BENEFITING FROM THE ALT AND AST VARIANCES IN THE EVALUATION OF PATIENTS WITH ABDOMINAL TRAUMA

A single physical examination is unreliable in the definitive of abdominal injury. Diagnostic Peritoneal Lavage (DPL) and abdominal computerized tomography (CT) has been shown to greatly reduce the risk of missed injuries. But the specificity of CT in hollow organ injuries is less, and also can cause time loss in unstable patient, and allergic complications in studies with contrast matter. While DPL is being performed iatrojenik intraabdominal injuries can happen and it is very also inaccurate diagnosing retroperitoneal injuries. In our study, we aimed to benefit from the variances in serum Aspartate Aminotransferase (AST) and serum Alanin Aminotransferase (ALT) values for giving direction to the detailed examination and treatment of liver and other intraabdominal injuries. Among the patients who applied Cumhuriyet University Faculty of Medicine Emergency Service with blunt abdominal trauma, 260 of them were taken in to the context of the study. All of the injuries sustained were noted after completion of the evaluation, and the Injury Severity Score (ISS) was calculated. 47 of these patients had intraabdominal injury. While mean serum AST values were 179 4 U/L and ALT values were 181 2 U/L in patients with intraabdominal injuries, these values were 60 2 U/L and 56 4 U/L respectively in patients with any injuries and the differences were statistically significant (p<0.01). The increase in the serum AST and ALT levels of the patients were directly proportional with the intensity of liver and other intraabdominal organ traumas. The variences in the patients' AST and ALT values, are beneficial in giving direction to the evaluation, detailed examination and treatment of intraabdominal traumas.

KARIN TRAVMALI HASTALARIN DEÐERLENDÝRÝLMESÝNDE SERUM ALT VE AST DEÐÝÞÝKLÝKLERÝNDEN FAYDALANILMASI

Karýn travmalarýnýn teþhisinde Fizik Muayene (FM) tek baþýna yeterli olamayabilmektedir. Diagnostik Peritoneal Lavaj (DPL) ve Bilgisayarlý Tomografiden yararlanmak teþhis hatalarýný azaltmada çok yararlý olur. Ancak BT'nin içi boþ organ yaralanmalarýnda spesifikliði azdýr, ayrýca unstabil hastalarda zaman kaybýna, kontrastlý çalýþmalarda ise allerjik komplikasyonlara neden olabilir. DPL iþlemi sýrasýnda karýn içi organ yaralanmalarý olabilir, ayrýca bu iþlem retroperitoneal yaralanmalarýn teþhisinde yetersiz kalabilmektedir. Çalýþmamýzda karaciðer ve diðer karýn içi organ yaralanmalarýnýn teþhisinde ileri tetkik ve tedaviyi yönlendirmede serum Aspartate Aminotransferaz (AST) ve Serum Alanýn Aminotransferaz (ALT) deðerlerinde deðiþimlerden yararlanmayý amaçladýk. Cumhuriyet Üniversitesi Týp Fakültesi Acil Servisine Genel Vücut Travmasý (GVT) ile baþvuran hastalarýn, karýn içi travma þüphesi olan 260'ý çalýþma kapsamýna alýndý. Hastalarýn yaralanmalarý kaydedilip, Yaralanma Þiddeti Skoru (YSS) hesaplandý. Bu hastalarýn 47'sinde karýn içi yaralanma mevcuttu. Karýn içinde laserasyonu olan hastalarýn serum AST deðerleri 179 4 U/L ve ALT deðerleri 181 2 U/L iken, laserasyonu olmayan hastalarda sýrasýyla 60 2 U/L idi ve farklýlýklar istatistiksel olarak anlamlýydý (p<0.01). Hastalarýn serum AST ve ALT düzeylerinde artýþ karaciðer ve diðer karýn içi organlardaki travmalarýn þiddeti ile doðru orantýlýydý. Hastalarýn AST ve ALT deðerlerindeki deðiþimler karýn içi travmalarýnýn deðerlendirmede ileri tetkik ve tedavilerini yönlendirmede yararlý olacaktýr.