Abdomen And Pelvis Flashcards
What is the Pringle manoeuvre
Clamping of the hepatoduodenal ligament to occlude the hepatic artery proper and hepatic portal vein
What would you suspect if bleeding continued after clamping the hepatoduodenal ligament
Source of bleeding was the IVC or hepatic vein
How is the spleen most commonly injured
Left rib fractures Deceleration incidents (mobile organ)
Why is it that a subtotal splenectomy can be carried out
There are no anastamoses of the splenic vessels
When might the pancreas be injured
Very rare
Direct blow to epigastrium compressed it against the vertebral bodies
What are the indications for a laparotomy
Trauma, hypotensive, +ve FAST scan
what is seatbelt syndrome
Seatbelt sign (linear bruising of abdominal wall) + organ damage (most likely fixed portions eg proxima jejunum or distal ileum) + thoracolumbar vertebral fracture
What is bucket handle sign
Small intestine separates from its mesentery leaving an avascular portion
What areas does FAST scanning assess and what is it looking for
Looks for free fluid in hepatorenal (Morrisons), splenorenal, Pouch of Douglas and pericardial sac
How is the diaphragm most commonly injured
RTC or other blunt trauma
Abdominal pressure rises so high that the diaphragm bursts
Which side of the diaphragm is most at risk of injury
Left (cushioned by liver on right)
Which abdominal vessels are most at risk in deceleration accidents
Intraperitoneal and in particular the splenic and renal as they are mobile with a large organ attached
What are the goals of REBOA
Control non-compressible abdominal haemorrhage and protect myocardial and cerebral perfusion
Who is REBOA currently performed on
Patients with exsanguinating pelvic haemorrhage at risk of imminent hypovolaemic cardiac arrest
What is the process of REBOA
US guided insertion of guide wire into femoral artery
Advance the balloon to 40cm
Inflate
Allow it to migrate distally until it gets stuck at the bifurcation
What are the zones used in REBOA
1: left subclavian artery to coeliac trunk
2: coeliac trunk to most caudal renal artery
3: most caudal renal artery to aortic bifurcation
What are the complications of REBOA
Passing the guidewire through the femoral artery causing retroperitoneal haemorrhage
Aortic dissection and perforation (wire or overinflated balloon)
Distal thrombus
Ischaemia
Proximal rise in BP worsening any TBI
How would renal infarction should up on contrast CT
It would be non-enhancing
How would a pelvic fracture present
Shortened and externally rotated leg
Bruising and swelling
Haemodynamically unstable
Compare the MOIs for the types of pelvic injury
APC: head on collision
LC: side on collision and pedestrian vs car
VS: axial force
What parts of the pelvis are damaged in an APC fracture
Separation of pubic bones
Separation of sacroiliac joint
Disruption of sacrotuberous and sarospinous ligaments
What parts of the pelvis are damaged in LC
Rami
Sacral alar
Iliac wing
Can also get a contralateral APC
Compare which structures are damaged in APC and LC
APC: superior gluteal artery and urethra
LC: obturator and internal pudendal arteries
Is bleeding from pelvic fractures intra or retroperitoneal
Retroperitoneal
However it can track down into the peritoneum and the long bones
What is the source of pelvic bleeding
Venous plexus (thin walls and close relation to sacroiliac joint) Cancellous bone
How are pelvic fractures managed
Pelvic binder centred over the greater trochanters
TXA
Packed red cells
What is an umbilical catheter
Type of central access that can be used for 5-7 days
Where can an umbilical catheter be placed
Umbilical artery - internal iliac - aorta
Umbilical vein - portal vein - ductus venosus - IVC - RA
