traumatismo pancreatico
DESCRIPTION
ArsenioTRANSCRIPT
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Traumatismo Pancreático
R2CG Eugenio García Cano
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Epidemiología
• 5% contusión abdominal
• 6% herida por arma de fuego abdominal
• 2% herida por arma blanca abdominal
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• Deben sospecharse en:
• Trauma penetrante
• Contusión del abdomen superior
• Duodeno, hígado y bazo
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• Ilahi y colaboradores:– 40 pacientes: ISS 29 +- 13
• Vasquez y colaboradores:– 62 pacientes: ISS 28+- 17
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Injury Severity Scoring
• Información compleja y variable reducido a un simple número.
• Representar el grado de enfermedad critica
• Pronóstico = Lesión anatómica + Lesión fisiológica + Reserva del paciente
Baker SP et al, "The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care", J Trauma 14:187-196;1974
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Baker SP et al, "The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care", J Trauma 14:187-196;1974
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Baker SP et al, "The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care", J Trauma 14:187-196;1974
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OIS
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Niveles de amilasa
• 35% lesión de conducto pancreático principal
• Si se encuentra anormal = obliga
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TAC
• Hemodinamicamente estable contusión abdominal
• Ilahi y colaboradores:– Sensibilidad del 68%– Grado de lesión correcto de menos de 50%
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CPRE
• Continuidad del ducto pancreático
• Localización exacta
• Uso terapeutico
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LAPE
• Prioridades:
– Control de la hemorragia
– Minimizar la contaminación
– Manejo de lesiones hepáticas y esplénicas
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1.- Determinar si hay lesión pancreática
– Hematoma central
– Edema peripancreático
– Bilis que tiñe el campo quirúrgico
– Saponificación de la grasa retroperitoneal
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2.- Reconocida la lesión, exponer la glándula apropiadamente :
- Apertura de ligamento grasrohepático
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Apertura del ligamento gastrocólico
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Maniobra de Kocher
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Maniobra de Aird y Helman
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3.- Determinar si hay lesión en conducto de Wirsung
- Observación de la lesión- Sección del páncreas- Lesión de más del 50% del diámetro de la
glándula- Perforación central de la misma
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OIS
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