Block 8- Appendix, Thyroid, Abdominal Trauma Flashcards
Which of the ff. Is an indication for operative intervention in a patient with an isolated duodenal hematoma?
Contained retroperitoneal leak
The most appropriate treatment for a duodenal hematoma that occurs from blunt trauma is
Observation
Damage control surgery (DCS)
A. Limits enteric spillage by rapid repair of small bowel injuries with whipstitch, and complete transection with a GIA stapling device
A 23 year old man fell off his skateboard, reporting blunt injury to his upper abdomen. Abdominal CT and magnetic resonance cholangiopancreatography (MRCP) confirmed he suffered transection of the main pancreatic duct at the middle of the pancreatic body. Which of the ff. would be the most appropriate next step in management?
A. Distal pancreatectomy with splenic preservation
The most appropriate treatment of gunshot wound to hepatic flexure that cannot be repaired primarily is
Resection of the right colon with ileocolostomy
A 45-year-old male came in at the ER with multiple stab wounds on the upper quadrant of the abdomen, NGT was inserted draining to a bloody to coffee ground drain. The patient is GCS 15 with vital signs as follows: BP 90/60, CR: 120, T: 37, RR:18, O2 saturation: 98%. What is your next step?
A. Schedule for emergency exploratory laparotomy
While waiting for the RT-PCR result, the patient deteriorated and was intubated and brought to the OR. Upon opening, there are multiple stab injuries to the body of the stomach that are closely situated together. What is your operative procedure?
Segmental resection and anastomosis
In which portion of the duodenum is the ampulla of Vater located?
A. 2nd
A 56 year old male patient came in with blunt abdominal injury secondary to vehicular crash. Upon physical examination, there was a note of abdominal tenderness on all quadrants. The patient was scheduled for STAT laparotomy. Upon opening of the abdomen, 3 x 3 cm periduodenal hematoma was observed in the first portion of the duodenum. No other injuries were seen. What is your next step?
A. It should be explored to exclude underlying perforation
With the same case scenario as mentioned above, the patient came into the trauma room with a soft abdomen and stable vital signs. There was minimal tenderness and the right upper quadrant area upon deep palpation. No other injuries were noted. What is your next step?
A. Request for abdominal ct scan with iv contrast
Please refer to case #10. The CT scan showed periduodenal hematoma approximately 2.2 x 1.8 cm in size, no free peritoneal fluid scene and pneumoperitoneum. What is your next step
A. Insert the NGT and start parenteral nutrition
An 18-year-old male patient was involved in a mass vehicular crash. He came in GCS 7 and was intubated, with note of upper quadrant hematomas in his anterior abdomen. Vital signs were BP: 60 palpatory, CR: 140s, RR: 22, T: 36, O2 saturation: 88%. After resuscitation the vital signs were stabilized but erratic. The abdomen was distended with boardlike rigidity upon examination. What is your next step?
A. Schedule patient for laparotomy and resection with anastomosis of the involved bowel
All of the following are components of damage control surgery, except?
Start early feeding per orem
The patient was scheduled for a second look procedure after stabilization upon full kocherization of the duodenum, a note of leaking bile on the area was noted with an avulsed tissue of the second portion of the duodenum. The surgeon should explore the area and look for what structure?
A. Ampulla of Vater
After examination of the second portion of the duodenum no any other injuries were noted. A primary repair was done in a transverse manner but a mild narrowing in the lumen was observed due to tissue loss. What is your next procedure?
A. Do a pyloric exclusion
A 26-year-old female came in with multiple self inflicted stab wounds in her anterior abdomen. Omental evisceration was seen in the left paraumbilical area stab injury. The patient was scheduled for laparotomy. Omentectomy was done prior to opening of the abdomen. No other associated injuries were seen except for a hematoma in the jejunum. As a part of exploration, what portion of the small bowel should be examined?
The bowel should be examined from the ligament of Treitz to the ileocecal valve
A 28 year old male patient came in with a shotgun injury in his anterior abdomen by an unknown assailant. A huge abdominal defect was observed with small bowel evisceration. The patient was then scheduled for laparotomy. Almost all of the entire length of the small bowels were devitalized and was resected with a remaining bowel of approximately 80 cm of the jejunum from the ligament of treitz. What is the most common complication expected in this patient?
A. Short bowel syndrome
The pancreas receives its blood supply from what artery?
A. Celiac artery
B. Superior mesenteric artery
In damage control surgery involving the distal pancreas or tail of the pancreas in a multiply injured patient, what procedure should be done?
En bloc resection of the distal pancreas
Which of the ff. statements is correct?
A. The management of pancreatic trauma is determined by the presence or absence of the pancreatic duct injury
A 25 year old man presents ff. blunt trauma to the abdomen. FAST exam shows injury to the spleen. His HR is 110, RR is 25, and he is mildly anxious. What percentage of his blood volume do you estimate he has lost?
A. 15-30%
A 45 year old, otherwise healthy woman presents after a moving vehicle accident. She is hemodynamically stable and with only minimal tenderness in her right upper quadrant. A FAST exam is positive with fluid seen in the hepatorenal fossa and the pelvis. Which of the ff. is the next best step in her management?
A. CT scan
A stable patient with a Grade III splenic laceration has the ff. laboratory results 2 hours after admission: Hg/Hct 8.7/29 Pit 70,000 INR 1.3.
A. Transfuse PRBCs only
Quadrate lobe is located in what functional surgical segment of liver?
A. Medial inferior
