy,TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock,18,。

Managementoftheabdominalinjury,Weshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwiththeotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.AAirwayBBreathingCCirculationwithhaemorrhagecontrol,19,。

Dontsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.,20,。

Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.,21,。

Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:

thesolidorgansdiaphragmastomachduodenumjejunumileummesenterypelvicorgansposteriorsurfaceofstomachpanceas,22,。

Splenicrupture,23,。

24,。

25,。

Thespleenremainsthemostcommonlyinjuredorgan.inclosedinjury:

20%40%inopeninjury:

10%,26,。

TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.,27,。

Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskofoverwhelmingpostsplenctomyinfection（OPSI）isgreatestinchildlessthan2yrs.RecognitionofOPSIhasstimulatedeffortstoConservespleenbysplenorrhaphy.,28,。

TREATMENT,InitialManagementNonoperativeapproach:

widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:

Decisiontoperformsplenctomyorsplenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.,29,。

Contraindicationforsplenicsalvage:

ThepatienthasprotractedhypotensionUnduedelayisanticipatedinattemptingrepairthespleenThepatienthasothersevereinjury,30,。

Liverrupture,31,。

32,。

33,。

Operativemanagement-liver,Gauzepackingmayhaveinfectivecomplications（IvaturyRRetal1986）OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshunt,34,。

35,。

36,。

pancreaticinjury,37,。

CharacteracuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuiceAMYinthebloodandurinedifficulttodiagnosebeforethelapartomy,38,。

Treatmentkposthesispartialexcisionanddrainage,39,。

Gastricinjury,40,。

CharacterPeritonitispneumoperitoneumTreatmentkposthesisexcision,41,。

Duodenalinjury,42,。

CharacternotinjuriedeasilynotnoticedeasilymostlysevereTreatmentkposthesisanastomosisdecompressionanddrainage,43,。

Smallintestinerupture,44,。

CharacterhighincidenceratePeritonitisisthemainmanifest.pneumoperitoneumTreatmentKposthesisPartialexcisionandanastomosisThebloodvesselsofintestinalmesentericradixshouldbeanastomosed.,45,。

Colonrupture,46,。

CharacterthethinintestinalwallandthepoorvascularsupplypoorhealingfunctionseriousinfectioneasytomissingdiagnoseTreatmentexteriorizetheintestinalcanalColostomyandKposthesissometimesprimarysuture,47,。

Rectalinjury,48,。

Charactersaresimilartothecolonrupture.TreatmentsigmoidostomyKposthesisandanastomoses,49,。

Retroperitonealhematoma,50,。

CharacterworseconditionmorecomplicatedinjuriesdifficultytodiagnoseTreatmentexpectanttreatmenttheexploratorylaparotomy,51,。

THANKYOU!

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