Runny nose

Abdominal wounds. Open injuries (wounds) of the abdomen Symptoms of penetrating abdominal injury

In the practice of surgeons, the most common penetrating abdominal wounds are gunshot and stab wounds. In such patients, an examination of the abdomen is carried out immediately after restoration of airway patency, adequate breathing and blood circulation. Indications for laparotomy are set based on signs of damage to internal organs requiring surgical treatment. Urgent surgical intervention is required for patients in a state of shock and with signs of peritonitis, patients in whom blood is released through a nasogastric tube or from the rectum, patients in whom free gas is detected in the abdominal cavity or in the retroperitoneal space, patients in whom internal organs are visible, as well as those taken to the hospital with a knife stuck in their stomach. In such cases, intravenous urography (IVP) is urgently performed, which can quickly identify the presence of two functioning kidneys. Intravenous urography is performed not so much to detect damage to the urinary system, but to make sure that the kidney on the uninjured side is functioning well (extremely necessary information in cases where the question of performing a nephrectomy arises during surgery).

Diagnosis in patients with gunshot wounds is quite simple. In contrast, the penetrating nature of stab wounds is more difficult to establish. These two types of penetrating abdominal wounds will be described below.

Gunshot wounds, in which the projectile penetrates the body from the chest to the hips, can cause damage to the abdominal organs. Of all penetrating gunshot wounds to the abdomen, 98% cause internal organ damage that requires immediate surgical intervention. However, in some cases, the nature of the gunshot wound may cause doubts among doctors. This situation occurs mainly with tangential gunshot wounds to the abdomen. In such cases, laparocentesis is performed, and if examination of the fluid obtained from the abdominal cavity during peritoneal lavage reveals more than 10.0 x 1012 red blood cells/L, the wound is penetrating and emergency laparotomy is required. Gunshot wounds of the thoracoabdominal region, back, lateral abdomen and pelvic region, which cause doctors to doubt their penetrating nature, are quite rare. In such cases, diagnostic tactics should be the same as for stab wounds of the abdomen.

For stab wounds of the anterior abdominal wall, doctors’ tactics may be different. It is always important to remember that only 50% of all abdominal stab wounds penetrate the abdominal cavity, and only 50% of them cause internal organ damage requiring emergency surgical intervention. In our opinion, the main task of examining such patients is to identify victims who have indications for emergency surgical intervention. Such patients must be quickly prepared for surgery. Conscious patients with stable hemodynamic parameters can be examined several times over time so as not to miss a penetrating wound. If they show signs of developing peritonitis or shock, surgery is necessary. All other patients can be discharged from the hospital after 24-48 hours. Examples when, during dynamic observation and examination, doubts about the diagnosis remain are quite rare. In these cases, many authors recommend using all possible diagnostic techniques, including laparocentesis and peritoneal lavage, local wound exploration (debridement and revision), diagnostic laparoscopy, and, finally, diagnostic laparotomy. Of all these techniques, the most informative for diagnosing a penetrating abdominal wound and setting indications for emergency surgical intervention, in our opinion, is laparocentesis and peritoneal lavage. There are three types of abdominal stab wounds that present significant diagnostic difficulties. These are thoracoabdominal wounds, wounds of the back and lateral abdomen. With thoracoabdominal wounds, the wound channel can enter the chest and penetrate through the diaphragm into the abdominal cavity. In this case, abdominal organs can often be damaged. The presence in such patients of signs of wound penetration into the abdominal cavity is an indication for emergency surgery. When examining these cases, we used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 x 1012/l was evidence of the penetrating nature of the injury. In such cases, drainage of the pleural cavity and laparotomy were performed, during which the defect in the diaphragm was sutured, and then adequate surgical intervention, depending on the damage found in the abdominal cavity. Stab wounds of the back and lateral abdomen can cause both damage to the retroperitoneal organs and the abdominal cavity. Injuries to the retroperitoneal part of the duodenum and colon are especially dangerous. In such patients, we also used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 x 1012/l indicates the penetrating nature of the injury. In such cases, emergency laparotomy was performed to eliminate damage to the abdominal organs and retroperitoneum. If the content of red blood cells in the fluid obtained from the abdominal cavity during peritoneal lavage was less than 10.0 x 1012/L, we performed a computed tomography scan of the abdomen with intravenous contrast agent injection into the duodenum and colon. With this method of computed tomography with “triple” contrast, the accuracy of the method in diagnosing damage to the organs of the retroperitoneal space is more than 95%. Stab wounds of the pelvis can cause damage to the organs of the gastrointestinal tract, organs of the urinary system, as well as the internal genital organs in women. To identify the penetrating nature of the wound, we also used laparocentesis and peritoneal lavage. In addition, all patients with stab wounds of the pelvic region underwent rigid proctosigmoidoscopy (sigmoidoscopy), cysto-urethrography, and women, in addition, underwent a vaginal speculum examination. Moreover, if the content of red blood cells in the fluid obtained from the abdominal cavity exceeded 10.0 x 1012/l, or other studies revealed signs of damage to internal organs, emergency surgery was performed. All other patients were followed up.

