Abdominal Trauma Flashcards
What is the most common cause of abdominal bleeding after trauma (i.e. MVC)?
Liver injury.
What is the most common cause of significant abdominal bleeding after trauma (i.e MVC)?
Splenic injury. The spleen is located immediately behind the 9th, 10th, and 11th ribs along the midaxillary line, and it descends slightly with inspiration.
What is the preferred initial diagnostic test for hemodynamically unstable patients with blunt abdominal trauma?
FAST (Focused Assessment with Sonography for Trauma).
What are the indications for emergent laparotomy in abdominal trauma?
Hypotension, peritonitis, evisceration, or positive FAST in an unstable patient.
What is the management of a stable patient with a positive FAST?
CT abdomen/pelvis with IV contrast to assess injury severity.
What is the Pringle maneuver?
Clamping the portal triad (hepatic artery, portal vein, bile duct) to control liver bleeding. Persistent bleeding suggests injury to hepatic veins or IVC.
What are the hallmarks of splenic injury?
Left upper quadrant pain, referred pain to the left shoulder (Kehr sign), and association with left lower rib fractures.
What are the indications for non-operative management of splenic injury?
Hemodynamically stable patient with no peritoneal signs and a contained splenic hematoma on CT.
What is the most common cause of duodenal hematoma?
Blunt abdominal trauma, especially in children due to less fat and thin bowel walls (bike handlebars).
How does duodenal hematoma present?
Delayed onset of symptoms (vomiting, bowel obstruction) 24-72 hours after trauma.
What is the management of duodenal hematoma?
Nasogastric decompression and parenteral nutrition. Surgery if obstruction persists.
How does bowel perforation present after trauma?
Free air under the diaphragm on upright CXR, peritonitis, progressive abdominal pain.
What is the best imaging modality for suspected bowel perforation?
CT abdomen with IV and oral contrast.
What is the treatment for bowel perforation?
Emergent laparotomy and repair.
What is the classic sign of pancreatic injury from blunt trauma?
Delayed presentation with epigastric pain, nausea, and possible retroperitoneal fluid collection on CT.
What is the best diagnostic approach for pancreatic injury?
CT scan initially, but MRCP or serial CT scans may be needed for subtle injuries.
What is the management of pancreatic injury?
Conservative for minor injuries; surgical drainage or debridement for major injuries.
What are the risks of seatbelt sign in blunt trauma?
High risk (30%) of intra-abdominal injury, including bowel perforation and mesenteric tears.
What is abdominal compartment syndrome?
Elevated intra-abdominal pressure leading to organ dysfunction (renal failure, respiratory compromise, decreased venous return). Patients receiving massive fluid resuscitation (eg, patients with severe burns) are at increased risk for abdominal compartment syndrome, especially when coupled with conditions (eg, trauma, burns) that cause a systemic inflammatory response, increased capillary permeability, and rapid third spacing of fluids (eg, into the abdominal cavity). The resulting increase in IAP may decrease perfusion to intraabdominal organs (ie, abdominal perfusion pressure = mean arterial pressure - IAP) and result in the following organ dysfunction. Renal vein compression impairs renal venous drainage, leading to renal dysfunction (eg, decreased urine output, increased creatinine). Diaphragmatic elevation causes extrinsic lung compression, which increases intrathoracic pressure and leads to high ventilation pressures (eg, peak inspiratory pressure) and jugular venous distension (JVD). Obstruction of venous return leads to decreased cardiac output (eg, hypotension) and increased venous hydrostatic pressure in the lower extremities (eg, 3+ pitting edema). Cardiac function is also diminished due to direct cardiac compression from an elevated hemidiaphragm.
How is intra-abdominal pressure measured?
Bladder pressure monitoring. To diagnose abdominal compartment syndrome (ACS), intraabdominal pressure (IAP) should be measured. Although IAP can be measured several ways (eg, via intragastric, intracolonic, or intravesical catheter), measurement of bladder pressure via a foley catheter is the standard method because it is accurate and easy to perform, especially when a foley catheter is already present. The foley catheter is attached to a pressure transducer. An elevated pressure (eg, >25 mm Hg) indicates ACS is likely present.
What is the treatment for abdominal compartment syndrome?
Surgical decompression (fasciotomy or open abdominal management). Definitive treatment for abdominal compartment syndrome is surgical decompression (ie, laparotomy without fascial closure, allowing for an open abdomen). However, if elevated IAP is recognized early, nonsurgical measures can potentially lower IAP and prevent progression to abdominal compartment syndrome. These measures include proper positioning (supine vs sitting up), gastrointestinal decompression (eg, nasogastric and rectal drainage), evacuation of any space-occupying fluid collections (eg, hematoma, ascites), judicious use of intravenous fluids, and adequate pain control and sedation (which relax the abdominal wall).
What is hematobilia?
Bleeding into the biliary tree due to liver trauma or AV fistula formation.
How does hematobilia present?
GI bleeding (melena/hematemesis), RUQ pain, and jaundice days after trauma.
What is the management of hematobilia?
Angiographic embolization or surgical repair.
What is the most commonly injured organ in penetrating abdominal trauma?
Small bowel (followed by liver).
When is emergent laparotomy indicated in gunshot wounds?
Peritonitis, hypotension, evisceration, or positive FAST in an unstable patient.
What is the role of CT in gunshot wounds?
CT with IV contrast is used in stable patients without peritoneal signs to evaluate for intra-abdominal injury.
What is the initial management of stab wounds to the abdomen?
Evaluate for fascial penetration. If positive, admit for serial exams and possible imaging.
What are the indications for surgery in stab wounds?
Hemodynamic instability, peritonitis, worsening clinical exam, or positive imaging findings.
