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Consider any upper abdominal injury a thoracicoabdominal injury until proven otherwise. Laboratory studies vary with the patient’s condition but usually include:
❑ chest X-rays (preferably done with the patient upright to show free air)
❑ abdominal X-rays
❑ examination of stools and stomach aspirate for blood
❑ blood studies (decreased hematocrit and hemoglobin levels point to blood loss; coagulation studies evaluate hemostasis; white blood cell count is usually elevated but doesn’t necessarily point to infection; type and crossmatch to prepare for a blood transfusion)
❑ arterial blood gas analysis to evaluate respiratory status
❑ serum amylase levels, which may be elevated in pancreatic injury
❑ aspartate aminotransferase and alanine aminotransferase levels, which increase with tissue injury and cell death
❑ excretory urography and cystourethrography to detect renal and urinary tract damage
❑ radioisotope scanning and ultrasound to detect liver, kidney, or spleen injury
❑ angiography to detect specific injuries, especially to the kidneys
❑ computed tomography scan to detect abdominal, head, or other injuries
❑ exploratory laparotomy to detect specific injuries when other clinical evidence is incomplete
❑ other laboratory studies to rule out associated injuries
❑ peritoneal lavage with insertion of a lavage catheter to check for blood, GI content, vegetable fibers, and bile. In blunt trauma with equivocal abdominal findings, this procedure helps establish the need for exploratory surgery.
Source: Professional Guide to Diseases (Eighth Edition), 2005
A history of abdominal trauma, signs and symptoms, and laboratory results confirm the diagnosis and help determine organ damage. Consider any upper abdominal injury a thoracicoabdominal injury until proven otherwise. Diagnostic studies vary with the patient’s condition but usually include:
Source: Handbook of Diseases, 2003
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