The first guidelines are the position of the wounded person and his behavior. A victim with damage to the abdominal organs tries to lie still. He tries not to change the initial position he has adopted. More often the wounded person lies on his back or on his side with his legs bent. The inspection begins with appearance assessments wounded.

A haggard, suffering face, a constant request: “Give me something to drink!”

First of all, the location of the damage is determined. Next, the severity of the condition is clarified, level of consciousness preservation and the wounded person’s reaction to the environment and the doctor’s interview. If the wounded person is conscious, the complaints and circumstances of the injury are clarified. Then the pulse, its frequency and filling are examined. As a rule, there is tachycardia, which is more significant the more severe the injury and blood loss; determine frequency, rhythm and depth breathing.

After this, they begin to identify local symptoms. If there is an open injury, check the location of the wound(s), its discharge and find out whether there is prolapse of internal organs (intestinal loops, omentum). If this is the case, then the diagnosis naturally becomes completely clear.

However, it should be noted that prolapse of viscera with penetrating abdominal wounds is observed in only 11% of the wounded. Then the participation of the abdominal wall in the act of breathing is checked.

If the abdominal organs are damaged, the anterior abdominal wall either does not participate in the act of breathing, or its movements are limited. This symptom is very important.

Only when all the above steps have been completed do careful palpation begin.

At the same time, the degree of rigidity of the anterior abdominal wall and its tension in certain areas are determined.

They check the Shchetkin-Blumberg symptom, a symptom of percussion pain.

Listen to intestinal peristalsis (at least one minute). Then they begin percussion of the abdomen to identify the presence of fluid (blood, exudate) in the abdominal cavity, as well as liver dullness and the level of protrusion of the bladder above the pubis. After this, bladder function is checked (the patient is asked to urinate). If spontaneous urination is impaired, bladder catheterization is performed. Pay attention to the amount of urine excreted or released.

Urine is assessed macroscopically.

The presence of dysuric phenomena is observed not only with damage to the bladder and urethra, but also with damage to the abdominal organs and retroperitoneal space.

The final stage of the clinical examination of the patient (in the hospital) is a rectal examination.

At the stage of first and first aid

application of an aseptic dressing, anesthesia, drinking water is prohibited.

Qualified assistance: victims with ongoing internal bleeding - go to the operating room, stop internal bleeding against the background of intensive anti-shock therapy.

Primary surgical treatment of wounds - in the operating room.

Surgery it is safest at a stable systolic pressure in the range of 90-100 mmHg. and diastolic not lower than 30 mm Hg, pulse rate 100 per minute, respiratory rate up to 25 per minute and shock index less than one.

Laparotomy is preferably performed under intubation anesthesia using relaxants. In time, it should take 1.5-2 hours. During this time, it is necessary to perform all interventions on the damaged organs. Such harsh conditions are dictated by the special situation at the stages of medical care, when other wounded are awaiting surgery in the anti-shock ward in the reception and triage department. The incision of the abdominal wall during laparotomy should provide the opportunity for a detailed examination of all abdominal organs and retroperitoneal space. If necessary, the midline incision can be extended upward and downward and supplemented with a transverse incision to the right or left. If you are fully confident that damage to the abdominal organs is limited to a certain area, a transverse incision is used above or below the navel with the intersection of the rectus abdominis muscle. Incisions parallel to the costal arch are used when the diagnosis of injury to the (isolated) liver or spleen is beyond doubt.

