TRAUMA ABDOMINAL

• Trauma abdomen adalah kerusakan organ abdomen (lambung, usus halus, pankreas, kolon, hepar, limpa, ginjal) yang disebabkan oleh trauma tembus, biasanya tikaman atau tembakan; atau trauma tumpul akibat kecelakaan mobil, pukulan langsung atau jatuh.

• Rongga abdomen memuat baik organ-organ yang padat maupun yang berongga. Trauma tumpul disebabkan adanya deselerasi cepat dan adanya organ-organ yang tidak mempunyai kelenturan (noncompliant organ) seperti hati, limpa, pankreas, ginjal, atau pembuluh darah dapat menimbulkan kehilangan darah substansional ke dalam rongga peritoneum. Trauma tumpul pada abdominal dapat terjadi karena kecelakaan motor, jatuh, atau pukulan. Kompresi dan perlambatan dari trauma tumpul menyebabkan fraktur pada kapsula dan parenkim organ padat, sementara organ berongga dapat kolaps dan menyerap energi benturan.

ETIOLOGI

• Trauma Tumpul : kecelakaan lalu lintas (auto-to-auto, auto-to-pedestrian) 50-70%. Jatuh dibidang industrial atau rekreasi. Jarang krn iatrogenik trauma CPR, daya dorong pada saat membebaskan jalan nafas.

• Trauma tajam : tikam oleh benda2 tajam

klasifikasi

• Trauma PenetrasiLuka tembakLuka tusuk• Trauma non-penetrasiKompresi (trauma tumpul)Hancur akibat kecelakaanSabuk pengamanCedera akselerasi

TRAUMA TUMPUL ABDOMEN

epidemiologi

• 5 juta orang meninggal di seluruh dunia krn trauma

• Di singapura 79% krn trauma tumpul abdomen• Berdasarkan usia, menurut penelitian

puncaknya yaitu usia 14-30 th• Berdasarkan jenis kelamin, pria lebih besar dr

wanita dg perbandingan 60:40

Sign and symptoms

• Pain• Tenderness• GIS hemorage• Hypovolemia• Evidance of peritoneal irritation• large amounts of blood can accumulate in the

peritoneal and pelvic cavities without any significant or early changes in the physical examination findings. Bradycardia may indicate the presence of free intraperitoneal blood

• menduga adanya trauma tumpul abdomen- Sedang menyetir kendaraan- Abdominal distention- Auskultation bowel sound in thorax indicate a diafragma

injury- Local or generalized tenderness, guarding, rigidity, or

rebound tenderness: Suggests peritoneal injury- Fullness and doughy consistency on palpation: May indicate

intra-abdominal hemorrhage- Crepitation or instability of the lower thoracic cage:

Indicates the potential for splenic or hepatic injuries

TRAUMA TAJAM ABDOMEN

Cedera fisik dan psikis, penetrasi kekerasan yang mengkibatkan cedera

etiologi

• Luka akibat terkena tembakan• Benda tajam• Akibat tusukan

Manifestasi klinis

• Terdapat luka robekan pada abdomen

diagnosis• Penilaian kestabilan status hemodinamik sangat penting jika tidak

stabil segera lakukan pemeriksaan penunjang1. Diagnistic peritonel lavage, indicate:• Patients with a spinal cord injury• Those with multiple injuries and unexplained shock• Obtunded patients with a possible abdominal injury• Intoxicated patients in whom abdominal injury is suggested• Patients with potential intra-abdominal injury who will undergo

prolonged anesthesia for another procedure + gross dijumpai darah yg diaspirasi dr kateter DPL sejak dimasukan + mikroskopis merujuk pada eritrosit >100.000/ul

2. FAST• Bedside ultrasonography is a rapid, portable, noninvasive, and accurate

examination that can be performed by emergency clinicians and trauma surgeons to detect hemoperitoneum.

• The current FAST examination protocol consists of 4 acoustic windows:1. perihepatic (kantong morrison / hepatorenal) pd kuadran kanan atas2. perisplenic (ressesus splenorenal) pd kuadran kiri atas3. pelvic4. Pericardial

• An examination is interpreted as positive if free fluid is found in any of the 4 acoustic windows, negative if no fluid is seen, and indeterminate if any of the windows cannot be adequately assessed.

• Kecuali untuk pericardial, minimal darah 300cc untuk bisa terdeteksi FAST

3. Computed tomography• Computed tomography is the standard for

detecting solid organ injuries. CT scans provide excellent imaging of the pancreas, duodenum, and genitourinary system.

• CT scanning often provides the most detailed images of traumatic pathology and may assist in determination of operative intervention[1, 2, 3,

4] Unlike DPL or FAST, CT can determine the source (sumber) of hemorrhage.

management

• Operative (laparotomi)Indikasi :- tanda-tanda peritonitis- Syok dan hemagic yg tdk terkontrol- Keadaan klinis yg semakin memburuk slm

observasi- Ditemukan hemoperitoneal pada px FAST atau

DPL

• Non OperativeBeradasrkan hasil CT dan hemodinamik yg stabil- For the most part, pediatric patients can be resuscitated and treated

nonoperatively; some pediatric surgeons often transfuse up to 40 mL/kg of blood products in an effort to stabilize a pediatric patient

- Hemodynamically stable adults with solid organ injuries, primarily those to the liver and spleen, may be candidates for nonoperative management

- Splenic artery embolotherapy, although not standard of care, may be used for adult blunt splenic injury

- Nonoperative management involves closely monitoring vital signs and frequently repeating the physical examination

Penatalaksanaan

• Airway• Breathing• Circulation• Dissability• Exposure

Cedera Hati

• Tanda dan gejala:- Rasa sakit perut kuadran kanan atas- Kekakuan, spasme, “involuntary guarding”- Rebound tenderness- BU hilang/berkurang- Syok hipovolemik

Cedera Limpa

• Rasa sakit di bahu kiri• Nyeri perut kuadran kiri atas• Kekakuan, spasme, “involuntary guarding”• Syok hipovolemik

Cedera Ginjal

• Echimosis di daerah flank• Nyeri di daerah flank• Gross/mikroskopik hematuri

Cedera Vesica urinaria dan uretra

• Nyeri suprapubic• Ingin bak tp tdk bisa• Hematuri• Terdapat darah diujung penis• Terdapat darah discrotum• Regiditas, spasme, involuntary guarding• Kelenjar prostat berpindah tempat

Cedera Organ Berongga

• Iritasi peritoneum : kekakuan, spasme, involuntary guarding, rebound tenderness dan rasa sakit.

• DPL dapat terlihat empedu, feses, serat2 makanan