29.9 Traumatic Abdominal Injuries

Question 1

Peritoneal cavity – “true abdomen” contains

Answer 1

1)Solid organs
2)Portions of the large intestine
3)Most of the small intestines
4)Female reproductive organs

Question 2

Retroperitoneal space – area located behind the peritoneum and contains

Answer 2

1)Kidneys
2)Ureters
3)Inferior vena cava
4)Aorta
5)Pancreas
6)Much of the duodenum
7)Ascending descending colon and rectum

Question 3

GSW most commonly injure:

Answer 3

1)Small bowel (50%)
2)Colon (40%)
3)Liver (30%)
4)Abdominal vessels (25%)

Question 4

Injuries most often involved in blunt abdominal trauma include:

Answer 4

a)Spleen 40-55%
b)Liver 35-45%
c)Small bowel 5-10%

Question 5

the most reliable indicator of intra-abdominal bleeding is

Answer 5

the presence of hypovolemic shock from an unexplained source

Question 6

What does the seat belt sign indicate

Answer 6

sudden force from deceleration) (20% chance ofintra-abd injury in adults) bowel

Question 7

Distended abdomen may result from what

Answer 7

greater than 1.5 L of blood or a stomach filled with air.

Question 8

What is the definitive treatment for patients that have sustained abdominal injuries

Answer 8

Surgical intervention

Question 9

Key Images of FAST Exam:
In the RUQ, visualize 4 areas

Answer 9

Morison’s Pouch, inferior tip of the liver, R hemithorax, sub diaphragmatic space

Question 10

Key Images of FAST Exam
In the LUQ, visualize 4 areas

Answer 10

Splenorenal recess, inferior tip of the spleen, L hemithorax, sub diaphragmatic space

Question 11

Focused questions for traumatic abdominal injuries

Answer 11

(a)Is there free fluid/blood in the abdomen?
(b)Is there free fluid/blood in the pericardium?
(c)Is there fluid/blood in the thorax?
(d)Is there a pneumothorax?

Question 12

Which quadrant of the abdomen?
Liver, kidney, diaphragm, Morison’s pouch, hemithorax (mirrorimage), inferior tip of the liver, subdiaphragmatic space

Answer 12

RUQ

Question 13

Which quadrant of the abdomen?
Liver, kidney, diaphragm, Morison’s pouch, hemithorax (mirrorimage), inferior tip of the liver, subdiaphragmatic space

Answer 13

LUQ

Question 14

What are you looking for in the pelvis during FAST exam

Answer 14

Posterior to the bladder (men) and Pouch of Douglas (women)

Question 15

What are you looking for in the heart during FAST exam

Answer 15

Be able to identify heart chambers in the subxiphoid view and PSLA view

Question 16

Treatment of Eviscerated bowel

Answer 16

(a)Most often the fatty omentum that cover the intestines
(b)Do not attempt to replace the protruding contents
(c)Viscera should be left in place
(d)Treatment should focus on protecting the protruding segment and provide moistenvironment
(e)Clean or sterile dressing moistened with saline
(f)Periodically re-moisten
(g)Initial dressing may be covered with large, dry dressing to keep warm
(h)Psychological support, keep patient calm. Any action that increases intra- abdominal pressure can cause more contents to protrude.