Surgical intervention for injuries to the abdominal organs is reduced to stopping bleeding, inspection of the abdominal organs and retroperitoneal space, introduction of drying tampons, actual surgical intervention on the organs, toilet of the abdominal cavity, and suturing of the abdominal wall.

After opening the abdominal cavity to identify the nature of the damage and draw up a plan for the operation, a sequential examination of its organs is required.

If blood is found in the abdominal cavity, it is necessary first of all, by removing it with tampons or an aspirator, to find the source of the bleeding and stop it .

If an operation for ongoing intra-abdominal bleeding is started against the background of decompensated shock, then after completing its main stage - identifying the source of bleeding and hemostasis - the operation should be suspended until hemodynamics are stabilized against the background of ongoing massive infusion-transfusion therapy. Only then can you continue and complete the operation

Open or penetrating wounds to the abdominal cavity are most often caused by firearms or cutting and stabbing objects.

Gunshot wounds, in which the projectile penetrates the body from the chest to the hips, can cause damage to the abdominal organs. Of all penetrating gunshot wounds to the abdomen, 98% cause internal organ damage that requires immediate surgical intervention. However, in some cases, the nature of the gunshot wound may cause doubts among doctors. This situation occurs mainly with tangential gunshot wounds to the abdomen. In such cases, laparocentesis is performed, and if the examination of the fluid obtained from the abdominal cavity during peritoneal lavage reveals more than 10.0 × 1012 red blood cells/l, the wound is penetrating and emergency laparotomy is required. Gunshot wounds of the thoracoabdominal region, back, lateral abdomen and pelvic region, which cause doctors to doubt their penetrating nature, are quite rare. In such cases, diagnostic tactics should be the same as for stab wounds of the abdomen.

For stab wounds of the anterior abdominal wall, doctors’ tactics may be different. It is always important to remember that only 50% of all abdominal stab wounds penetrate the abdominal cavity, and only 50% of them cause internal organ damage requiring emergency surgical intervention. In our opinion, the main task of examining such patients is to identify victims who have indications for emergency surgical intervention. Such patients must be quickly prepared for surgery. Conscious patients with stable hemodynamic parameters can be examined several times over time so as not to miss a penetrating wound. If they show signs of developing peritonitis or shock, surgery is necessary. All other patients can be discharged from the hospital after 24-48 hours. Examples when, during dynamic observation and examination, doubts about the diagnosis remain are quite rare. In these cases, many authors recommend using all possible diagnostic techniques, including laparocentesis and peritoneal lavage, local wound exploration (debridement and revision), diagnostic laparoscopy, and, finally, diagnostic laparotomy. Of all these techniques, the most informative for diagnosing a penetrating abdominal wound and setting indications for emergency surgical intervention, in our opinion, is laparocentesis and peritoneal lavage. There are three types of abdominal stab wounds that present significant diagnostic difficulties. These are thoracoabdominal wounds, wounds of the back and lateral abdomen. With thoracoabdominal wounds, the wound channel can enter the chest and penetrate through the diaphragm into the abdominal cavity. In this case, abdominal organs can often be damaged. The presence in such patients of signs of wound penetration into the abdominal cavity is an indication for emergency surgery. When examining these cases, we used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l was evidence of the penetrating nature of the injury. In such cases, drainage of the pleural cavity and laparotomy were performed, during which the defect in the diaphragm was sutured, and then adequate surgical intervention, depending on the damage found in the abdominal cavity. Stab wounds of the back and lateral abdomen can cause both damage to the retroperitoneal organs and the abdominal cavity. Injuries to the retroperitoneal part of the duodenum and colon are especially dangerous. In such patients, we also used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l indicates the penetrating nature of the injury. In such cases, emergency laparotomy was performed to eliminate damage to the abdominal organs and retroperitoneum. If the content of red blood cells in the fluid obtained from the abdominal cavity during peritoneal lavage was less than 10.0 × 1012/l, we performed a computed tomography scan of the abdomen with the introduction of a contrast agent intravenously, into the duodenum and into the colon. With this method of computed tomography with “triple” contrast, the accuracy of the method in diagnosing damage to the organs of the retroperitoneal space is more than 95%. Stab wounds of the pelvis can cause damage to the organs of the gastrointestinal tract, organs of the urinary system, as well as the internal genital organs in women. To identify the penetrating nature of the wound, we also used laparocentesis and peritoneal lavage. In addition, all patients with stab wounds of the pelvic region underwent rigid proctosigmoidoscopy (sigmoidoscopy), cysto-urethrography, and women, in addition, underwent a vaginal speculum examination. Moreover, if the content of erythrocytes in the fluid obtained from the abdominal cavity exceeded 10.0 × 1012/l, or other studies revealed signs of damage to internal organs, emergency surgery was performed. All other patients were followed up.

