🔰Specific Organ Injury
🔸A. Liver Injury
▪︎Most Liver Injuries Are Minor & Don't Need Surgery

▪︎Liver is Well Vascularized Organ & Has High Risk Of Bleeding


🔷Types Of Liver Injuries
📍1. Blunt Trauma (Most Common) :
▪︎Results in Liver Compression Between Impacting Object & RibCage Or Vertebral Column

▪︎Leads To Liver Contusions/Lacerations/Avulsions

▪︎Blunt Liver Trauma Usually Associated With Splenic/Mesenteric/Renal Injuries

📍2. Penterating Trauma :
▪︎Liver Injury Suspected During Upper Abdominal & Lower Thoracic Penetrating Injuries

▪︎Liver Injury Usually Associated With Chest Or Pericardial Injury


🔷Liver Surgery Principles During Laparotomy (Pressure/Pringle/Plug/Pack)
📍1. Direct Biannual Liver Compression (Pressure) To Decrease Bleeding

📍2. Direct Compression On Portal Triad (Hepatic A/Portal V/CBD) To Decrease Their Inflow (Pringle's Manoeuvre)

📍3. Plugging The Penetrating Holes in The Liver Using Silicon Or Sengstaken-BlakMore Tube

📍4. Vascular Injuries :
▪︎Hepatic Artery Injury ➡ Can Be Tied Off نعگده

▪︎Portal Vein Injury ➡ Repaired At Same Time Or Shunted (Not Tied Off Because This Increase Mortality Rate >50%)

📍5. Liver Packing

📍6. Put Drain & Close The Abdomen


🔷Complications Of Liver Trauma
📍1. Hematoma (SubCapsular Or IntraHepatic)

📍2. Liver Abscess & Ascites

📍3. Bile Collection & Biliary Fistula

📍4. Vascular Complications :
▪︎Hepatic Artery Aneurysms

▪︎AV Fistula (Connection Between Hepatic Artery & Hepatic Vein Has Risk Of Heart Failure/Hepatic Artery & Portal Vein Has Risk Of Portal Hypertension)

▪︎ArterioBiliary Fistula (HaemoBilia)

📍5. Liver Failure (After Extensive Trauma)

📍6. Biliary Strictures

📍7. Iatrogenic Liver Necrosis Or Abdominal Compartment Syndrome (Due To Strong Liver Packing During Surgery)

🔸B. Splenic Injury
▪︎Most Commonly Injured Intra-Abdominal Organ

▪︎Usually Due To Direct Blunt Trauma

▪︎Splenic Injury Or Rupture Should Be Always Suspected During Abdominal Trauma (Specially Left Upper Quadrant Abdominal Trauma)

🔷Mx Of Splenic Injury
📍1. Conservative (For Most Isolated Splenic Injuries Specially in Children)

📍2. Laparotomy :
▪︎Packing/Meshing (Mesh Bag)/Suturing

▪︎Selective AngioEmbolisation Of The Spleen

▪︎SplenEctomy (Safest Option)

📍3. Vaccination (Pneumococcal) Within 2-3w

📍4. Transient Changes In Blood Physiology Seen After SplenEctomy (Increase Platelets & WBCs) ➡ DDX As Sepsis


🔸C. Bowel Injury :
▪︎Bowel Injuries Need Urgent Surgery For Haemorrhage Control & Resection Of Ischemic Segments

▪︎Primary (Definitive) Repair For Minor Injuries & Temporary Repair (Stoma) For Severe Injuries

📍1. Duodenum :
▪︎Usually Associated With Injuries To The Pancreas

▪︎Most Duodenal Injuries Are Hidden (Due To RetroPeriToneal Position)

▪︎During Ix Gas Or Fluid Collection Around PeriDuodenal Tissue & Leakage Of Contrast Can Be Seen

📍2. Other Small Bowel :
▪︎Usually Occurs Due To Blunt Trauma That Results in Loop Rupture Or Mesenteric Tear

