Case-Based Abdominal Trauma

Posted by e-Medical PPT Wednesday, October 6, 2010
The liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury. The liver is the second most commonly injured organ in abdominal trauma, but damage to the liver is the most common cause of death after abdominal injury. The most common cause of liver injury is blunt abdominal trauma.
The liver is the largest intra-abdominal solid organ and is enclosed anteriorly and laterally by the rib cage. The large size of the liver, its friable parenchyma, its thin capsule, and its relatively fixed position in relation to the spine make the liver particularly prone to blunt injury.

Liver trauma may result in the following:
    * Subcapsular hematoma or intrahepatic hematoma
    * Laceration
    * Contusion
    * Hepatic vascular disruption
    * Bile duct injury

A patient history of blunt or penetrating abdominal trauma may be forthcoming
    * Signs and symptoms of hepatic injury are related to loss of blood, peritoneal irritation, right upper quadrant tenderness, and guarding
    *Clinical signs and symptoms of biliary peritonitis include abdominal pain, nausea, and vomiting. These signs may evolve gradually, making diagnosis difficult and leading to increased morbidity and mortality rates.
Contrast-enhanced CT scanning remains the examination of choice in patients with blunt abdominal trauma.Diagnostic peritoneal lavage has been shown to be useful in evaluating patients with blunt abdominal trauma, with reported sensitivities of as high as 95%.

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