ABD trauma

Question 1

MC injured ABD organs

Answer 1

Liver - overall

Spleen - sports related

Question 2

MC MOI for blunt trauma is?

Answer 2

MCV

- then falls

Question 3

Typical blunt trauma mechanism is

Answer 3

Hollow viscous rupture

Question 4

W/ any penetrating injury of lower chest, pelvis, flank, or back assume it has?

Answer 4

Penetrated the ABD cavity until R/O?

Question 5

What hematoma mimics intra-abdominal injury

Answer 5

Rectus abdominas hematomas from epigastric trauma/Abd wall vessel injury

Question 6

Rectus abdominas hematomas May evolve into?

Answer 6

Painful palpable mass between rectus sheath inferior to umbilicus

Question 7

S/S of solid organ injury is due to? S/S?

Answer 7

Blood loss

- increased pulse pressure

Question 8

Referred pain into shoulders may indicate what type of ABD injury?

Answer 8

Splenic injuries - left arm

Liver injuries - right arm

Question 9

What conditions may predispose a pt to splenic conditions?

Answer 9

Pregnancy and mononucleosis

Question 10

Hollow viscous injuries produce S/S due to?

Answer 10

Blood loss and peritoneal contamination from GI

• Gastric acid = chemical irritation
• Bacterial GI flora - Delayed

Question 11

Are Pancreatic injuries generally low M/M?

Answer 11

NO - high M/M

Question 12

Pancreatic injury S/S?

Answer 12

No specific S/S - Use MOI for clues (ex- unrestrained driver who hits steering column/bicyclist against handle bar.

Question 13

Duodenal injuries S/S?

Answer 13

Relatively asymptomatic
Duodenal hematoma expands- gastric outlet obstruct
- ABD pain, distention, vomiting
High Velocity - duodenal rupture

Question 14

ABD Abscess/sepsis S/S?

Answer 14

Delayed presentation

• fever
• leukocytosis

Question 15

Direct blow to epigastric may cause?

Answer 15

Diaphragm spasm - difficulty breathing

-cant relax and expand

Question 16

Diaphragmatic Injuries MC occurs where?

Answer 16

Left side

Question 17

Failure to Dx diaphragmatic rupture may lead to?

Answer 17

Herniation or strangulation of bowel through diaphragm defect

Question 18

Primary diagnostic study of ABD injuries?

Answer 18

FAST

Question 19

FAST greatest benefit is?

Answer 19

Rapid identification of free intraperitoneal fluid in HOTN pt w/ blunt ABD trauma and w/ serial images can estimate rate

Question 20

Average time to perform FAST exam of thoracic and abdominal cavaties?

Answer 20

=<4m

Question 21

View of Morrisons pouch w/ HOTN pt may reveal?

Answer 21

Massive hemoperitoneum

Question 22

One major advantage of FAST exam over Dx peritoneal lavage is?

Answer 22

FAST can also eval pericardial/pleural fluid and for PTX

Question 23

Main disadvantage of FAST over CT is?

Answer 23

Inability to ID source of free intraperitoneal fluid

-also cannot eval retroperitoneum as well as CT

Question 24

Other general disadvantages of FAST?

Answer 24

Skilled operator
Eval obese, Sub-Q air, excess bowel gas
Differ bleed from ascites

Question 25

What can FAST or CT eval for intravascular volume and mortality prediction?

Answer 25

IVC

Question 26

Is a positive DPL (dx peritoneal lavage) an absolute indication for exploratory laparotomy?

Answer 26

No

Question 27

What is gold standard of abdominal injury dx?

Answer 27

CT w/ contrast

Question 28

Major advantage of CT w/ contrast?

Answer 28

ID precise location, grade of injury, type of fluid and amount + Eval retroperitoneal injuries (duodenum/pancreas)

Question 29

CT imaging reqs a pt to be?

Answer 29

Hemodynamically stable

Question 30

TXT Gold standard for significant intra-abdominal injury?

Answer 30

Laparotomy | -complete eval of abdomen/retroperitoneal

Question 31

All pts w/ persistent HOTN, abdominal wall disruption or peritonitis in regards to trauma req?

Answer 31

Surgical exploration

Question 32

Absolute Indications - blunt

Answer 32

``` Anterior ABD injury + HOTN ABD wall disruption Peritonitis Free air under diaphragm on CXR Positive FAST or DPL + unstable hemodynamically CT - Dx injury req surgery ```

Question 33

Relative indications - blunt?

Answer 33

Positive FAST or DPL and stable hemodynamically Solid visceral injury in stable pt Hemoperitoneum on CT w/out clear source

Question 34

Absolute Indications - penetrating?

Answer 34

``` Injury to ABD, back, flank ABD TTP GI Evisceration High suspicion for transabdominal trajectory after gunshot CT-Dx injury req surgery ```

Question 35

Relative indications - penetrating?

Answer 35

Positive local wound exploration after stab wound.

Question 36

Non-op management for blunt trauma is based on?

Answer 36

CT grading

Question 37

Pts w/ ABD trauma at in extremis may benefit from?

Answer 37

REBOA - Resuscitative endovascular balloon occlusion of the aorta.

Question 38

Fx of REBOA is to?

Answer 38

Quickly stop intra-abdominal hemorrhage by aortic occlusion while maintaing/increasing heart/lung perfusion.

Question 39

REBOA aorta zones

Answer 39

I- descencding thoracic aorta - between subclavian/celiac II- between celiac and lowest renal artery III- Lowest renal artery to Bifurcation

Question 40

Maximum time REBOA may stay in place?

Answer 40

60m

Question 41

D/C pts who develop fever, vomiting, increased pain, or symptoms suggestive of blood loss (dizzy/weak/fatigue) should?

Answer 41

Return promptly to ED - other msot pts are admitted