Abdo trauma

Question 1

What are the most commonly injured abdominal organs?

Answer 1

1. Spleen
2. Liver

Question 2

What is a Chance # and what is it commonly associated with?

Answer 2

Ant’r crush # of T12/L1.

Associated with:

• hyperflexion at waist -> eg lap belt in MVA.
• small bowel (duodenum) injury
• pancreatic injury

Question 3

What are the immediate and emergent indications for laparotomy in the blunt trauma patient.

Answer 3

Immediate:

1. ​Hypotension + evidence of ant’r abdo trauma
2. ​Hypotension + positive FAST
3. Abdo wall disruption
4. Peritonitis
5. Free air on erect CXR
6. CT-diagnosed injury req’g surgery

Emergent:

1. Normal BP + positive FAST
2. Normal BP + solid organ injury
3. Haemoperitoneum + ? source

Question 4

What are the immediate and emergent indications for laparotomy in the penetrating trauma patient.

Answer 4

Immediate:

1. Penetrating injury (to abdo/flank/back) + hypotension
2. Penetrating injury + abdo tenderness
3. GI evisceration
4. Likely intra-abdo trajectory post GSW
5. CT-diagnosed injury requiring surgery

Emergent:

1. Positive local wound exploration post stab-wound

Question 5

What are the criteria of a +ve DPL?

Answer 5

1. >10ml free-flowing blood on initial aspiration
2. Faecal contents in lavage fluid
3. RBCs >100k in abdo wounds
4. RBCs >10k in lower chest wounds

Question 6

What are Cullen’s Sign and Grey Turner’s Sign? What do they indicate?

Answer 6

Cullen’s Sign: Periumbilical ecchymosis

Grey Turner’s Sign: Flank Ecchymosis

Both are delayed signs of intraperitoneal haemorrhage.

Question 7

List the retro-peritoneal structures.

Answer 7

SAD PUCKER

Supra-renal glands (adrenals)

Aorta + IVC

Duodenum (segments II + III)

Pancreas

Ureters

Colon (ascending and descending only)

Kidneys

oEsophagus

Rectum

Question 8

What % of blunt abdo trauma patients have pancreatic injury?

Answer 8

4%

NB it is associated w/ sig’t morbidity/mortality