Abdominal trauma Flashcards
Most commonly involved organs in blunt abdominal trauma
Spleen > liver > small intestine
Most commonly involved organs in penetrating abdominal trauma
Liver > small intestine > diaphragm
Most commonly involved organs in GSW
Small intestine > liver
Most commonly involved structure in deceleration injury
Duodeno-jejunal flexure
Most commonly involved structure in seatbelt syndrome
Mesentery of bowel
Overall involved organ in abdominal trauma
Spleen
What is IOC in hemodynamically stable patient presented with blunt abdominal trauma
First : FAST
IOC : CE-CT scan
What is IOC in hemodynamically unstable patient presented with blunt abdominal trauma
First : FAST
IOC : FAST
Where does ultrasound probe kept in FAST
- Sub-Xiphoid space/Epigastrium:
To look for cardiac tamponade. - RUQ /Right Hypochondrium :
To look for collections around Liver/Hepatic space. - LUQ/Left Hypochondrium:
To look for collections around spleen. - Suprapubic area:
To look for collections around pelvis.
FAST can detect as little as… cc of fluid
50-100 cc
Next step in mgt in patients with positive FAST
Exploratory laparotomy (midline)
DPL cannot evaluate
Retro peritoneum
Positive DPL is said when
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
What If 10 cc of blood comes out in DPL
Infuse 1 liter of saline/RL and aspirate again
Splenic trauma is suspected when there is a fracture of
9 to 11 ribs
& bruising over left lower chest wall
Which sign is seen in splenic injury
Kehr sign
raise left lower limb blood accumulates below the left dome of, diaphragm leading to referred pain to left shoulder tip
Complications following splenectomy
Hemorrhage
Injury to pancreatic tail (turbid discharge in drain) rich in amylase
Hematological changes
Permanent changes seen in peripheral smear funding after splenectomy
Presence of basophilic stippling
Howell jolley bodies
Reticulocyte
Hyper segmented WBCs
Most common organism involved for infection, post splenectomy
S.pneumonia > H. influenza
Most common complication following splenectomy
Left lower lung complication/ atelectasis/Pneumonia
First step in mgt in grade 4 to 6 liver trauma patient
Explore patient (4P’s)
Push/bimanual compression
Pringle’s manuovre
PLUG : Using sengstaken blakemore tube
Packing
What is Pringles maneuver ?
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)
What is the most important prognostic factor in pancreatic injury?
Injury to main pancreatic duct (poor prognosis)
What if there is head injury to pancreas is present
Berger procedure.
Duodenal preserving pancreatic head resection.
Went to do if trauma patient presents with peritonitis
Sx (Hartman procedure)
Proximal end taken out as colostomy and Distal end kept inside and closed after 8-12 weeks 2 ends are anastomosed.
When should we carry out damage control surgery
Carried out when there is terrible triad of trauma
Terrible triad of trauma / Triangle of death includes
Hypothermia
Acidosis
Coagulopathy
Definition of ACS
sustained elevation of IAP >20 mm hg with new organ dysfunction
IAH is defined as the
IAP more than or qual to 12 mm Hg
What is eFAST
FAST + thoracic cavity assessment (Lt and right) = 6 quadrants
Aka BOAST. (Bedside organ Assessment Sonogram in Trauma)
The most commonly injured bowel in cases of blunt trauma is
Jejunum
ACS Characterized by
• 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.
