Professional Documents
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ANATOMY
SURFACE ANATOMY
* Ant-or Abd : lin intermammaria, lig Poupart + pubic,
Lin
Axil. Ant-or
* Flank Area : Lin.Axil Ant-or - Post-or, 6th ICS, Illiac Crist.
* Post-or Abd (Back) : Post-or to LAP, Inf Angle of
Scapula, Illiac Crist
INTERNAL ANATOMY
* Peritoneal Cavity (Treitz Lig.)
> Upper : diaphragm, gaster, H/L, Colon Trans.
> Lower : Jej/Illeum, Duodenum Desc, Colon sigmoid,
Female Reprod Organs
* Retroperitoneal Cavity : Duodenum-other, pancreas,
ren - ureter, ColonAsc/Desc, vessels.
* Pelvic Cavity: Rectum, Female internal reprod organs,
VU,
illiaca vessels
Blunt Trauma
TRAUMA
Penetrating Trauma
Blunt Trauma
Penetrating Trauma
In gun-shot cases :
- always find bullet way out
- predict the bullet pathway within patients body
- commonest affected organs:
intestine (50%), colon (40%), liver (30%), blood vessels (25%)
Primary Survey
A-irway
B-reathing
stabilize step by step.
C-irculation*
D-isability level of consciousness
E-xposure front and back side, log-roll
technique
* Plus bleeding control, predict class of hemorrhage, apply 2
i.v line w/the largest bore catheter crystaloid 2 L
Class of hemorrhage
Class I
Class II
Class III
Class IV
750-1500
15-30%
1500-2000 >2000
30-40%
>40%
Pulse
BP
Pulse
Press.
<100
N
N/
100-120
N
120-140
>140
RR
Diuresis
LoC
Fluid th/
14-20
>30
CM
Crystaloid
20-30
20-30
Anxiety
Crystaloid
30-40
5-15
Confused
Crystaloid+
Blood
>35
Least
Lethargic
Crystaloid
+Blood
History Taking
Biomechanism of trauma
Physical Examination
INSPECTION
Auscultation
Bowel sound?
Blood retroperitoneum/GIT BS (-)
BS (-) not diagnostic for intraabd trauma
Palpation
Urethral rupture?
Additional maneuvers
Gastric Tube
Urine Catheter
Urine+Blood sample
X-ray
DPL
DPL (2)
Consider (+) if
WBC > 500/mmc
RBC > 100,000/mmc
Gram staining (+) for bacterias
FAST
To detect hemoperitoneum
Operator dependent
4 locations:
- Pericard sac
- Hepatorenal fossa
- Splenorenal fossa
- Douglas Cave
Obtain a control scan 30 after the 1st one; what
for?
Pericard Sac
Morisons Pouch
LUQ
Suprapubic / Douglas
Pouch
CT-Scan
Laparotomy
I/:
Whats Inside?
GIT
Abd. Cavity
Urinary Tr
Female Internal Genital Organs
Embriology
Part of Fetal
Gut
Organs
Blood
Supply
Region of Abd
Pain
Foregut
a.Coeliac
Epigastric
Midgut
Remainder of
duodenum, jej, ill, asc
colon, 2/3 proc colon
trans
a.Mesenterica Sup-or
Umbilical
Hindgut
Remainder of colon
trans, colon desc,
rectum
a.Mesenterica Inf
Suprapubic/Hypogastric
History Taking
Abd Pain
+ Referred Pain
Parietal/Somatic Pain
Visceral Pain
Parietal Pain
Referred pain
Physical Examination
Peptic Ulcer,
Dyspepsia
AcutePancreatitis
Process
Acute imflam.
pancreas
Location
Quality
Aching, burning,
boring, hunger-like
Usually steady
Timing
Intermittent
(prominent in ulcer)
Aggravator
Variable
Lying supine
Reliever
Foods, antacids
Leaning forward;
flexed trunk
Associated
symptoms&Settin
Nause-vomit, bloating,
heartburn
Nausea-vomit, abd
distention, fever
Biliary Colic
Acute Cholecystitis
Process
Sudden obstruction
biliary tree
Inflammation
gallbladder
Location
RUQ/Epigastric; right
scapula/shoulder
Quality
Steady, aching,NOT
colicky
Steady, aching
Timing
Rapid onset-several
hours-subsides
gradually
Aggravator
Reliever
Associated
symptoms&Settin
Nausea,vomit,
restlessness
Anorexia, nausea,
vomit, fever
Acute App
Mesenteric Ischemia
Process
Inflamm. app
Blood supply,
bowel/mesentericblocked; hypoperfusion
Location
Periumbilical-RLQ
1st:periumbilical, then
diffuse
Quality
1st:cramping. Then
steady
Timing
Aggravator
Movement, cough
Reliever
Associated
symptoms&Settin
Anorexia, nausea,
vomit, low fever
Vomit,
diarrhea/constipation,
shock
Finding
Cullen's sign
Kehr's sign
McBurney's sign
Murphy's sign
Iliopsoas sign
Obturator's sign
Grey-Turner's
Chandelier sign
Rovsing's sign
Manipulation of cervix
patient to lift buttocks off table
RLQ pain with palpation of
LLQ
Association
Retroperitoneal hemorrhage
(hemorrhagic pancreatitis,
AAA rupture)
Splenic rupture, Ectopic pregnancy
rupture
Appendicitis
Acute cholecystitis
Appendicitis
Appendicitis
Retroperitoneal hemorrhage
(hemorrhagic pancreatitis, AAArupture)
Pelvic inflammatory disease
Appendicitis
Epigastric
Gastritis, Peptic Ulcer, Pancreatitis, Crohns Dis,
Heart Dis
Left Hypochondriac
Splenomegaly, IBS, Pn.
Umbilical
Early App, Small bowel obstruction, perforated peptic
ulcer, AAA ruptured, mesenteric artery occlusion,
Crohns Dis., Meckels Diverticulitis
Left Lumbar
Ureteric colic, Pyelonephritis, IBS, Diverticulitis
Hypogastric
Left Iliac
GEA
App
Mittelschmerz / Dysmenorrhoea
IBS
Ectopic pregnancy
(Sigmoid) volvulus
Perforated ulcer
Often missed
App
Myofascial tear
Pulmonary origin
Fecal impaction
HZ
Rare: porphyria, lead poisoning,
hemochromatosis, tabes dorsalis, sickle cell
anemia
Thank You