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Penetrating Abdominal Trauma
24 PENETRATING ABDOMINAL TRAUMA
Clay Cothren M.D., Ernest E. Moore M.D.
1. Why is there a different approach to stab and gunshot wounds?
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Whereas one third of stab wounds to the anterior abdomen do not penetrate the peritoneum, 80% of gunshot wounds violate the peritoneum. Furthermore, penetration of the peritoneum by a bullet is associated with visceral or vascular injuries in > 95% of cases, whereas only one third of stab wounds violating the peritoneal cavity produce significant injury. (See Figure 24-1.)
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Penetrating Abdominal Trauma. Controversy
CONTROVERSY
14. What is the role of laparoscopy and thoracoscopy after penetrating abdominal trauma?
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Although an intriguing diagnostic modality with additional therapeutic capabilities, laparoscopy thus far appears to have limited application after trauma. With the exception of suspected diaphragmatic injury, an isolated solid organ injury, or evaluation for peritoneal penetration, laparoscopy has yet to demonstrate advantages over the algorithm delineated above. The potential for missed injuries, poor evaluation of the retroperitoneum, and expense are major drawbacks. In patients with wounds to the lower chest with pneumothorax (and, thus, an indication for chest tube placement), thoracoscopy is reasonable to exclude diaphragmatic injury.
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25 HEPATIC AND BILIARY TRAUMA
Reginald J. Franciose M.D., Ernest E. Moore M.D.
1. How often is the liver injured in trauma?
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The liver is both big and central, so it is an easy target.
2. Do the liver and spleen respond similarly to injury?
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No. The liver has a unique ability to establish spontaneous hemostasis even with extensive injuries. For this reason, the majority of liver injuries in hemodynamically stable patients can be managed nonoperatively. In contrast, many splenic fractures continue to bleed; therefore, a greater percentage require operative intervention.
Penetrating Thoracic Trauma
22 PENETRATING THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with penetrating chest wounds need an operation?
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Surprisingly rarely. Most civilian penetrating injuries are from knives and low-energy handguns. Consequently, although injuries to the chest wall and lung are common, the majority of patients can be treated with tube thoracostomy alone. Formal thoracotomy or median sternotomy is required in < 15% of isolated penetrating chest injuries.
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www answers com trauma diaphragm,Trauma To The Colon & Rectum. Colon Trauma
28 TRAUMA TO THE COLON AND RECTUM
W. Andrew Lawrence M.D., Jon M. Burch M.D.
COLON TRAUMA
1. How do most colon injuries occur?
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Nearly all (> 95%) colon injuries are caused by penetrating trauma from gunshot, stab, iatrogenic, or sexual injury. Blunt colonic trauma is rare and usually results from seat belts during motor vehicle accidents.
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colonic injury grade, iatrogenic colon injury, trauma dos colons, trauma of the colon,Thoracic Surgery For Non-Neoplastic Disease. Pleural Effusion
PLEURAL EFFUSION
6. What is a pleural effusion?
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Pleural fluid is generated in normal adults at a rate of 5-10 L per 24 hours in the combined hemithoraces, but normal adults have only 20 mL of pleural fluid present at any time. Pleural effusions develop when there is either increased production or decreased resorption. Pathologic conditions leading to effusions include increased capillary permeability (inflammation, tumor), increased hydrostatic pressure (e.g., in congestive heart failure [CHF]), decreased lymphatic drainage (tumor, radiation fibrosis), decreased oncotic pressure (hypoalbuminemia), or combinations of these.
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triglycerides in fluid query chylothorax,Blunt Thoracic Trauma
21 BLUNT THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with isolated blunt chest trauma need an emergent operation?
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Rarely. In patients who arrive in the hospital alive, operative injuries to the pulmonary, vascular, and mediastinal structures are surprisingly rare; only 5% of patients with isolated blunt injury to the chest require thoracotomy.
2. In a patient with a hemothorax after blunt chest injury, what is the most important guide for the decision to operate?
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The hemodynamic status of the patient. Hemothorax after blunt injury is most often caused by nonoperative lesions of the lung and chest wall. In stable patients, therefore, evacuation of the hemothorax (with a chest tube); reexpansion of the lung, and correction of coagulopathy, hypothermia, and acidosis should be the initial focus. Chest tube output is helpful but is not the principal consideration.
