Traumatismes Abdominaux et Épidémiologie

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Questions and Answers

Les traumatismes de l'abdomen sont moins fréquents en traumatologie.

False (B)

Quel est le principal risque lié aux traumatismes abdominaux ?

Le risque hémorragique.

Quelle est la cause la plus fréquente des traumatismes abdominaux ?

Les accidents du travail

Les agressions

Les accidents de la voie publique (correct)

Les accidents de sport

La proportion des traumatismes pénétrants est en baisse.

False (B) Signup and view all the answers

Quelle est la difficulté principale lors d'un traumatisme abdominal ?

Porter un diagnostic de gravité. Signup and view all the answers

Quelle est la principale cause des contusions abdominales ?

Les accidents de la voie publique. Signup and view all the answers

Quel est le sexe le plus souvent touché par les traumatismes abdominaux ?

Le sexe masculin (B) Signup and view all the answers

Les traumatismes pénétrants abdominaux surviennent principalement dans quel contexte ?

Dans un contexte de rixe ou d'agression. Signup and view all the answers

Quelle est la structure qui limite la dissipation immédiate et complète d'énergie cinétique lors des accidents de la voie publique ?

L'airbag (B) Signup and view all the answers

Quelle est la conséquence de l'augmentation de la pression intra abdominale ?

Diminution du retour veineux et du débit cardiaque (A), Oligoanurie (B), Ischémie digestive (C), Syndrome du compartiment abdominal (D), Hypertension intracrânienne (E) Signup and view all the answers

Le risque septique est lié à une contamination par le biais d'un agent vulnérant.

True (A) Signup and view all the answers

A quel niveau sont les lésions engendrées lors d'un traumatisme abdominal ?

Abdominal antérieure, postérieure et latérale. Signup and view all the answers

Le FAST est un outil de tri utilisé principalement dans les centres de traumatologie.

True (A) Signup and view all the answers

La TDM est une méthode de choix dans l'exploration de l'abdomen en urgence.

True (A) Signup and view all the answers

Qu'est-ce que la classification AAST ?

La classification AAST est une échelle qui permet de graduer la sévérité des lésions de chaque organe. Signup and view all the answers

Quel examen peut permettre d'évaluer le parenchyme rénal, sa vascularisation ?

L'uroscanner (C) Signup and view all the answers

Quel est le traitement de référence pour les lésions spléniques de grade 1, 2, ou 3 ?

Le traitement conservateur (B) Signup and view all the answers

Quelle est la technique chirurgicale la plus utilisée pour le contrôle de l'hémorragie hépatique ?

Le packing hépatique (B) Signup and view all the answers

Le traitement chirurgical pour les lésions du pancréas est toujours facile.

False (B) Signup and view all the answers

Quel est le traitement de référence pour les lésions intestinales ?

La suture simple (C), La résection anastomose (D) Signup and view all the answers

Les complications post-traumatiques sont souvent bénignes.

False (B) Signup and view all the answers

Study Notes

Traumatisme Abdominal

Abdomen trauma is common in trauma, with a high mortality rate (around 20%) primarily due to hemorrhage risk.
Most abdominal traumas are closed injuries, without a break in the parietal continuity.
Common causes of closed injuries are contusions (spleen, liver, kidneys, pancreas) and perforations (duodenum, small intestine, colon) and diaphragmatic tears.
Increased urban violence and easier access to weapons lead to more open injuries (penetrating trauma) and parietal perforations.
Assessment of severity in polytrauma cases is crucial for identifying those needing hospitalization and tailored treatment.
Epidemiology of intra-abdominal trauma is primarily dominated by contusions (70% spleen and 60% liver injuries), largely due to road traffic accidents (70%).

Epidemiology

Contusion abdominal injuries are more common (70% of spleen and 60% of liver injuries) in terms of closed traumas compared to open traumas.
Most causes of abdominal contusions are due to road accidents (70%).
Other causes include falls, sports accidents, and occupational accidents.
Male patients (70%) and young adults (mean age 30) are often involved.
Penetrating trauma is most associated with acts of violence (stab wounds or gunshot).

Anatomical Review

Superior limit of the abdomen: inferior costal margin and diaphragm
Posterior limit of the abdomen: thoracolumbar spine (T12-L5)
Inferior limit: pelvic girdle / pelvic floor
Anterior and lateral limits: musculo-aponeurotic wall
Contents: solid and hollow organs; large blood vessels.

Physiopathology

Multiple injuring mechanisms are possible with closed abdominal trauma.
Direction of the impact wave affects the trauma.
Direct impacts lead to compression and crushing of abdominal organs.
Lateral impacts are more damaging in road traffic accidents.
Contusions often occur in high-speed collisions.
Airbags and seatbelts can mitigate the force of impact, reducing the occurrences of intra-abdominal injuries.
Shearing forces during rapid deceleration can cause indirect damage by creating differential movements in intra-abdominal organs, injuring vascular pedicles, mesentery, and the ligaments.
The severity of open injuries (e.g from a stabbing injury) depends more heavily on the weapon's characteristics (length, width).

Diagnostic

Clinical assessment: Vital signs (especially hemodynamic status for potential blood loss), and history from the victim if possible, witness statements, accident details.
Physical examination: Comprehensive and methodical including skin markings, examination for wound entry/exit points, abdominal distension, palpation for painful areas, and signs of shock (pale mucous membranes, faint pulse, low blood pressure, cold extremities).
Biological tests: Blood typing, ABO and Rh factor, complete blood count (CBC), coagulation parameters, ionogram, blood gas analysis, liver function tests, and pancreatic enzymes.
Imaging: Chest radiography (to rule out rib fractures), pelvic radiography (to evaluate for pelvic fracture and associated hemorrhage), FAST (focused assessment with sonography for trauma) to detect internal bleeding, abdominal/pelvic ultrasound to locate and confirm intraabdominal collection with blood or fluid, and abdominal/pelvic CT scan (advanced imaging to detect and quantify injury to various abdominal organs).
Classification: AAST (American Association for the Surgery of Trauma) grading system for splenic, hepatic, and other organ injuries is used to assess the severity.

Treatment

Initial treatment: focuses on stabilizing the patient's vital signs and addressing potential hemorrhage. This commonly includes IV fluid resuscitation, blood transfusions, and oxygen therapy.
Surgical Intervention: Damage control surgery is often performed (limited initial surgery to control ongoing bleeding, followed by more extensive procedures in the post-operative period). Depending on the nature of the injury and stability of the patient, an embolisation procedure might be necessary. Alternatively, a conservative approach (no surgery) is performed based on the assessment of the patient.
Treatments for specific organ injuries: surgical spleens resection (for severe injuries), and treatment for liver injuries such as packing.
Post-operative care focuses on monitoring the patient, further management depending on the condition found.

Prognostic

Mortality and morbidity are related to severity of the injuries, the organs damaged (internal organs) and the speed of treatment.
Thorough assessment and rapid interventions are essential in improving patient outcomes.

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Description

Ce quiz explore les traumatismes abdominaux, en mettant l'accent sur les blessures fermées et ouvertes, ainsi que sur leur épidémiologie. Découvrez les causes communes des traumatismes, les statistiques de mortalité et l'importance de l'évaluation de la gravité dans les cas de polytraumatismes.