Abdominal Trauma

Question 1

Iatragenic Injury to the spleen usually occurs due to _________

Answer 1

a traction-type injury with avulsion of a portion of the splenic capsule.

Question 2

Largest risk Post-splenectomy

Answer 2

Abscess formation in subphrenic recess

Question 3

Type I Splenic injury

Answer 3

Capsular tear or Minor parenchymal laceration

Question 4

Type II splenic injury

Answer 4

Capsular Avulsion w/ minor parenchymal injury

Question 5

Type III Splenic injury

Answer 5

Major parenchymal fracture/laceration OR

Through-and-through gunshot/stab wound

Question 6

Type IV Splenic injury

Answer 6

Sever parenchymal stekkate fracture, crush, or bisection, or Hilar injury

Question 7

Type V Splenic injury

Answer 7

Shattered spleen; multiple injuries

Question 8

Kehr’s sign

Answer 8

shoulder pain secondary to diaphragmatic irritation

Question 9

Ballance’s sign

Answer 9

fixed dullness to percussion with or without apalpable mass

Question 10

Severe Splenic injury hemodynamic

Answer 10

• Hypotension
• Narrow Pulse
• Tachycardia
• Distended Abdomen

Question 11

Indication for splenic repair

Answer 11

Type I-III

Question 12

Type I Liver Haematoma

Answer 12

• Subcapsular <10% SA Laceration

- Capsular tear; <1 cm parenchymal depth

Question 13

Type II Liver haematoma

Answer 13

• Subcapsular, 10-50% SA

- Intraparenchymal <10 cm laceration; 1-3 cm parenchymal depth

Question 14

Type III Liver Haematoma

Answer 14

• Subcapsular > 50% SA; suptured

- Intraparenchymal > 10 cm; >3 cm depth

Question 15

Type IV Liver

Answer 15

Laceration w/ parenchymal disruption involving 24-75% of hepatic lobe OR 1-3 Coinaud’s segments

Question 16

Type V Laceration Liver

Answer 16

• > 75% parenchymal disruption OR >3 coinauds segments

- Juxtahepatic/retrovenous injuries

Question 17

Type VI Liver

Answer 17

Vascular injuries Or hepatic Avulsion

Question 18

• Children and patients with gross hematuria, hypotension, or with a major deceleration injury

Answer 18

Avulsion of ureteropelvic junction

Question 19

Grade I Kidney

Answer 19

• Contusion or subcapsular hematoma

- No parenchymal laceration

Question 20

Grade II Kidney

Answer 20

• Non-expanding perirenal hematoma OR <1 cm cortical laceration
• No Urinary extravation

Question 21

Grade III Kidney

Answer 21

• Laceration of Parenchyma < 1 cm that extends into cortex w/ no urinary extravasion

Question 22

Grade IV Kidney

Answer 22

• Laceration of parenchyma extending through corticomedullary junction into collecting system
• Laceration of segmental vessels may occur

Question 23

Grade V Kidney

Answer 23

• Thrombosis/Avulsion of main artery/vein w/ intimal tear
  OR
• Shattered kidney w/ multiple lacerations

Question 24

Renal imaging in unstable patient heading to OR

Answer 24

“one-shop” IVP (Intravenous Pyelogram)

Question 25

Renal imaging in stable patient

Answer 25

CT Scan

Question 26

Indications for Renal exploration during surgery

Answer 26

• Abnormalities on IVP

- Pulsing retroperitoneal hematoma