3. What is a tension pneumothorax?
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Air in the pleural space under pressure caused by a one-way valve mechanism. This can be a life-threatening condition because the increase in intrathoracic pressure decreases venous return, which impaires right ventricular filling, resulting in a decrease in cardiac output.
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Hepatic & Biliary Trauma. Biliary Tract Injury
BILIARY TRACT INJURY
22. Why are complications associated with bile duct leaks?
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Bilomas (i.e., collections of bile) frequently become infected and may result in lethal peritonitis. Biliopleural fistula, a communication between the biliary system and pleural cavity, persists because of the relative negative pressure in the thorax and may result in a bile empyema.
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biliary trauma, trauma hepatic, biliary tract injury, billiary trauma and its management, fistula biliopleural trauma, hepatic trauma, hepatic trauma and its management, liver trauma and biliary stenting, trauma to biliary tract,Trauma To The Colon & Rectum. Rectal Trauma
RECTAL TRAUMA
9. How do rectal injuries occur?
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Similar to colon injuries, most rectal injuries result from penetrating trauma. Blunt pelvic fractures should be assessed with a strong suspicion for rectal (and urethral) injury.
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colon rectal trauma, rectal injuries, trauma of the colon, colon trauma and antibiotics, demetriades d penetrating colon injuries requiring resection: diversion or primary anastomosis? an aast prospective multicenter study, principles of rectal trauma, recovery time for rectal trauma, rectal trauma, rectum trauma, suspection rectal injury, thorough examination in rectal trauma, trauma colorectal, trauma de recto extraperitoneal, trauma to the colon,Hepatic & Biliary Trauma. Operative Management Of Liver Injury
OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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23 BLUNT ABDOMINAL TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What elements of the history are important in evaluating a patient with suspected blunt abdominal trauma (BAT)?
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First, the mechanism of injury (e.g., motor vehicle collision, automobile-pedestrian accident, fall) is important. In motor vehicle accidents, note the position of the victim in the car, velocity of impact (high, moderate, low), type of accident (front, lateral, or rear impact; side swipe; rollover), and type of restraint used (shoulder restraint, air-bag, lap belt). Information about damage to the vehicle, such as a broken windshield or bent steering wheel, may raise suspicion of cervical and chest injuries. In a fall, it is important to note the distance fallen and the site of anatomic impact. Vertical landing on the feet or in a sitting position causes a different pattern of injury than lateral landing on the side. Serial vital signs and mental status are always important.
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Thoracic Surgery For Non-Neoplastic Disease. Empyema
EMPYEMA
10. What is an empyema, and what causes it?
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An empyema is a purulent (infected) effusion. Fluid or blood in the pleural space can be directly innoculated (with bugs) during surgery or trauma (33%) or by contamination from contiguous sites (50%) such as bronchopulmonary infection (most common). Most empyemas are parapneumonic, and the most commonly involved organisms are Staphylococcus aureus, enteric gram-negative bacilli, and anaerobes. Many times, infections are polymicrobial. Often there is no growth of an empyema culture because of effective antibiotic therapy or inadequate culture techniques, particularly with anaerobes.
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Lower Urinary Tract Injury & Pelvic Trauma
31 LOWER URINARY TRACT INJURY AND PELVIC TRAUMA
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What are the causes of bladder injury?
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Iatrogenic manipulation and penetrating or blunt trauma. Because of the rich detrusor blood supply, bladder injury is usually accompanied by hematuria. Other signs may include suprapubic pain, inability to void, or incomplete recovery of catheter irrigation.
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Abdominal Tumors. Controversy
CONTROVERSY
6. Should patients with hepatoblastoma receive preoperative chemotherapy to shrink the tumors?
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woc tumor,Tracheoesophageal Malformations
85 TRACHEOESOPHAGEAL MALFORMATIONS
Denis D. Bensard M.D., David A. Partrick M.D.
1. What are tracheoesophageal fistula (TEF) and esophageal atresia (EA)?
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The trachea and esophagus appear as a ventral diverticulum arising from the primitive foregut during the third week of gestation. The trachea and esophagus undergo separation by the ingrowth of ectodermal ridges during the fourth week of gestation. Failure of separation results in anomalous connection of the trachea to the esophagus (i.e., TEF) with or without incomplete formation of the esophagus (i.e., EA).
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