Most often, with penetrating stab wounds of the abdomen, the liver (in 37% of cases), spleen (7%) and kidneys (5%) are damaged from parenchymal organs. However, in general, hollow organs are most often damaged by stab and penetrating wounds of the abdomen. Their hollow organs are most often damaged in the small intestine (26% of cases), stomach (19%) and large intestine (16.5%).

With penetrating abdominal wounds, only the peritoneum may be injured. In this case, the intestines and omentum may fall out into the wound, being located between the muscles or falling out.

In the vast majority of cases, penetrating abdominal wounds are accompanied by injuries to the abdominal organs (liver, spleen, stomach, intestines, mesentery, bladder).

Symptoms. Symptoms of injury to the abdominal organs vary. In the first hours after injury, slight tension in the abdominal muscles usually appears; in some cases there is shock from the very beginning. Of the other symptoms, the most important are those of internal bleeding and irritation of the peritoneum. The pulse in such wounded people is usually frequent and weak. When the stomach and intestines are injured, tension in the abdominal walls is sharply expressed, which does not go away even with the patient in a resting position. When pressure is placed on the abdomen, patients complain of sharp pain. In most cases, vomiting is observed.

In addition to these symptoms, symptoms of injury to individual abdominal organs may be observed. When the liver and spleen are injured, symptoms of internal bleeding, increased dullness of the liver and spleen with dullness spreading to the right or left iliac region are observed. When the stomach is injured, bloody vomiting occurs and in some cases (rarely) bloating and tympanitis develop. When the large intestines are injured, in addition to the symptoms common to all abdominal injuries, bloody stools and a fecal odor from the wound are observed.

Diagnosis of penetrating abdominal injury not always easy. If there is a prolapsed omentum or intestine, recognition is not difficult. The leakage of bile and intestinal contents from the wound facilitates the diagnosis. Severe, increasing anemia, a drop in pulse, and fluid accumulation may indicate bleeding.

When the gastrointestinal tract is injured, tension in the abdominal muscles and chest type of breathing are sharply expressed. Vomiting with blood and bloody stools are observed.

Treatment . If a penetrating wound is suspected, the wound of the abdominal wall is expanded, i.e., primary treatment is performed, during which the diagnosis is clarified. In the event of a penetrating wound or prolapse of viscera, transection is performed immediately, if possible. The operation gives good results before the onset of diffuse peritonitis. As a rule, all wounded people should be operated on immediately if their condition allows, but operations performed after 24 hours or later usually give an unfavorable result.

If it is impossible to perform an immediate operation, prolapsed viscera should not be reset into the abdominal cavity, taking into account the possibility of introducing foreign bodies (pieces of clothing, etc.) and infection. The wounded are injected with antitetanus and antigangrenous serum.

Patients with abdominal wounds are admitted to the surgical department without taking a bath, as they are subject to emergency surgery.

