Abdominal Trauma Flashcards
Iatragenic Injury to the spleen usually occurs due to _________
a traction-type injury with avulsion of a portion of the splenic capsule.
Largest risk Post-splenectomy
Abscess formation in subphrenic recess
Type I Splenic injury
Capsular tear or Minor parenchymal laceration
Type II splenic injury
Capsular Avulsion w/ minor parenchymal injury
Type III Splenic injury
Major parenchymal fracture/laceration OR
Through-and-through gunshot/stab wound
Type IV Splenic injury
Sever parenchymal stekkate fracture, crush, or bisection, or Hilar injury
Type V Splenic injury
Shattered spleen; multiple injuries
Kehr’s sign
shoulder pain secondary to diaphragmatic irritation
Ballance’s sign
fixed dullness to percussion with or without apalpable mass
Severe Splenic injury hemodynamic
- Hypotension
- Narrow Pulse
- Tachycardia
- Distended Abdomen
Indication for splenic repair
Type I-III
Type I Liver Haematoma
- Subcapsular <10% SA Laceration
- Capsular tear; <1 cm parenchymal depth
Type II Liver haematoma
- Subcapsular, 10-50% SA
- Intraparenchymal <10 cm laceration; 1-3 cm parenchymal depth
Type III Liver Haematoma
- Subcapsular > 50% SA; suptured
- Intraparenchymal > 10 cm; >3 cm depth
Type IV Liver
Laceration w/ parenchymal disruption involving 24-75% of hepatic lobe OR 1-3 Coinaud’s segments
Type V Laceration Liver
- > 75% parenchymal disruption OR >3 coinauds segments
- Juxtahepatic/retrovenous injuries
Type VI Liver
Vascular injuries Or hepatic Avulsion
• Children and patients with gross hematuria, hypotension, or with a major deceleration injury
Avulsion of ureteropelvic junction
Grade I Kidney
- Contusion or subcapsular hematoma
- No parenchymal laceration
Grade II Kidney
- Non-expanding perirenal hematoma OR <1 cm cortical laceration
- No Urinary extravation
Grade III Kidney
- Laceration of Parenchyma < 1 cm that extends into cortex w/ no urinary extravasion
Grade IV Kidney
- Laceration of parenchyma extending through corticomedullary junction into collecting system
- Laceration of segmental vessels may occur
Grade V Kidney
- Thrombosis/Avulsion of main artery/vein w/ intimal tear
OR - Shattered kidney w/ multiple lacerations
Renal imaging in unstable patient heading to OR
“one-shop” IVP (Intravenous Pyelogram)
