Abdo Trauma

Question 1

state some indications for laparotomy ?

Answer 1

unexplained shock
peritonism - rigid silent abdo
evisceration
radiological evidence of intraperitoneal gas
radiological evidence of ruptured diaphragm
gunshot wounds
positive diagnostic peritoneal aspiration or CT

Question 2

what would haematuria on a urine dipstick suggest?

Answer 2

renal tract damage

Question 3

what are some advantages of FAST scans in trauma?

Answer 3

check for fluid in abdo, pelvis and pericardium

Question 4

what are pros and cons of diagnostic peritoneal lavage ?

Answer 4

98% sensitive for intra abdominal haemorrhage
may be better at identifying injury to hollow viscus
unable to identify retroperitoneal injury

Question 5

how is a diagnostic peritoneal lavage done?

Answer 5

midline incision through skin and fascia at 1/3rd distance from umbilicus to pubic symphysis
instil 10ml/kg of warmed hartmanns and drain fluid back into bag and send sample to lab

positive if >100,000 RBCs/mm3

Question 6

what is Kehrs sign?

Answer 6

shoulder tip pain secondary too blood in the peritoneal cavity

Question 7

what are the 4 degrees of spleen rupture ?

Answer 7

capsular tear
tear and parenchymal injury
tear up to the hilum
complete fracture

Question 8

what is the management of spleen rupture ?

Answer 8

1-3 = observation in HDU 
4 = consider laparotomy

Question 9

what is the difference between management for intraperitoneal and extraperitoneal bladder rupture ?

Answer 9

intra - laparoscopic repair with urethral and suprepubic drainage

extra - conservative treatment with urethral drainage