Shaving, if the stomach is not painful, can be done before surgery. If there is inflammation of the peritoneum and the stomach is very sensitive, then shave under anesthesia. After surgery, an intramuscular injection of penicillin and streptomycin is prescribed. Penicillin and streptomycin are also administered into the abdominal cavity (200,000-1,000,000 units). As with closed injuries of the abdominal organs, blood and blood-substituting fluid transfusions by jet and drip methods are widely used. If internal bleeding is suspected, blood transfusions are started only during surgery. Patients with suspected injury to the stomach or intestines are not given anything to drink or eat by mouth. To quench thirst in such cases, it is better to inject saline solution under the skin. In case of internal bleeding before and after surgery, it is better to place the patient on a bed with the leg end raised. For abdominal pain - ice.

In the first days after the operation, they give only liquids, then jelly, porridge, and later they switch to a common table. In the absence of injury to the stomach and intestines - diet in the first days; from the 4-5th day you can give bread, minced meat, and by the 7-8th day they move on to regular food, of course, provided that the stomach has normal function. The rest of the patient care is general.

JSC "Astana Medical University"

Department of General Surgery

Medical history

Full name sick: Gappasov Aibek Galymzhanuly

Diagnosis: Penetrating injury to the abdominal cavity, with damage to the left lobe of the liver

Curator: student 333 gr. Marcus A.

Checked by: Kovalenko T.F.

Astana 2010

Medical record of inpatient No. 4429

Date and time of admission: 8.11.10 21:00

Check out date and time:

Department: Surgery

Type of transportation: On a gurney

Blood type: 0(I) first

1. Full name patient: Gappasov Aibek Galymzhanuly

2. Gender: Male

3. Age: 08/10/1989 (21) full years

4. Permanent place of residence: Astana, Sary-Arkinsky district, st. A. Moldagulova 29d room 141

5. Place of work, profession position: RC “Preschool Education” typographer

6. Who sent the patient: Ambulance

7. Delivered to the hospital due to emergency, 1 hour after the injury

8. Diagnosis of the referring organization: stab wound to the abdominal cavity

9. Diagnosis on admission: Penetrating injury to the abdominal cavity

10. Clinical diagnosis: Penetrating injury to the abdominal cavity, with damage to the left lobe of the liver

Initial examination of the patient

Patient: Gappasov A.G., 21 years old

General condition of the patient: the condition is closer to moderate severity. The patient is conscious, somewhat excited, adequate. There are no disturbances in posture and gait. When examining the head, face, and neck, no pathological changes are observed. The facial expression is calm. Asthenic build, moderate nutrition. The skin and visible mucous membranes are of normal color. The hair growth is pronounced, according to the male type. Nails are of normal shape, pale pink, elastic. Peripheral lymph nodes are not enlarged, painless, mobile and not fused to each other and surrounding tissues. There is no sinking or protrusion of the eyes, no swelling around the eyes. The pupils are symmetrical, the reaction to light is preserved. Breathing in the lungs is vesicular, there are no wheezes, and it is carried out in all fields. NPV – 20 per minute. Heart sounds are muffled, rhythmic, body temperature is 36.7 degrees, blood pressure is 140/90 mm Hg, pulse is 90 per minute.

Thyroid gland. Not visually detectable, not enlarged upon palpation, soft elastic consistency. There are no symptoms of thyrotoxicosis.

Muscular system. It is developed satisfactorily for the patient’s age, the muscles are painless, their tone and strength are sufficient. No hyperkinetic disorders were identified.

Osteoarticular system. The bones of the skull, chest, pelvis and limbs are not changed, there is no pain on palpation or percussion, the integrity is not broken. The joints are of normal configuration, there is no pain on palpation, active and passive movements are in full range. The spine is not curved; there is no pain when palpating or tapping individual vertebrae. The gait is normal.

Respiratory organs. The nose is straight, the mucous membrane and skin are normal. There is no separation. The voice is normal. The chest is asthenic, the epigastric angle is 90 degrees, symmetrical, the excursion of both sides during breathing is uniform. Breathing is rhythmic, respiratory rate is 19-20 per minute, breathing type is mixed. On palpation, the chest is painless and elastic. Voice tremors are unchanged. With comparative percussion over the entire surface of the lungs, a clear pulmonary sound is heard. There are no dullings.

