Abdominal and genitourinary Trauma

Question 1

What is Kehr’s sign?

Answer 1

severe pain in the left shoulder that occurs in some patients with a ruptured spleen

Question 2

What is Cullen’s sign?

Answer 2

periumbilical bruising, may indicate intraperitoneal bleeding

Question 3

What is Grey Turners sign?

Answer 3

bruising of the loins in acute hemorrhagic pancreatitis, also called Turner’s sign, may indicate retroperitoneal bleeding

Question 4

Consult a ____ ____ for any patient suspected of having an abdominal or genitourinary injury. If a trauma surgeon is unavailable, what should you do?

Answer 4

trauma surgeon

transfer the patient to another facility.

Question 5

Before inserting a urinary catheter into a male patient with blunt abdominal trauma, a ____ exam should be performed in order to confirm the position of the ____, look for ____ ____, and check the ____ ____

Answer 5

rectal
prostate
rectal tone
sphincter tone

Question 6

what is FAST sonography?

Answer 6

Focused Assessment with Sonography in Trauma
The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%

Question 7

What is the most commonly injured organ in the abdomen due to its location?

Answer 7

spleen

Question 8

What are the S/S that indicate an injured spleen?

Answer 8

LUQ pain and tenderness, Kehr’s sign, abdominal muscle rigidity, involuntary guarding, rebound tenderness, signs of hemorrhagic or hypovolemic shock

Question 9

How do you treat an injured spleen?

Answer 9

Might not require surgery, just bedrest and possible transfusion

Question 10

Spleen injuries are described by a grading system. How may grades are there?

Answer 10

5

Question 11

Describe a Grade 1 spleen injury.

Answer 11

nonbleeding capsular tear is less than 1 cm deep

Question 12

Describe a Grade 2 spleen injury.

Answer 12

subcapsular hematoma covers 10% to 50% of the surface area and does not expand. Intraparenchymal hematoma is less than 2 cm wide
Laceration - capsular tear is accompanied by active bleeding. Intraparenchymal injury is 1 to 3 cm deep.

Question 13

Describe a Grade 3 spleen injury.

Answer 13

subcapsular hematoma involves more than 50% of the surface area or is expanding. Intraparenchymal hematoma is 5 cm or larger or expanding. Ruptured subcapsular hematoma is accompanied by active bleeding.
Laceration is more than 3 cm deep or involves intracellular vessels.

Question 14

Describe a Grade 4 spleen injury.

Answer 14

ruptured intraparenchymal hematoma is accompanied by active bleeding
Laceration is segmental or involves hilar vessels and devascularization of more than 25% of the spleen

Question 15

Describe a Grade 5 spleen injury.

Answer 15

spleen is shattered. Laceration causes hilar vascular injury. Spleen is devascularized.

Question 16

At any given time, __% of the circulating blood is in the liver

Answer 16

30%

Question 17

Overall mortality of liver injury is __ %

Answer 17

12.5 %

Question 18

Expect to see liver injuries when the patient receives a direct blow to this area.

Answer 18

the RUQ from the 6th rib to the central abdomen.

Question 19

S/S of liver injury include what? (7)

Answer 19

Pain in RUQ or referred pain to the right shoulder
Abdominal muscle rigidity, spasm, or involuntary guarding
Rebound tenderness
Hypoactive bowel sounds
Cullen’s sign
Dullness with percussion
Elevated liver function tests.

Question 20

When the liver sustains major damage, ____ ____ almost always occurs, The trauma team should consider acute hepatic injury if this occurs.

Answer 20

hemodynamic instability

the patient remains hypotensive despite aggressive intravenous fluid resuscitation.

Question 21

More than __% of patients with liver injury are successfully treated with nonoperative management.

Answer 21

85%

Question 22

Liver injury has a grading system that consists of __ grades.

Answer 22

6

Question 23

Describe a Grade 1 liver injury.

Answer 23

non expanding subcapsular hematoma involves less than 10% of the liver’s surface
Laceration - nonbleeding capsular tear is less than 1 cm deep

Question 24

Describe a Grade 2 liver injury.

Answer 24

non expanding subcapsular hematoma covers 10 to 50% of the surface area and is less than 2 cm deep.
Laceration penetrates less than 3 cm into the parenchyma and is less than 10 cm long

Question 25

Describe a Grade 3 liver injury.

Answer 25

subcapsular hematoma covers more than 50% of the surface area or is expanding. Ruptured subcapsular hematoma causes active bleeding. Intraparenchymal hematoma is more than 2 cm wide.
Laceration 1s more than 3 cm deep

Question 26

Describe a Grade 4 liver injury.

Answer 26

central hematoma ruptures

Laceration from 15 to 25% of the hepatic lobe is destroyed

Question 27

Describe a Grade 5 liver injury.

Answer 27

more than 75% of the hepatic lobe is destroyed

Laceration - major hepatic veins are injured

Question 28

Describe a Grade 6 liver injury.

Answer 28

the liver is avulsed

Question 29

All patients with gastric injury require this intervention.

Answer 29

Sx exploration

Question 30

The intestines

About __ meters long and are fixed at various points in the what?

Answer 30

7.5

the peritoneal cavity

Question 31

What should you NEVER do for Bowel evisceration?

Answer 31

never attempt to push eviscerated bowel back into the peritoneal cavity because it can further injure the tissue

Question 32

What SHOULD you do for Bowel evisceration?

Answer 32

Cover the evisceration with saline soaked pads but do not pour saline onto pads that are in place on the wound, then cover the wound with an occlusive dressing.

Question 33

The pancreas is located where?
Therefore it is more likely to be injured by what?
The pancreas does not usually sustain this type of injury.

Answer 33

Behind the liver and stomach

penetrating trauma. A pancreatic blunt force injury usually does not occur.

Question 34

Diaphragm Rupture almost always occurs on the ____ because the ____ side is behind the ____.

Answer 34

left
right
liver

Question 35

May find bowel sounds in the chest if this organ is ruptured.

Answer 35

diaphragm