Abdominal trauma

Question 1

What proportion of trauma patients present with abdominal trauma?

Answer 1

7-10%

Question 2

Name 2 types of abdominal trauma

Answer 2

Blunt trauma

Penetrating trauma

Question 3

Name the 3 commonest abdominal injuries due to blunt trauma

Answer 3

Spleen injuries (45%)
Liver injuries (40%)
Retroperitoneal haematoma (15%)

Question 4

What are the consequences of blunt trauma?

Answer 4

Compression or crushing ➔ organ rupture

Deceleration injury ➔ tearing from vascular supply e.g. liver tear and vena cava rupture

Question 5

What factors of an RTA increase the likelihood of blunt trauma?

Answer 5

Fatalities
Any casualty being ejected from vehicle
Closing speed >50mph

Question 6

Name 2 causes of blunt trauma to the abdomen

Answer 6

Road traffic accident (RTA)

Fall or impact

Question 7

Name 2 causes of penetrating trauma

Answer 7

Stab wounds

Gunshot wounds

Question 8

Name the 3 commonest abdominal injuries due to penetrating trauma from stab wounds

Answer 8

Laceration of:
Liver (40%)
Small bowel (30%)
Diaphragm (20%)
Colon (15%)

Question 9

Name the 3 commonest abdominal injuries due to penetrating trauma from high velocity gunshot wounds

Answer 9

Laceration, cavitation, tumble, and fragmentation of:
Small bowel (50%)
Colon (40%)
Liver (30%)
Vessels (25%)

Question 10

Following abdominal trauma, what would be suggestive of intra-abdominal bleeding?

Answer 10

Patient is persistently hypotensive despite resuscitation, and no obvious cause of blood loss identified.

Question 11

What is indicated following abdominal trauma if the patient is stable?

Answer 11

Emergency abdominal CT

Question 12

What is indicated following abdominal trauma if the patient remains critically unstable?

Answer 12

Emergency laparotomy typically

Question 13

Which routine investigations should be done in a presentation of abdominal trauma?

Answer 13

Routine bloods
Urinalysis
Serum amylase ➔ small bowel or pancreatic injury
Erect CXR ➔ perforation

Question 14

What is FAST imaging in abdominal injury?

Answer 14

Focused abdominal sonography for trauma.

Imaging of 4 Ps: Morrison’s pouch (hepatorenal recess), Pouch of Douglas (rectouterine pouch), Perisplenic, and Pericardium.

To detect peritoneal and pericardial haemorrhage.

Question 15

What is the role of abdominal CT in abdominal trauma?

Answer 15

Investigation of choice in haemodynamically stable patients with no indication of emergency laparotomy.

Provides detailed information relative to specific organ injury and its extent ➔ may guide management

Question 16

What are the indications for urgent laparotomy in abdominal trauma?

Answer 16

Blunt abdominal trauma with CT features of solid organ injury, not suitable for conservative management.
Peritonitis
Knife injury associated with visible viscera, haemodynamic instability, sepsis
Any gunshot wound

Question 17

What is the indication for resuscitative laparotomy in abdominal trauma?

Answer 17

Blunt abdominal trauma with unresponsive hypotension despite adequate fluid resus, and no other identified cause of bleeding.