Abdominal trauma

Question 1

Most commonly involved organs in blunt abdominal trauma

Answer 1

Spleen > liver > small intestine

Question 2

Most commonly involved organs in penetrating abdominal trauma

Answer 2

Liver > small intestine > diaphragm

Question 3

Most commonly involved organs in GSW

Answer 3

Small intestine > liver

Question 4

Most commonly involved structure in deceleration injury

Answer 4

Duodeno-jejunal flexure

Question 5

Most commonly involved structure in seatbelt syndrome

Answer 5

Mesentery of bowel

Question 6

Overall involved organ in abdominal trauma

Answer 6

Spleen

Question 7

What is IOC in hemodynamically stable patient presented with blunt abdominal trauma

Answer 7

First : FAST
IOC : CE-CT scan

Question 8

What is IOC in hemodynamically unstable patient presented with blunt abdominal trauma

Answer 8

First : FAST
IOC : FAST

Question 9

Where does ultrasound probe kept in FAST

Answer 9

1. Sub-Xiphoid space/Epigastrium:
   To look for cardiac tamponade.
2. RUQ /Right Hypochondrium :
   To look for collections around Liver/Hepatic space.
3. LUQ/Left Hypochondrium:
   To look for collections around spleen.
4. Suprapubic area:
   To look for collections around pelvis.

Question 10

FAST can detect as little as… cc of fluid

Answer 10

50-100 cc

Question 11

Next step in mgt in patients with positive FAST

Answer 11

Exploratory laparotomy (midline)

Question 12

DPL cannot evaluate

Answer 12

Retro peritoneum

Question 13

Positive DPL is said when

Answer 13

If 10 cc of blood comes out: positive DPL
OR If aspirate contain
>1 lakh RBC/cu.mm
> 500 WBC / cu.mm
S.Amylase >175 Iu/L
Presence of fecal content

Question 14

What If 10 cc of blood comes out in DPL

Answer 14

Infuse 1 liter of saline/RL and aspirate again

Question 15

Splenic trauma is suspected when there is a fracture of

Answer 15

9 to 11 ribs
& bruising over left lower chest wall

Question 16

Which sign is seen in splenic injury

Answer 16

Kehr sign
raise left lower limb blood accumulates below the left dome of, diaphragm leading to referred pain to left shoulder tip

Question 17

Complications following splenectomy

Answer 17

Hemorrhage
Injury to pancreatic tail (turbid discharge in drain) rich in amylase
Hematological changes

Question 18

Permanent changes seen in peripheral smear funding after splenectomy

Answer 18

Presence of basophilic stippling
Howell jolley bodies
Reticulocyte
Hyper segmented WBCs

Question 19

Most common organism involved for infection, post splenectomy

Answer 19

S.pneumonia > H. influenza

Question 20

Most common complication following splenectomy

Answer 20

Left lower lung complication/ atelectasis/Pneumonia

Question 21

First step in mgt in grade 4 to 6 liver trauma patient

Answer 21

Explore patient (4P’s)
Push/bimanual compression
Pringle’s manuovre
PLUG : Using sengstaken blakemore tube
Packing

Question 22

What is Pringles maneuver ?

Answer 22

Compress Hepatic pedicle. Hepatoduodenal ligament (at foramen of winslow/ epiploic foramen )
If bleeding stops (it’s bc of portal vein/hepatic artery, branches) do Pringles for 15 to 20 minutes and release clamp to prevent hypoxic damage .
If bleeding continues (bc of Hepatic vein tributaries)

Question 23

What is the most important prognostic factor in pancreatic injury?

Answer 23

Injury to main pancreatic duct (poor prognosis)

Question 24

What if there is head injury to pancreas is present

Answer 24

Berger procedure.
Duodenal preserving pancreatic head resection.

Question 25

Went to do if trauma patient presents with peritonitis

Answer 25

Sx (Hartman procedure)
Proximal end taken out as colostomy and Distal end kept inside and closed after 8-12 weeks 2 ends are anastomosed.

Question 26

When should we carry out damage control surgery

Answer 26

Carried out when there is terrible triad of trauma

Question 27

Terrible triad of trauma / Triangle of death includes

Answer 27

Hypothermia
Acidosis
Coagulopathy

Question 28

Definition of ACS

Answer 28

sustained elevation of IAP >20 mm hg with new organ dysfunction

Question 29

IAH is defined as the

Answer 29

IAP more than or qual to 12 mm Hg

Question 30

What is eFAST

Answer 30

FAST + thoracic cavity assessment (Lt and right) = 6 quadrants
Aka BOAST. (Bedside organ Assessment Sonogram in Trauma)

Question 31

The most commonly injured bowel in cases of blunt trauma is

Answer 31

Jejunum

Question 32

ACS Characterized by

Answer 32

• A sudden increase in intraabdominal pressure
• Increased peak inspiratory pressure
• Hypercarbia and respiratory acidosis
• Decreased urinary output - due to reduced renal blood flow
• Hypotension - secondary to decreased venous return to the heart.