Abdominal And Pelvic Trauma

Question 1

What anatomy is within the anterior abdomen cavity?

Answer 1

Most of the hollow viscera

Question 2

What anatomy is within the thoracoabdominal cavity?

Answer 2

Diaphragm, liver, spleen, stomach

Question 3

What anatomy is found within the flank and back anatomy?

Answer 3

The retroperitoneal space: abdominal aorta, inferior vena cava, duodenum, pancreas, kidneys, ureters, descending colon, ascending colon

Question 4

What anatomy is found within the pelvis cavity?

Answer 4

Rectum, bladder, iliac vessels, female reproductive organs

Question 5

Where in the diaphragm is more likely to get a blunt tear?

Answer 5

Left hemidiaphragm

Question 6

What kind of patients are often found to have duodenal ruptures as a result of a direct blow to the abdomen?

Answer 6

Unrestrained drivers involved in head on collision

Question 7

What are pancreatic injuries often a result of?

Answer 7

A direct epigastric blow that compresses the pancreas against the vertebral column

Question 8

What are markers for potential underlying renal injuries?

Answer 8

Contusions, haematomas and ecchymoses of the back and flank

Question 9

What are the indicators of increased risk of renal injuries?

Answer 9

Gross and microscopic haematuria in patients with an episode of hypotension

Question 10

What is blunt injury to the bowel generally associated with?

Answer 10

Sudden deceleration with subsequent tearing near a fixed point of attachment, often connected with the incorrect positioning of a seatbelt

Question 11

What are common causes of hypovolemic shock in trauma patients?

Answer 11

Injuries to the liver, spleen and kidney

Question 12

If patients with solid organ injuries are unstable, what do they require?

Answer 12

Urgent assessment for a laparotomy

Question 13

Why is FAST scan used in trauma?

Answer 13

It allows for immediate assessment of the trauma patient because of its ability to detect splenic and hepatic injuries

Question 14

What is a FAST scan?

Answer 14

Focused assessment with sonography in trauma

Question 15

What are the main drivers for using FAST in trauma?

Answer 15

Economic benefits, non-invasiveness and the repeatability of examinations

Question 16

What are some of the negatives of a FAST scan in trauma?

Answer 16

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

Question 17

What should be considered with regards to the risk of false negative results for FAST scan?

Answer 17

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

Question 18

If a high level of suspicion of intrabdominal injury exists, what is the preferred scan of choice?

Answer 18

CT scan (commutated tomography)

Question 19

Are pelvic fractures common after blunt or penetrating trauma?

Answer 19

Blunt trauma

Question 20

What can pelvic fractures result in?

Answer 20

Life threatening injuries that produce exsanguination

Question 21

What are the common causes of pelvic fractures?

Answer 21

Road traffic accidents or falls from height

Question 22

Why is high energy trauma required to cause disruption in the pelvis?

Answer 22

The pelvic ring is much more solid than most other bones

Question 23

What artery originated in the sacroiliac joint and gives rise to the superior and inferior gluteal arteries?

Answer 23

The internal iliac artery

Question 24

What artery follows an oblique path, infront of the secure line in the pelvis?

Answer 24

The external iliac artery

Question 25

What position is the venous system in the pelvis?

Answer 25

Posterior position, in a pattern similar to the artery system

Question 26

Who describes the 3 types of underlying mechanism for pelvic fractures?

Answer 26

Tile and Pennal

Question 27

What is a type 1pelvic fracture and risk of haemorrhage?

Answer 27

Antero-posterior compression with transverse opening of the pelvic ring (open book) and risk for iliac artery lesion

Question 28

What is a type 2 pelvic fracture and risk of haemorrhage?

Answer 28

Lateral compression with risk for iliac vessel and retropubic plexus vein lesion

Question 29

What is a type 3 pelvic fracture and risk of haemorrhage?

Answer 29

Vertical instability with posterior structure lesions of the pelvic ring

Question 30

What are retroperitoneal haematomas in patients with pelvic fractures secondary to?

Answer 30

Vascular and/or bone lesions

Question 31

Patients who present with haemodynamic instability and a pelvis fracture are likely to have what type of lesions?

Answer 31

Arterial lesions

Question 32

Up to 90% of vascular lesions within the pelvis are arterial or venous?

Answer 32

Venous

Question 33

What will patients with retroperitoneal haematomas with associated haemodynamic instability require?

Answer 33

Exploration in theatre