📍3. Colon ➡ Usually Due To Penterating Injuries

📍4. Rectum :
▪︎Usually Due To Penterating Injuries Or Pelvic Fractures

▪︎Usually Associated With Bladder & Proximal Urethral Injury

▪︎Rectal Examination Reveal Blood

▪︎IntraPeriToneal Injuries Mx As Colon While ExtraPeriToneal Injuries Mx By Primary Repair


🔸D. Pancreas Injury
▪︎Usually Occurs Due To Blunt Trauma

▪︎Most Pancreatic Injuries Are Hidden (Due To RetroPeriToneal Position Like Duodenum)

▪︎Pancreatic Enzymes Not Sensitive For Dx

▪︎Pancreatic Injuries Usually Need Conservative Tx & Closed Low-Suction Drainage

🔷Mx Of Pancreatic Injuries
📍1. Distal Injuries (Injury To Body Of Pancreas To The Left Of Superior Mesenteric Artery & Tail Of Pancreas) ➡ Conservative Tx

📍2. Pancreatic Duct Injury ➡ Distal Pancreatectomy

📍3. Proximal Injuries (To Right Of Superior Mesenteric Artery) ➡ Conservative Tx As Much As Possible Or Partial Pancreatectomy

🔸E. Stomach Injury
▪︎Usually Occurs Due To Penetrating Trauma

▪︎Blood in NG Tube Confirm Dx

#AbdominAl_Trauma
#part 3
#Surgery
–––––––––
#تفاعل_ومشاركة_للمنشور ❤️🫶
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﴿وَآخِرُ دَعْوَاهُمْ أَنِ الْحَمْدُ لِلَّهِ رَبِّ الْعَالَمِينَ﴾

​كان الرسول ﷺ يودع رمضان بقوله: ​"اللهم لا تجعله آخر العهد من صيامنا إياه، فإن جعلته فاجعلني مرحوماً ولا تجعلني محروماً. الحمد لله على التمام، الحمد لله على البلاغ، الحمد لله على الصيام والقيام، ​اللهم اجعلنا ممن صام الشهر إيماناً واحتساباً، وأدرك ليلة القدر وفاز بالأجر.

عيدكم مبارك، وتقبل الله طاعتكم، وجعلنا وإياكم من عتقاء شهر رمضان.

وكل عام وانتم بالف خير 💜

اهم امسكيوهات وبنوك الجراحة
#د_علي_برط

والموقع هذا لا تنسوه اعملوا له لفه قبل الإمتحان ⬇️
Chapter 29 Chest Injuries | Quizlet
https://quizlet.com/547976088/chapter-29-chest-injuries-flash-cards/


#Surgery
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Murphy’s Triad – Acute Appendicitis

Murphy’s triad is a classic clinical combination seen in acute appendicitis:

• Abdominal pain
• Vomiting
• Fever

Typical sequence:
Pain starts first → followed by vomiting → then fever.

High-yield point:
Pain preceding vomiting is a key feature that favors appendicitis over other causes.

Clinical tip:
If vomiting occurs before pain, consider other diagnoses.


Diagnosis is mainly clinical and supported by imaging if needed.

⚠️ Important note:
Do not confuse Murphy’s triad with Murphy’s sign of acute cholecystitis.

Murphy’s sign:
Inspiratory arrest during deep palpation of the right upper quadrant.

#مهم
#Surgery
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🚨 Urethral Trauma

Trauma to the urethra is serious and most commonly occurs with pelvic fractures, especially in males.

🔺 Key Red Flags
• Blood at the urethral meatus
• Inability to pass urine
• Distended bladder

⚠️ Clinical Pearls
• Classic Triad: blood at meatus + Perineal hematoma + distended bladder

• Do NOT insert a catheter until urethral injury is ruled out

• Often occurs with pelvic fractures or straddle injuries

• Early recognition = prevents long-term complications: stricture, incontinence


❇️ Diagnosis
• Retrograde urethrogram (RUG) → gold standard
• Avoid blind catheterization

High-Yield Tip
• Think urethral injury every time there is pelvic trauma + blood at meatus

#Surgery #Urology
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