Abdominal Trauma: Surgical and Radiologic Diagnosis

ISBN-13: 9781461258520 / Angielski / Miękka / 2011 / 224 str.

H. M. Delany; R. S. Jason;C. M. Moss

Opis

Trauma to the abdomen, both accidental and willful, has become increasingly common in this era of increasing violence. Large numbers of patients all over the country are admitted to emergency rooms because of abdominal trauma of varying degrees of severity. All too often the correct diagnosis is suspected belatedly or not at all, so that proper treatment is not initiated in sufficient time to be lifesaving. Not infre quently, the injured patient is examined by an intern or an insufficiently experienced resident physician. Even in instances where more senior internists and surgeons are available, detailed knowledge about the necessary methodology to establish the correct diagnosis and institute the appropriate treatment is lacking. This monograph, representing the felicitous collaboration of a surgeon and a radiolo gist together with several other contributors, is timely and important. The authors (and their contributors) have approached their subject with a wealth of clinical experi ence obtained in several very active acute-care municipal hospitals in the largest city in this country. They have observed and treated a very large number of patients with a multitude of traumatic causes, including firearm injuries, stab wounds, vehicular accidents, falls, and assaults. The authors have divided this work into four main sections: General Perspectives on Abdominal Injury, Types of Abdominal Injuries, Specific Diagnostic Techniques, and Specific Organ or Supporting-Structure Injury."

Spis treści

1 General Perspectives on Abdominal Injury.- Incidence of Abdominal Injuries.- Variables Affecting Morbidity and Mortality.- General.- Age and Sex.- Condition of the Patient prior to the Trauma.- Multiple-System and Multiple Abdominal Organ Injury.- Condition of the Patient following Trauma.- 2 Types of Abdominal Injury.- Penetrating Injury.- Historic View and Changing Mortality Rate.- Etiology.- Age, Sex, and Race.- Stab Wounds.- Mortality.- Site of Injury.- The Selective Approach to Surgery.- Roentgenographic Evaluation by Stab-Wound Contrast Injection.- Gunshot Wounds.- The Weapon.- Wounding Potential.- Shotgun Injury.- Mandatory Surgical Intervention and Selectivity.- The Military Experience.- Blunt, Nonpenetrating Injuries.- Incidence and Mortality.- Multiple Injury.- Falls from Heights.- Seat-Belt Injuries.- 3 Specific Diagnostic Techniques.- History Taking.- General Considerations.- Medicolegal.- Subtle Injuries.- Delayed Manifestations of an Old Injury.- Physical Diagnosis.- The General Examination.- Examining Stab Wounds.- Examining Gunshot Wounds.- Examining the Patient Subjected to Blunt Trauma.- Laboratory Evaluation.- Hematocrits.- Leukocyte Count.- Serum Enzymes.- Serum Amylase.- Creatine Phosphokinase.- Glutamic Oxaloacetic Transaminase.- Lactic Dehydrogenase.- Alkaline Phosphatase.- Peritoneal-Fluid Enzymes.- Radiologic Evaluation.- Technique of the Radiographic Examination.- Chest Examination.- Abdominal Examination.- Plain-Film Evaluation.- Paracentesis and Peritoneal Lavage.- Technique.- Indications for Paracentesis and Peritoneal Lavage.- Interpretation of Results of Lavage.- Radionuclide Scanning.- History.- Technical Considerations.- Spleen.- Method.- Results.- Liver.- Methods.- Liver-Lung Scans.- Kidney.- Arteries.- Peritoneoscopy.- Indications.- Technique.- Illustrative Case Reports.- Exploratory Laparotomy.- The Incision.- Controlling Hemorrhage.- Inspection of Abdominal Organs.- Running the Bowel.- The Spleen, Pancreas, and Retroperitoneum.- 4 Specific Organ or Supporting-Structure Injury.- Diaphragm.- General Aspects of Injury.- Radiologic Features.- Spleen.- General Aspects of Injury.- Types of Splenic Injury.- Splenic Contusion with an Intact Capsule.- Capsular Tear with Oozing.- Splenic Laceration or Disruption with Hemorrhage.- Plain-Film Findings.- Alteration of Splenic Size, Position, and Contour.- Gastric Dilatation.- Serration of the Greater Curvature of the Stomach.- Sonographic Evaluation.- Contrast Evaluation.- Complications of Splenic Injury.- Delayed Splenic Rupture.- Pseudoaneurysm Formation.- Cyst Formation.- Splenosis.- Liver and Biliary Tract.- General Aspects of Injury.- Mechanism of Blunt Injury.- Sonography.- Radiologic Studies.- Associated Injuries to Supporting Structures.- Associated Intra- and Extraabdominal Injury.- Plain-Film Signs of Hepatic Injury.- Fluoroscopy.- Angiography.- Gallbladder.- Extrahepatic Biliary Ducts.- Intestinal Tract.- General Aspects of Injury.- Use of Contrast Agents for Diagnosis of Upper and Lower Gastrointestinal-Tract Traumatic Lesions.- Stomach.- Radiologic Diagnosis.- Duodenum.- Intramural Hematoma.- Retroperitoneal Perforation.- Intraperitoneal Perforation.- Small Bowel.- Intraperitoneal Perforation.- Colon and Rectum.- Mesenteric Laceration.- Intramural Hematoma.- Colonic Laceration.- Rectal Injury.- Mesenteric Injury.- Retroperitoneum.- Pancreas.- Mechanism of Injury.- Types of Injury.- Vascular System.- Total Transection.- Partial Transection and Pseudoaneurysm Formation.- Traumatic Arteriovenous Fistula.- Traumatic Dissection.- Genitourinary Tract.- Kidneys.- Diagnostic Evaluation.- Ureters.- Urinary Bladder.- Urethra.- Pelvic Fractures.- Classification and Mortality.- Associated Injuries and Mortality.- Exploratory Laparotomy.- Radiographic Diagnosis.- Angiographic Evaluation.