Cardiovascular system. On examination, there is no protrusion or pulsation in the area of large vessels. The cardiac and apex beats are not visually determined, the chest at the site of the projection of the heart is not changed. On palpation, the apical impulse is palpated in the 5th intercostal space along the left midclavicular line, limited, low, not amplified, unresistant. The symptom of “cat purring” is negative. On auscultation, heart sounds are rhythmic and muffled. There is no noise.

Genitourinary system. When examining the lumbar region, there is no redness, swelling, or swelling of the skin. The kidneys are not palpable. The effleurage symptom is negative on both sides. There is no pain during percussion and palpation in the area of projection of the bladder. Urination is voluntary, free, painless.

Neuropsychic sphere. The patient is correctly oriented in space, time and his own personality. He is sociable, willingly communicates with the doctor, his perception is not impaired, his attention is not weakened, he is able to concentrate on one thing for a long time. Memory is preserved, intelligence is preserved, thinking is not impaired. The mood is even, the behavior is adequate.

Examination and treatment plan

1. general blood test

2. General urine test

3.Microreaction

4.Blood group, Rh – factor

5. Emergency surgical treatment.

Preoperative epicrisis

The patient is indicated for surgical treatment for life-saving reasons. A laparotomy and examination of the abdominal organs under intubation anesthesia are planned. The further course of the operation depends on the intraoperative findings.

The patient's consent for surgical treatment was obtained and a receipt was taken. Blood group 0(I) first Rh + positive.

Doctors on duty: Kovalenko T.F.

Kaukeev A.S.

Abeldin S.K.

Consultation with an anesthesiologist

Date of examination: 8.11.10 Time of examination: 21:20

Anesthesiologist: Lyaginskov V.B.

Full name patient: Gappasov A.G.

I/B number: 4429

Gender: Male

Rh factor: Rh(+) positive

Side effects of drugs: Not noted 8.11.10

Complaints: pain in the wound area.

1. There are no previous diseases

2. Previous operations, no complications

3. Previous anesthesia, no complications

4. No concomitant diseases

5. No allergies

6. There is no constant use of medications.

7. Blood transfusions, no complications

8. bad habits: no smoking

alcohol and drug abuse yes

Objective status: Body weight: 56 kg. Height: 168 cm

The physique is correct, there is no pathology of the veins of the lower extremities, the neck is average, the oral cavity is without any features, the skin is of normal color.

Conclusion:

ASA Physical Status: ASA II

Suggested type of surgery: laparotomy

Anesthetic risk according to Ryabov: IIA

Purposes: a) general blood test, general urinalysis, biochemical.

b) Determination of blood group, Rh – factor

Premedication on the operating table: atropine 0.1%, diphenhydramine 10mg, promidol 2%

Induction anesthesia: Propofol 100 mg, orenthanil 0.005%-2.0

Tracheal intubation through the mouth with a cuffed tube

Features and complications: b/o

Mechanical ventilation, respirator - P060S

MOD – 8.0 l/min

Inhalation pressure - 10 cm water column,

Primary anesthesia: Propofol 500 mg, 0.005% - 8.0

Breathing can be heard in all departments

Hemodynamics are stable

Drug support: Dicynon 500 mg IV, cephalosparin III 2g

No blood loss

Infusion and transfusion support: NaCl 0.9% - 750.0

Duration:

Anesthesia: from 21:35

Operations: from 21:45 to 22:55

The patient was transferred to the specialized ICU department on mechanical ventilation.

Diagnosis after surgery: Perforating injury to the liver

The patient’s condition at the time of transfer to the specialized department corresponds to the severity of the surgery.

Indicators at the time of transfer: blood pressure - 130/80 mmHg.

Heart rate – 84 beats/min

Pace. hail C – 36.6

Additionally: Sol NaCl 0.9% - 1000 + quamatel 20mg

Operation No. 360

Description of operation

Laparotomy, suturing of the liver wound. Sanitation, drainage of the abdominal cavity.

