Abdominal Injury in Children

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ABDOMINAL INJURY

IN CHILDREN

Ms. Subin Mariya Jacob2nd year MSc Nursing

NUINS


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ABDOMINAL TRAUMA

Accounts for 8 % of pediatric trauma Abdomen is the third most commonly

injured anatomical region in children

TYPES OF TRAUMA

Blunt injury [ >80%]

Penetrating injury


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ABDOMINAL ORGANS


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PATTERNS OF ABDOMINAL ORGAN INJURY

BY MECHANISM OF INJURY

Frequency of Organ Injury Blunt Penetrating

Liver 15% 22%

Spleen 27% 9%

Pancreas 2% 6%

Kidney 27% 9%

Stomach 1% 10%

Duodenum 3% 4%

Small bowel 6% 18%

Colon 2% 16%

Other 17% 6%


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ETIOLOGYMotor vehicle related crashes- as an

Occupant ,

Pedestrian or

Bicycle rider

Other causes

Sporting activities

Falls &

Child abuse


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Powerpoint Templates

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ANATOMICAL FEATURES CONTRIBUTINGTO ABDOMINAL INJURIESRibs are horizontally oriented,

More flexible- less likely for fractures

offering less protection to the abdominal

organs e.g spleen , liver.
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Abdominal muscles are

less developed &

therefore thinner than in

the adult.

Organs are relatively

large and closer to the

source of impact.


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PATHOPHYSIOLOGY

BLUNT INJURY ABDOMINAL ORGANS

crushing & bursting of the solidupper abdominal organs, perforation of the hollow viscus or shearing of the vascular supply after

ra id deceleration forces


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PATHOPHYSIOLOGY

Penetrating injuries abdomen

The degree of damage is directly attributed to

the amount of kinetic energy

transferred to the surrounding tissue.

A high velocity weapon such as a gun produces more

damage to surrounding tissues than a knife wound


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DIAGNOSIS

History Collection

Physical Examination

Abdominal CT

Abdominal X Ray


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PHYSICALSIGNRapid, shallow breathing

Abdominal tenderness, Increasing abdominal

girth

Flank or abdominal mass, contusion or wound

Blood in the urethral meatus, hematuria

Inability to void


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Genital swelling or discoloration

Referred shoulder pain with upper abdominalpalpation

Internal bleeding

hypotension : under 80 mm Hg in older

children; under 60 mm Hg in infants

increasing pallor

rapid respirations


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Injuries frequently associated

with abdominal injury Fractured lower ribs

Penetrating trauma to the lower chest

Pelvic fracture

Multisystem trauma sustained duringmotor vehicle crash


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MANAGEMENT

Non-operatively- most blunt injuries

Operative

-unstable vitals even in the face ofaggressive fluid resuscitation, absence ofextra vascular volume loss or an enlarging

abdomen-based on CT and physical findings:peritoneal irritation, hypovolemia or free air

on plain film


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Suspected abdominal injury-

NG tube aspirated content inspected forvisible blood & tested for occult blood

If blood low suction

Foleys- examine urine for blood

If blood

emergency IVP Paracentesis


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SPLENIC RUPTURE


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CLINICAL FEATURES Tenderness in the left upper quadrant esp. on

deep inspiration

Blood on abdominal paracentesis

KEHRS sign- radiated left shoulder pain


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MANAGEMENT

IVF- replacement

IVP- Left kidney damage

CBC- extent of blood loss

Blood typing & cross matching- blood transfusion-

replacement


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Mild blood loss from rupture

- admitted for observation

Severe blood loss

- scheduled for immediate surgery: partialor total splenectomy to halt bleeding &save life

FOLLOWING SPLENECTOMY

Return of bowel functions Susceptible to infection e.g. pneumococcal

infections- immunisation


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LIVER RUPTURE OR

LACERATION


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CLINICAL FEATURES

Severe abdominal pain , most marked on

inspiration

Symptoms of blood loss:

Tachycardia, hypotension, anxiety & pallor,

low or falling hematocrit: SURGERY: liver

highly vascular organ & blood loss from it is

acute & dama in


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May have colicky upper abdominal pain

relieved by emesis

GI bleeding such as hematemesis or malena

occur within few days

LIVER ARTERIOGRAM


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MANAGEMENT

Assess for peritonitis

Following surgery observe return of

bowel functions

Careful re-introduction of oral nutrition

Abdominal Injury in Children

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