Abdominal And Pelvic Trauma Flashcards
What anatomy is within the anterior abdomen cavity?
Most of the hollow viscera
What anatomy is within the thoracoabdominal cavity?
Diaphragm, liver, spleen, stomach
What anatomy is found within the flank and back anatomy?
The retroperitoneal space: abdominal aorta, inferior vena cava, duodenum, pancreas, kidneys, ureters, descending colon, ascending colon
What anatomy is found within the pelvis cavity?
Rectum, bladder, iliac vessels, female reproductive organs
Where in the diaphragm is more likely to get a blunt tear?
Left hemidiaphragm
What kind of patients are often found to have duodenal ruptures as a result of a direct blow to the abdomen?
Unrestrained drivers involved in head on collision
What are pancreatic injuries often a result of?
A direct epigastric blow that compresses the pancreas against the vertebral column
What are markers for potential underlying renal injuries?
Contusions, haematomas and ecchymoses of the back and flank
What are the indicators of increased risk of renal injuries?
Gross and microscopic haematuria in patients with an episode of hypotension
What is blunt injury to the bowel generally associated with?
Sudden deceleration with subsequent tearing near a fixed point of attachment, often connected with the incorrect positioning of a seatbelt
What are common causes of hypovolemic shock in trauma patients?
Injuries to the liver, spleen and kidney
If patients with solid organ injuries are unstable, what do they require?
Urgent assessment for a laparotomy
Why is FAST scan used in trauma?
It allows for immediate assessment of the trauma patient because of its ability to detect splenic and hepatic injuries
What is a FAST scan?
Focused assessment with sonography in trauma
What are the main drivers for using FAST in trauma?
Economic benefits, non-invasiveness and the repeatability of examinations
What are some of the negatives of a FAST scan in trauma?
Quality of assessment is operator dependent
Not able to detect volumes of fluid less than 200mls so the potential of missed visceral injury or delayed diagnosis
What should be considered with regards to the risk of false negative results for FAST scan?
Where there is a high index of suspicion for injury, other causes should be considered for a negative scan; e.g. centralised circulation or limited arterial perfusion of injured solid organs
If a high level of suspicion of intrabdominal injury exists, what is the preferred scan of choice?
CT scan (commutated tomography)
Are pelvic fractures common after blunt or penetrating trauma?
Blunt trauma
What can pelvic fractures result in?
Life threatening injuries that produce exsanguination
What are the common causes of pelvic fractures?
Road traffic accidents or falls from height
Why is high energy trauma required to cause disruption in the pelvis?
The pelvic ring is much more solid than most other bones
What artery originated in the sacroiliac joint and gives rise to the superior and inferior gluteal arteries?
The internal iliac artery
What artery follows an oblique path, infront of the secure line in the pelvis?
The external iliac artery
What position is the venous system in the pelvis?
Posterior position, in a pattern similar to the artery system
Who describes the 3 types of underlying mechanism for pelvic fractures?
Tile and Pennal
What is a type 1pelvic fracture and risk of haemorrhage?
Antero-posterior compression with transverse opening of the pelvic ring (open book) and risk for iliac artery lesion
What is a type 2 pelvic fracture and risk of haemorrhage?
Lateral compression with risk for iliac vessel and retropubic plexus vein lesion
What is a type 3 pelvic fracture and risk of haemorrhage?
Vertical instability with posterior structure lesions of the pelvic ring
What are retroperitoneal haematomas in patients with pelvic fractures secondary to?
Vascular and/or bone lesions
Patients who present with haemodynamic instability and a pelvis fracture are likely to have what type of lesions?
Arterial lesions
Up to 90% of vascular lesions within the pelvis are arterial or venous?
Venous
What will patients with retroperitoneal haematomas with associated haemodynamic instability require?
Exploration in theatre