After treating the surgical field three times with hibitoma, three times under intubation anesthesia, an upper-midline laparotomy was performed. In the abdominal cavity there is a small amount of fresh blood along the right lateral canal, above the hepatic space on the right it is drained. Upon further inspection, a wound of the parietal peritoneum measuring 0.5x0.5 was discovered - suturing with catgut + hemostasis using a Sergisila plate. The colon, small intestine, liver, spleen, pancreas and stomach were inspected, the omental bursa was examined, and no damage was found. The abdominal cavity is drained. The abdominal cavity was drained with a silicone tube into the subhepatic space through a separate incision in the right hypochondrium. Homeostasis – dry. The postoperative wound is completely sutured. Stitches on the skin. The wound on the anterior abdominal wall is sutured in layers with interrupted lavsan sutures. Alcohol. Ac. Bandage.

Rationale for clinical diagnosis.

Complaints upon admission: pain and the presence of a wound in the abdominal area.

Patient's history: According to the patient, 1 hour before admission, he was stabbed in the abdomen, after which he was taken by ambulance to an urgent clinic at the Federal Joint-Stock Company "ZhGMC" "Central Road Hospital" with a blood pressure of 140/90 mmHg, examined surgeon - during inspection of the wound, the penetrating nature of the wound was revealed. Considering the penetrating nature of the wound, the patient was taken from the emergency room to the operating room.

Life history: suffered Botkin's disease in childhood, sexually transmitted diseases, denies tuberculosis. Denies operations, injuries and blood transfusions. Allergological history and heredity are not burdened.

General condition of the patient: the condition is closer to moderate severity. The skin and visible mucous membranes are of normal color. . Breathing in the lungs is vesicular, there are no wheezes, and it is carried out in all fields. NPV – 20 per minute. Heart sounds are muffled, rhythmic, body temperature is 36.7 degrees, blood pressure is 140/90 mm Hg, pulse is 90 per minute.

Locally: The tongue is dry, covered with a white coating. The abdomen is of regular shape, participates in the act of breathing, is symmetrical, and is painful on palpation in all parts. Symptoms of peritoneal irritation are positive. Percussion reveals dullness in sloping areas. Peristalsis is heard. The effleurage syndrome is negative on both sides. Urination is free and painless. Gases go away. The chair is without any features.

Status Localis: When examined to the right of the midline along the edge of the costal arch in the epigastric region, there is a wound with smooth edges and sharp corners measuring 2.0 x 1.5 cm. It is bleeding profusely; upon inspection of the wound at the trauma center, the bleeding nature of the wound into the abdominal cavity was revealed.

Diagnosis on admission: penetrating injury to the abdominal cavity.

Postoperative diagnosis: penetrating injury to the abdominal cavity with injury to the liver. Hemoperitoneum.

Based on the above, a clinical diagnosis was made: Penetrating injury to the abdominal cavity with injury to the liver. Hemoperitoneum.

Heart rate – 80/min

NPV – 18 per minute

Examination by the surgeon on duty.

The general condition of the patient is of moderate severity, consistent with the duration and severity after the surgical intervention. The patient is conscious and adequate. Complains of moderate pain in the surgical area. The skin and visible mucous membranes are normal. Breathing in the lungs is vesicular, audible throughout all pulmonary fields. No wheezing. Heart sounds are muffled and rhythmic. The tongue is clean and moist. Urination is free and painless.

Heart rate – 78 per minute

NPV – 16 per minute

Examination by the attending physician.

The general condition of the patient is moderate. Complains of moderate pain in the surgical area. The skin and visible mucous membranes are normal. Breathing in the lungs is vesicular, audible throughout all pulmonary fields. No wheezing. Heart sounds are muffled and rhythmic. The tongue is clean and moist. Urination is free and painless.

Locally: The abdomen is of regular shape, not swollen, participates in breathing, is soft on palpation, moderately painful in the areas of surgical intervention. Peristalsis is heard and gases do not pass away. There is no chair. The Shchetkin-Blumberg symptom is negative. The bandage was moderately wet with hemorrhagic discharge. The skin around the drainage is not swollen, moderately hyperemic, and treated with alcohol. There is no discharge from the drainage, washed with kanamycin, aseptic bandage on the area of the suture and drainage. Rubber graduate removed. Receives treatment.

Examination by a psychiatrist

DS: Psychopathic-like behavior is situationally determined in an accentuated personality of the psychasthenic circle. Acute reaction to stress. Suicide attempt?

