Abdominal Trauma and Hernias

Question 1

What are common etiologies for abdominal trauma?

Answer 1

Motor vehicle accident, animal bites, sharp and blunt trauma, abuse, or unknown

Question 2

What are the common organ involvements associated with abdominal trauma?

Answer 2

In the abdomen- assess the urologic system, spleen, hepatobiliary system, repro organs, and look for hernias of body wall or diaphragmatic

In the thorax-look for pulmonary contusions, pneumothorax or other injuries

Question 3

What diagnostics are the most important after trauma to the abdomen?

Answer 3

Physical exam- look for subtle cues
-imaging (radiographs, fast scan, maybe CT)
-abdominocentesis or diagnostic peritoneal lavage if fluid seen on fast scan

Question 4

What might be seen on radiographs after abdominal trauma?

Answer 4

Loss of abdominal detail (fluid or mass), free abdominal air (near diaphragm), herniation

Question 5

How do you perform abdominocentesis?

Answer 5

Empty the urinary bladder if possible
-then use the hawian punch method (two 1 1/2 inch 22 g needle and a 1 mL syringe in gravity dependent portion of abdomen) or four quadrant method (linea alba with umbilicus bisecting and inserting needle in middle of each)

Question 6

What tests should you run on abdominal fluid?

Answer 6

PCV/TS: PCV > 2-5% is diagnostic for hemorrhage

Cytology: look for RBCs/WBCs, intracellular bacteria, vegetative material

Biochemical tests: Creatinine and potassium (can be used to determine uroabdomen), bilirubin (bile duct rupture), lactate and glucose (to determine septic effusions)

Question 7

What do you expect glucose and lactose to be for a septic abdomen

Answer 7

Low glucose and high lactose (greater than 20 diagnostic) as bacteria will eat up the glucose and produce lactose

Question 8

How do you perform diagnostic peritoneal lavage?

Answer 8

More invasive than abdominocentesis, requires sedation
- infuse warm saline into a needle and remove via suction (can determine a smaller amount of free fluid in the abdomen)

Question 9

What are the clinical signs for a biliary obstruction or leakage?

Answer 9

Abdominal pain and/or distension

Question 10

What do you expect to see on CBC for bile rupture?

Answer 10

Elevated liver enzymes

Question 11

How long can biliary ruptures go undetected?

Answer 11

Up to 4-6 weeks
- must stabilize before going to surgery

Question 12

What should you do in the case of uroabdomen?

Answer 12

Get the urine out through abdominocentesis, urinary catheter
-stabilize before surgical repairs
-requires cystotomy or possibly cystectomy

Question 13

What is indicated in the case of hemoabdomen?

Answer 13

Must figure out what is bleeding, then stabilize (with fluids and blood products as needed). Conservative management should be attempted before surgery -but intervene surgically before getting too severe (monitor blood trends)

Question 14

What is indicated in the case of a septic abdomen?

Answer 14

Determine cause (external seeding or ruptured viscous), stabilize, then get them to surgery as soon as possible (emergency abdominal exploratory)

Question 15

What should always be on your list for complications after abdominal trauma?

Answer 15

Hernias!

Question 16

What is the definition of a hernia?

Answer 16

A protrusion of an organ through a defect in an anatomical cavity

Question 17

T/F: traumatic hernia is an example of a false hernia?

Answer 17

True- contents go into an area without a hernial sac

Question 18

What is a true hernia?

Answer 18

When contents are contained in an anatomic hernial sac

Question 19

What are the classification methods for hernias?

Answer 19

Anatomic site, reducible or non-reducible, incarcerated (not moving back to where they should with digital manipulation), strangulated (incarcerated with blood flow cut off), acquired vs congenital

Question 20

What are some examples of external hernias?

Answer 20

Paracostal, dorsal lateral, inguinal, cranial pubic ligament, femoral, umbilical, ventral, scrotal

Question 21

What is the term for surgical correction of a hernia?

Answer 21

Herniorrhaphy

Question 22

What are the surgical goals when correcting a hernia?

Answer 22

Identify the defect, replace the organs, assess viability, and repair the defect, utilize patient tissues and provide a tension free closure, excise devitalized and redundant tissue

Question 23

How do you return the contents to a normal location during a herniorrhaphy?

Answer 23

Enlarge the ring if necessary and break down incarcerated hernias
-be careful as tissue may be friable

Question 24

Should you freshen edges for hernia repair of the ring?

Answer 24

May have to in order to encourage tissue healing
-always grab strong tissue for closure

Question 25

What are some examples of materials you can use to assist in tension free closure in area with not a lot of autogenous tissue?

Answer 25

Flaps, mesh, swine intestinal submucosa