Abdominal and Pelvic trauma

Question 1

What is the highest surface landmark where an injury could lead to abdominal injury

Answer 1

Diaphragm rises to the level of 4th intercostal space

Any injury below the nipple line could injure abdominal viscera

Question 2

Most common abdominal organs injured after a blunt injury (eg a deceleration injury)

Answer 2

Spleen 40%

Liver 35%

Small bowel 5%

Question 3

Most common organ injured from stab wounds

Answer 3

Liver 40%

Small bowel 30%

Colon 15%

Question 4

Most common organ injured from a gunshot

Answer 4

Small bowel 50%

Colon 40%

Liver

Abdominal vasculature

Question 5

Correct position of pelvic binder

Answer 5

Centred over the trochanter

(not over the iliac crest)

Question 6

Examination of a potentially unstable pelvis

Answer 6

If evidence of ruptured urethra, a discrepancy of limb length, a rotational deformity of limb present, do not manipulate the pelvis as may dislodge a clot

Instead do gentle palpation

Question 7

Catheterisation in presence of a possible urethral injury

Answer 7

Dont do a urethral catheter

Do a suprapubic

Question 8

Indications for a retrograde urethrogram

Answer 8

Pt unable to void

Pelvic binder in situ

Blood at meatus

Scrotal haematoma

Perineal bruising

Question 9

Should a CT scan be done if already indicated to transfer to a tertiary centre

Answer 9

No don’t delay transfer

Question 10

Diagnostic peritoneal lavage (DPL) indications

Answer 10

Abnormal haemodynamics in abdominal trauma without indication for immediate laparotomy

Question 11

Problems with DPL

Answer 11

Invasive

Requires gastric and urinary decompression to avoid injury but interferes with subsequent FAST or CT

Now mostly replaced by FAST scan

Question 12

What findings from DPL indicates for an urgent laparotomy

Answer 12

Aspiration of GI content

Aspiration of 10 ml of blood in haemodynamically abnormal patient

Question 13

FAST scan components

Answer 13

Pericardial sac

Hepatorenal fossa

Splenorenal fossa

Pelvis or pouch of Douglas

Question 14

Limitations of FAST scan

Answer 14

Bowel gas or subcutaneous air distort images

Does not completely assess retroperitoneal structures

Doesn’t show extra-luminal air

Obesity

Question 15

Indications for laparoscopy for diaphragmatic injury

Answer 15

In haemodynamically stable patients, to diagnose:

• diaphragmatic injury
• peritoneal perforation

Question 16

What type of CT to assess for urinary system injuries

Answer 16

Contrast CT (non-contrast for kidney stones)

Question 17

Indications for urgent laparotomy

Answer 17

Haemodynamically unstable

Gunshot with a transperitoneal trajectory

Signs of peritoneal irritation

Signs of peritoneal perforation (extra-luminal air)

Bleeding from stomach, rectum or genito-urinary tract following penetrating trauma

Question 18

Urethral disruption injuries classification

Answer 18

Above urogenital diaphragm (posterior)

Below urogenital diaphragm (anterior)

Question 19

Cause of posterior urethral disruption

Answer 19

multisystem injuries and pelvic fractures

Question 20

Causes of anterior urethral injury

Answer 20

Isolated injury from a straddle impact

Question 21

Chance fracture

Answer 21

Lumbar distraction fracture

Are commonly associated with intestinal injuries

Fracture all the way through the spinous process to vertebral body

Question 22

Mechanism of injury causing chance fractures

Answer 22

compression- distraction

Question 23

Pelvic fracture types

Answer 23

Lateral compression 60-70%

Anterior posterior (AP) compression 15-20%

Vertical shear 5-15%

Question 24

Pathophysiology of AP compression pelvic fracture

Answer 24

Associated with motorcycle or head-on motor vehicle crash

The disruption of the pelvic ring widens, tearing the posterior venous plexus and branches of internal iliac artery

Question 25

Risk with AP compression pelvic injury

Answer 25

Haemorrhage as a result of internal iliac a and venous plexus tear

Question 26

The risk with lateral compression injury

Answer 26

Damage to urethra or bladder

Haemorrhage (less than AP compression)

Question 27

Example of injury causing vertical shear pelvic injury

Answer 27

Fall from greater than 12 feet (3.5 m)

Question 28

Before and after xrays of pelvic stabilisation

Answer 28