A psychotherapeutic conversation was held.

Recommendation: - Individual post

Relanium 0.5% - 10 mg IM at night. N 2

Inspection in dynamics

Heart rate – 76 per minute

NPV – 18 per minute

Examination by the attending physician.

The general condition is relatively satisfactory. Complains of moderate pain in the surgical area. The skin and visible mucous membranes are normal. Breathing in the lungs is vesicular, audible throughout all pulmonary fields. No wheezing. Heart sounds are clear and rhythmic. The tongue is covered with a white coating. Urination is free and painless.

Locally: The abdomen is not swollen, symmetrical, involved in breathing, soft on palpation, moderately painful in the areas of surgical intervention. Peristalsis is heard and gases are released. There is no chair. The Shchetkin–Blumberg symptom is negative. The bandage was moderately wet with hemorrhagic discharge. The skin around the drainage is not swollen, moderately hyperemic, and treated with alcohol. There is no discharge from the drainage, washed with kanamycin, aseptic bandage on the area of the suture and drainage. A rubber graduate has been installed. Aseptic dressing. It is recommended to apply a heating pad with ice to the laparotomy wound dressing.

11/12/10 – Ultrasound of the abdominal organs

Heart rate – 74 per minute

NPV – 16 per minute

Examination by the attending physician.

Joint inspection with the manager. Department of Surgery Verwijk S.K. The general condition is relatively satisfactory, with positive dynamics. Complains of moderate pain in the laparotomy area. The skin and visible mucous membranes are normal. Breathing in the lungs is vesicular and can be heard throughout all pulmonary fields. No wheezing. Heart sounds are clear and rhythmic. The tongue is clean and moist. Urination is free and painless.

Locally: The abdomen is not swollen, symmetrical, involved in breathing, soft on palpation, slightly painful in the areas of surgical intervention. Peristalsis is heard and gases are released. There is no chair. The Shchetkin-Blumberg symptom is negative. The bandage is dry. The skin around the drainage is not swollen, not significantly hyperemic, the edges of the suture bleed slightly in the umbilical area. The seam is treated with alcohol. There is no discharge along the drainage, rinsed with kanamycin, an aseptic bandage was applied to the suture and drainage areas, an aseptic bandage, and an ice pack. Rubber graduate removed. On ultrasound of the abdominal organs dated 11/12/10; No fluid was found in the abdominal cavity.

The following patient is offered surgical treatment: Gappasov A.G., 21 years old, who was admitted as an emergency on 08.11.10 at 21:00 with complaints of pain and a wound in the abdominal area. According to the patient, 1 hour before admission, he received a stab wound in the abdomen, after which he was taken by ambulance to an urgent clinic at the Federal Joint-Stock Company "ZhGMC" "Central Road Hospital" with a blood pressure of 140/90 mmHg, examined by a surgeon - at Inspection of the wound revealed the penetrating nature of the wound. Considering the penetrating nature of the wound, the patient was taken from the emergency room to the operating room.

Can hurt left share liver and other organs located in the upper part abdominal cavities. This is... DAMAGE (WOUNDS) CHEST Injuries breasts are divided into penetrating and non-penetrating. Penetrating injuries come with damage or without damage ...

Therapeutic physical education (2)

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Hypoxia, overheating, penetrating radiation, some toxic... lower segment shares left lung is carried out... abdominal cavities is exposed to significant toxic effects liver...closed. Open damage - injuries joint areas and...

Gallstone disease. Chronic calculous cholecystitis, exacerbation

Abstract >> Medicine, health

... left shares liver area 1 by 1 by 1 cm. Other pathologies in abdominal cavities not found. Drainage abdominal cavities... with the possibility damage elements of the hepatoduodenal...: Penetrating stab-cut wound abdominal cavities. Through wound liver. ...

Organization of post-mortem veterinary examination

Abstract >> Medicine, health

Gunshot wounds, traumatic damage, phlegmon, ulcers, ... belatedly, in abdominal cavities there is a smell of gastrointestinal contents... all left share liver permeated with mass... fish with wounds on the bottom... dark spots, deep penetrating deep into the muscles...