INTRODUCTION
Abdominal cavity is a cavity with the support of the rear of the structure of the spine, lumbo-sacral torako entire cavity is filled with muscle and connective tissue which is relatively vulnerable to trauma, when compared with the framework of the chest.
On the top is below the diaphragm and pelvic diaphragm constituted by a skeleton propped up by the pelvis. The side of the face entirely in the form of the muscle, whose strength is relative depending on the degree of burden that are routinely given to the muscles.
As a result of protective construction abdominal cavity, the organs contained within the abdominal cavity becomes very susceptible to trauma either sharp or blunt trauma injury, trauma is a relatively "lightweight" is enough to cause organ damage, intra-torakal, but without handled quickly and appropriately, will be able to cause a fatal condition.
Three things that cause medical emergencies Intra-Abdomen, Namely:
th hemorrhage due to trauma that damage the liver, lymph, abdominal aortic or venous blood vessels of the mesentery, mesocolon and omentum, and retroperitoneal organ damage.
Peritonitis due to th difusa tercecernya intestinal contents into the peritoneal cavity due to intestinal leakage.
Dissemination th kidney damage and urinary bladder.
Pathophysiology
Abdominal Trauma divides the sharp trauma, trauma and blunt trauma bullets.
Trauma sharp or sharps puncture gave lesion on kutis and subcutis, when more deeply involve the abdominal muscles, and the puncture will penetrate deeper into the peritoneum and intraperitoneal organs capable of injuring or may directly injure when traumatic retroperitoneal organs come from behind. Very rarely encountered sharp penetrating trauma from the face to the rear wall of the abdomen or vice versa.
Sharp trauma of the abdominal wall will cause bleeding in situ, when the trauma through the peritoneum, there may be polas omentum.
Sharp trauma can easily injure the liver, mesentery and mesocolon, gastric, pancreatic or jar, but due to the nature of mobility, rarely injure the small intestine, colon, spleen and kidney.
Resulting from sharp trauma on the bleeding that usually is observed, or if the injury is affected by gastric, gastric acid will be found to spread within the peritoneal cavity, which will give a great enough stimulus, such as signs of peritonitis.
The situation somewhat different on the bullet penetrating trauma, in which organ damage rather "Complicated", because it made possible the emergence of multi-organ damage. Due to the rotation speed and bullet penetration which occurred, in the form of laceration injuries that occurred greater than the diameter of the bullet. In the event of perforation diameter of the abdomen, possible occurrence of intraperitoneal and retroperitoneal organ damage at once. In these circumstances, other than bleeding, frequent intestinal perforation was also found that multiple, and extensive retroperitoneal hemorrhage.
Blunt trauma from the direction of advance, the damage generally occurs due to trauma by pinching between the lumbar spine. The situation that often occurs is perforated gastric or hepatic rupture. Liver and spleen rupture was found in a state of hepatomegaly and / or splenomegali. Ruptured jar found, if at the appropriate trauma advance jars - jars in a state full of urine.
ENFORCEMENT DIAGNOSIS
Sharp trauma and penetrating trauma of the bullet is very easily diagnosed, which needs to be established with certainty is whether the trauma is through the abdominal wall. Blunt abdominal trauma requires a careful physical examination, to determine whether there is damage to intraperitoneal organs. Necessary to distinguish the existence of peritonitis or peritonitis due to reaction tertumpahnya intestinal contents or blood in the peritoneal cavity freely, or signs of bleeding peritonismus due to stimulation of the abdominal wall or retroperitoneal bleeding. When clinical diagnosis is not obtained by physical-certainty, abdominal x-rays need to be made in an upright position or semi-sitting and lateral decubitus position, with the hope of finding of free air or free intraperitoneal fluid.
Intraperitoneal hemorrhage allegations are supported by the location of trauma, general condition of patients, specifically the state of hemoglobin and hematocrit levels in blood, and when necessary with kanula puncture the abdominal wall.
Suspicion of renal trauma, which is supported by the diantarannya hematuria, can be assessed by making nefrografi with intra venous contrast (IVP) and rupture mug, can be detected with sistografi, which is found when blunt trauma is accompanied suprasimfisis signs of peritonitis, haematuria with a diuresis relatively small.
ACTION RESPONSE
Evaluation th state of the heart-lung
Overcome th state of shock as well as improving the condition of fluid and electrolyte balance
Place the catheter in dauer th
Exploration th injury / trauma laparotomy in all cases, sharp and penetrating trauma rounds, held in an operating room, in general narcotics, with a preparatory tool for laparotomy.
Exploration th wound to ensure, whether the wound through the peritoneum or not, if the wound through the peritoneum, exploratory laparotomy forwarded action.
th laparotomy exploration has been conducted to blunt abdominal trauma, when the lesion for signs of bleeding and / or intra-peritoneal free air.
Preparation th blood transfusion Hb level sufficient to at least 10 benchmarks.
Special Policy:
th arterial haemorrhage: controlled by ligation
th intestinal perforation / Gastric: closed perforations. When there are multiple intestinal perforation, or extensive laceration of the intestines / colon, should be simple to hemikolektomi resection, in order to minimize trauma and operation time shortened.
th liver rupture: a simple sewing done until lobektomia liver taste.
th Ruptured spleen: splenectomy performed, suturing the spleen to be unsatisfactory, because kerapukan network and the high level of bleeding.
Damage th pancreas: attempted reconstruction, when the trauma of the head of the pancreas which, if damaged section toward the caudal pancreatic body, pancreatic resection should be performed.
Ruptured th jar: usually just a simple suturing
th Ruptured kidney: tends to conservative therapy, antibiotics and hemostatikum. In a state of "Shattered Kidney" or the hilum progressive renal bleeding, considered nefrektomi action.
th prolapsed omentum: can not ever put omentum is not in the operating room in conjunction with exploratory laparotomy
CLOSING
yr, good observation, followed by quick action and adequate treatment, patients do not have to die as a result of abdominal trauma, except in the state of the abdominal aorta rupture.
Although th state of the process toward medical emergencies in abdominal trauma going pretty slow, does not mean we can put the triage victims of abdominal trauma at a low level.
th Need to exercise, education, adequate or extensive experience, so that someone who engaged in the field of medical emergencies can quickly, accurately and precisely, to determine the definitive diagnostics of abdominal trauma, especially in blunt trauma, so that therapy is fast, accurate and adequate can be applied.
th physical examination, clinical diagnostics is very important with or without medical support.
