Abdomen And Pelvis Flashcards

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1
Q

What is the Pringle manoeuvre

A

Clamping of the hepatoduodenal ligament to occlude the hepatic artery proper and hepatic portal vein

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2
Q

What would you suspect if bleeding continued after clamping the hepatoduodenal ligament

A

Source of bleeding was the IVC or hepatic vein

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3
Q

How is the spleen most commonly injured

A
Left rib fractures
Deceleration incidents (mobile organ)
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4
Q

Why is it that a subtotal splenectomy can be carried out

A

There are no anastamoses of the splenic vessels

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5
Q

When might the pancreas be injured

A

Very rare

Direct blow to epigastrium compressed it against the vertebral bodies

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6
Q

What are the indications for a laparotomy

A

Trauma, hypotensive, +ve FAST scan

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7
Q

what is seatbelt syndrome

A

Seatbelt sign (linear bruising of abdominal wall) + organ damage (most likely fixed portions eg proxima jejunum or distal ileum) + thoracolumbar vertebral fracture

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8
Q

What is bucket handle sign

A

Small intestine separates from its mesentery leaving an avascular portion

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9
Q

What areas does FAST scanning assess and what is it looking for

A

Looks for free fluid in hepatorenal (Morrisons), splenorenal, Pouch of Douglas and pericardial sac

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10
Q

How is the diaphragm most commonly injured

A

RTC or other blunt trauma

Abdominal pressure rises so high that the diaphragm bursts

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11
Q

Which side of the diaphragm is most at risk of injury

A

Left (cushioned by liver on right)

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12
Q

Which abdominal vessels are most at risk in deceleration accidents

A

Intraperitoneal and in particular the splenic and renal as they are mobile with a large organ attached

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13
Q

What are the goals of REBOA

A

Control non-compressible abdominal haemorrhage and protect myocardial and cerebral perfusion

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14
Q

Who is REBOA currently performed on

A

Patients with exsanguinating pelvic haemorrhage at risk of imminent hypovolaemic cardiac arrest

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15
Q

What is the process of REBOA

A

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

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16
Q

What are the zones used in REBOA

A

1: left subclavian artery to coeliac trunk
2: coeliac trunk to most caudal renal artery
3: most caudal renal artery to aortic bifurcation

17
Q

What are the complications of REBOA

A

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

18
Q

How would renal infarction should up on contrast CT

A

It would be non-enhancing

19
Q

How would a pelvic fracture present

A

Shortened and externally rotated leg
Bruising and swelling
Haemodynamically unstable

20
Q

Compare the MOIs for the types of pelvic injury

A

APC: head on collision
LC: side on collision and pedestrian vs car
VS: axial force

21
Q

What parts of the pelvis are damaged in an APC fracture

A

Separation of pubic bones
Separation of sacroiliac joint
Disruption of sacrotuberous and sarospinous ligaments

22
Q

What parts of the pelvis are damaged in LC

A

Rami
Sacral alar
Iliac wing
Can also get a contralateral APC

23
Q

Compare which structures are damaged in APC and LC

A

APC: superior gluteal artery and urethra
LC: obturator and internal pudendal arteries

24
Q

Is bleeding from pelvic fractures intra or retroperitoneal

A

Retroperitoneal

However it can track down into the peritoneum and the long bones

25
Q

What is the source of pelvic bleeding

A
Venous plexus (thin walls and close relation to sacroiliac joint)
Cancellous bone
26
Q

How are pelvic fractures managed

A

Pelvic binder centred over the greater trochanters
TXA
Packed red cells

27
Q

What is an umbilical catheter

A

Type of central access that can be used for 5-7 days

28
Q

Where can an umbilical catheter be placed

A

Umbilical artery - internal iliac - aorta

Umbilical vein - portal vein - ductus venosus - IVC - RA