Abdo

Question 1

Name 2 trauma mechanism of pancreas injury

Answer 1

Crush injury
Handle bar injure (of bike)
- crushed between vertebral body and abd wall

Question 2

Describe type 1 intestinal failure (4)

Answer 2

• acute, self-limiting, most common
• <28 days duration
• post-op ileus or acute bowel obstruction

Question 3

Define intestinal failure

Answer 3

Reduction of gut function below minimum necessary for absorption of macronutrients, water and electrolytes such that iv supplementation is required

Question 4

In what time period should perimortem C section be done and why?

Answer 4

Within 4 minutes of resuscitation to improve maternal ventilation and perfusion. At bedside, only need blade.

Question 5

Name 3 paediatric anatomical and physiological considerations in abdominal trauma

Answer 5

• Abdominal organs less protected. In close proximity. Bladder not “hidden” in pelvis. Less fat and muscle so internal organs closer to surface.
• solid organs larger - liver not fully covered by ribcage,.
. Children prone to severe gastric distension

Question 6

Most commonly injured organ in blunt trauma?

Answer 6

Liver

Question 7

What determines need for surgery in abdominal trauma? (7)

Answer 7

. Hemorrhage Shock
• peritonitis
• Impalement
• evisceration organs or omentum
• blood on ngt. or rectal exam
• abdominal free air - blunt trauma
• inability to perform proper physical exam due to abnormal mental status or spinal cord injury and increased risk based on mechanism

Question 8

Treatment of anterior omental evisceration?

Answer 8

• Clean and reduce omentum
• suture closed
• admit for abdominal serial clinical exams
• laparotomy indicated if develop signs peritonitis or shock
All other eviscerations need surgery!

Question 9

Name 5 indications urgent laparotomy during non-op management abdominal trauma

Answer 9

. Shock
• peritonitis: severe pain, ileus, vomit, rigidity, tender
.free abdominal air
• impaled foreign object
• signs systemic infection

Question 10

Name 6 common indications laparotomy following blunt trauma

Answer 10

-shock: signs organ hypoperfusion, metabolic acidosis
-ongoing need blood transfusions
-signs peritonitis : tender, guarding, ileus
-pneumoperitoneum
-traumatic diaphragmatic hernia
-rectal or vag bleeding, esp in pelvic fractures

Question 11

Name 7 common indications laparotomy following penetrating abdominal trauma

Answer 11

-shock
-ongoing need blood transfusions
-signs peritonitis
-evisceration
-traumatic diaphragmatic hernia
-blood on NGT, rectum, vagina
-impaled object

Question 12

Name 4 relative contraindications to SNOM

Answer 12

-age more than 65
-high AAST grade organ injury
-TBI
-uncontrolled comorbidity

Question 13

Name 5 critical indications for damage control surgery

Answer 13

-hypothermia
-severe metabolic acidosis : ph less than 7,2; serum lactate more than 5
-coagulopathy: oozing blood
-abnormal coagulation : raised INR, Abn TEG
-need massive transfusion

Question 14

Name 5 secondary indications for damage control surgery

Answer 14

-inability to perform definitive surgery
-inaccessible major anatomical injury eg liver, vascular, retroperitoneal
-time consuming procedures required eg multiple bowel anastomosis, sx in 2 or more cavities
-need to re-evaluate abdo contents (ischaemia, packing)
-need for non-surgical control eg angio-embolization

Question 15

Antibiotic treatment of community acquired intra-abdominal sepsis?

Answer 15

Kefzol, gentamicin and metronidazole (flagyl)

Question 16

How does retroperitoneal hollow viscus injury present?

Answer 16

Retroperitoneal gas on xray

Question 17

What type of abdominal surgical incision for children younger than 5?

Answer 17

Transverse

Question 18

What type of abdominal surgical incision for children older than 5?

Answer 18

Midline

Question 19

Most common mechanism of injury of pancreas? Which part of pancreas?

Answer 19

Crush or handle bar injury
Neck of pancreas crushed between vertebral body and abdominal wall

Question 20

Primary presentation of hollow viscous injury?

Answer 20

Peritonism

Question 21

Which vascular structures may be damaged in zone l injury?

Answer 21

Inferior vena cava

Question 22

Which vascular structures may be damaged in zone 2 abdominal injury?

Answer 22

Renal arteries

Question 23

Which vascular structures may be damaged in zone 3 injury?

Answer 23

Internal iliac arteries