腹部闭合性损伤(英文版)

Abdominal Injury,Section1 Introduction,Abdominal injury refers to the histological damage and dysfunction caused by different kinds of injuries to the abdomen Abdomen occupy large surface of the total body ，no skeleton to protect it,so abdominal injury is more common. In particular, with the increasing development of modern transportation，the damage is more and more popular . morbidity 0.4-1.8% Mortality 10-20%,The focus and the difficulties of this chapter,Emphasis：（1）Master the first aid, the principles of the early diagnosis and treatment （2）Familiar with the different diagnosis and treatment of the rupture of intestinal ,liver,or spleen,Difficulties 1 is there visceral injury? 2 Which kind of visceral organs has gotten injured? 3 Are there multiple injuries? 4 What do we do with diagnostic difficulties?,Anatomy of the human abdomen, by Ties van Brussel / tiesworks.nl,The classification of the Abdominal injury,1 Open abdominal injuries (Open) Usually caused by sharp object, obvious wound tract, clear injuries, diagnosis is easy and clear. timely and easy handling, the treatment and prognosis is good. （1）Penetrating injury: perforation of the peritoneum are; non-penetrating injuries: even visceral injury （2）Penetrating wound; non-penetrating wound （3）Iatrogenic injury,2 Blunt abdominal injury (Closed) Usually caused by a blunt object, no surface scars, often visceral injury, easily missed, so they have important clinical significance. Identification of serious intra-abdominal pathology is often challenging,一、Etiology,1、Violence (direct, indirect), fall, collision, impact, squeezing, kicking, punching and so on. 2、Common visceral injury in the order is: Closed injury: spleen, kidney, small intestine, liver, mesentery Open injury: liver, small intestine, stomach, colon, large vessels 3、The severity of the injury depend on mechanism of injury and organ anatomy, pathology, functional status.,Mechanism of injury,The intensity of violence: size, speed, direction Site of the action violence, hardness,Characteristics of the organs,Physiological factors: ： 1、liver, spleen is fragile,pipe-rich, fixed, easy bleeding. 2、Intestine fixed place 3、Organ in front of the spine Pathological factors：The original pathological conditions of liver and spleen Functional status：Stomach, bladder filling,The main pathological changes in severe abdominal injuries： Intra-,retroperitoneal bleeding and peritonitis Abdominal retroperitoneal duodenal injury performance： Testicular pain, scrotal hematoma, priapism,二、Clinical manifestation,Simple abdominal injury: Signs and symptoms of mild pain in the injured area, the limitations of abdominal swelling and tenderness, subcutaneous ecchymosis, etc., to reduce over time. Often without gastrointestinal symptoms,Abdominal hollow viscus injury： (1)Diffuse peritonitis (peritonitis) based (2) Gastrointestinal symptoms (3) Systemic symptoms can occur in septic shock. Intra-abdominal organ injury mixed: hemorrhage and peritonitis,Parenchymal organ injury: Hemorrhage,shock, abdominal signs(The part with the most obvious signs is often the place of the damage which bit),Intra-abdominal organ injury mixed: Hemorrhage and peritonitis,三、Diagnosis,The most critical issue is to determine whether visceral injury, followed by the nature of the multiple organ injury and whether the damage is not one 1、With or without visceral injury (1）Emphasis on the general condition of T, P, R, BP, and consciousness （2）Learn more about the history of injury, especially injury conditions （3）Comprehensive and focused physical examination （4）The necessary laboratory tests:blood count, urine test, serum or urine amylase,You should consider organ damage if one of the following things happen,1、Early shock (hemorrhagic). 2、Continuous or aggravating abdominal pain with progressive gastrointestinal symptoms. 3、Significant peritoneal irritation. 4、pneumoperitoneum performers. 5、With shifting dullness 6、Hematemesis 吐血or hematochezia便血, or hematuria尿血 7、Rectal examination positive findings:Rectal wall tenderness, a sense of volatility, blood-stained finger Easy to lose sight of the forest for the trees,2、What kind of organ damage Substantive organ- main shock Hollow organ -Peritonitis base Vomiting,nausea,haematemesis,hematochezia pneumoperitoneum- gastrointestinal tract Dysuria, hematuria and referred pain of genitals-Urinary system Lower rib bone fractures, back pain-Rupture of liver or Spleen Diaphragm irritation-liver or spleen Pelvis fractures-rectum and bladder,Amylase increased Pancreatic injury Gastrointestinal perforation Retroperitoneal duodenal rupture,But The normal amylase can not exclude the organ damage above Important indicator of urinary tract injury:Hematuria,3、Is it the multiple injury?（ attention specially） Include :（1）multiple injuries in one organ （2） more than one organ damaged inside the peritoneal cavity （3）injuries inside the peritoneal cav