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GI II > Clinical Approach to Abdominal Trauma > Flashcards

Clinical Approach to Abdominal Trauma Flashcards

1
Q

describe the visceral history of appendicitis

A

vague, nonspecific, aching/cramping abdominal pain

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2
Q

describe the typical presentation of appendicitis

A

RLQ abdominal pain
anorexia
nausea/vomiting
+/- fever

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3
Q

describe the treatment for appendicitis

A 
NPO
IVF
antiemetic
pain medication
possible preoperative antibiotics

surgery

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4
Q

what can mimic gastroenteritis or viral illness?

A

early appendicitis

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5
Q

can a patient with a normal CBC have appendicitis?

A

yes

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6
Q

can a patient with an abnormal UA still have appendicitis?

A

yes

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7
Q

what is the most frequent site of obstruction in the GI tract?

A

esophagus

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8
Q

name three spaces in which esophageal foreign bodies are often impacted

A
  1. UES
  2. at the level of the aortic arch
  3. diaphragmatic hiatus/LES
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9
Q

approximately half of the individuals with esophageal food impacts have underlying…

A

eosinophilic esophagitis

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10
Q

drooling and inability to swallow liquids is indicative of…

A

an esophageal obstruction, and requires emergent endoscopic evaluation

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11
Q

fever, abdominal pain, and repetitive vomiting after foreign body ingestion are concerning and warrant…

A

further workup

make sure history includes type of foreign body, time of ingestion, and presence and type of ongoing symptoms

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12
Q

imaging is only performed in patients […] signs of symptoms suggestive of…

A

[without] – it is so important not to delay EGD imaging

an esophageal obstruction

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13
Q

for what patients do you order CT scans?

A
  1. suspected perforation
  2. sharp or pointed foreign body ingestion
  3. ingested packets of narcotics or other drugs
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14
Q

describe the expectant “watch and wait” management for foreign body ingestion

A

watch and wait applies when the object is beyond the ligament of treitz; XR every week

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15
Q

name the three situations for emergent endoscopy (within 6 hours)

A
  1. complete esophageal obstruction (drooling)
  2. disk batteries in the esophagus
  3. sharp-pointed objects in the esophagus
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16
Q

all foreign bodies in the esophagus require removal within…

A

24 hours; perform urgent endoscopy

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17
Q

most foreign bodies that enter the stomach pass within…

A

4-6 days

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18
Q

when is urgent endoscopy indicated? there are six situations

A
  1. sharp-pointed objects in the stomach or duodenum
  2. objects >5cm in length at or above the proximal duodenum
  3. high powered magnets within endoscopic reach
  4. blunt objects in the stomach that are >2cm in diameter
  5. disk batteries and cylindicral batteries
  6. objects containing lead
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19
Q

with foreign body ingestion, when is endoscopic or surgical intervention indicated?

A

signs or symptoms suggesting inflammation or intestinal obstruction (fever, abdominal pain, vomiting)

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20
Q

75% of all hernias are…

A

inguinal hernias

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21
Q

2/3 of all inguinal hernias are…

A

indirect

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22
Q

constant or intermittent mass in the groin gradually increasing in size, +/- other symptoms

A

hernia

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23
Q

describe hernia classification

A
  1. anatomic location (ventral, groin)
  2. hernia contents (bowel, fat)
  3. status of those contents (reducible, incarcerated, strangulated)
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24
Q

name the two most common ventral hernias

A
  1. epigastric

2. umbilical

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25
Q

name the three kinds of groin hernias

A
  1. inguinal (indirect, direct)
  2. femoral
  3. obturator
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26
Q

where are incisional hernias most commonly located?

A

midlines; spigelian and parastomal hernias occur off the midline

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27
Q

hernia which passes directly through a weakness in the transversalis fascia in the Hesselbach triangle

A

direct inguinal hernia

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28
Q

hernia which passes from the internal to the external inguinal ring through the patent process vaginalis, and then the scrotum

A

indirect inguinal hernia

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29
Q

hernia sack is soft and easy to replace back through the hernia neck defect

A

reducible

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30
Q

hernia sack is firm, often painful, and nonreducible by direct manual pressure; no signs of systemic illness

A

incarcerated

31
Q

hernia sack is firm and very painful, usually with signs of systemic illness (NVF) which implies impairment of blood flow

A

strangulated

can be arterial, venous, or both

32
Q

which hernia is an acute surgical emergency?

A

strangulated

33
Q

describe the steps taken when strangulated hernia is suspected…

A
  • consult general surgery, immediately
  • broad-spectrum IV antibiotics
  • fluid resuscitation and adequate narcotic analgesia
  • obtain preoperative laboratory studies
34
Q

describe the steps taken when strangulated hernia is suspected…

A
  • consult general surgery, immediately
  • broad-spectrum IV antibiotics
  • fluid resuscitation and adequate narcotic analgesia
  • obtain preoperative laboratory studies
35
Q

how do you care for an incarcerated hernia?

A

attempt to reduce, if unsuccessful consult surgery

36
Q

how do you care for reducible hernia?

A

outpatient surgery follow up

37
Q

what size is sufficient to diagnose AAA?

A

diameter exceeding 3.0 cm

38
Q

what is the most common site of AAA?

A

inferior to the renal arteries

39
Q

what is the most important factor for risk of AAA rupture?

A

smoking

40
Q

small and medium sized AAAs (<5.5 cm) expand at an average rate of…

A

2-3 mm/year

41
Q

larger AAAs (>5.5 cm) expand at approximately…

A

3-4 mm/year

42
Q

AAAs that exhibit rapid diameter expansion are at an increased risk for rupture, what counts as rapid expansion?

A

> 5 mm over six months or >10 mm over 12 months

43
Q

describe a symptomatic but not ruptured AAA

A

abdominal pain, flank pain, limb ischemia, fever, malaise

  • AAA rapidly expanding; large enough to compress surrounding structures, inflammatory or infectious
44
Q

describe the triad of ruptured and symptomatic AAA

A
  • severe acute abdominal and/or flank pain
  • hypotension, shock
  • pulsatile abdominal mass
45
Q

describe the risk factors for AAA

A 
advanced age
male gender
caucasian
positive family history
smoking
presence of other large vessel aneurysms
atherosclerosis
46
Q

what are the symptoms, if any, present with AAA?

A
  • abdominal, back, or flank pain
  • syncope
  • thromboembolism and/or limb ischemia
  • aneurysms that produce symptoms are at an increased risk for rupture
47
Q

what is ruptured AAA commonly mistaken for?

A
  • renal colic
  • perforated viscus
  • diverticulitis
  • gastrointestinal hemorrhage
  • ischemic bowel
48
Q

describe the screening for AAA

A

one time US for at risk patients over 65

49
Q

describe the monitoring for asymptomatic AAA

A

6 month or annual US or CT Abd/pelvis

50
Q

describe the testing for symptomatic AAA

A

stable: CT Abd/pelvis w/ IV cont.

unstable: if known hx of AAA –> OR!
if unknown hx but suspected AAA –> CT Abd/pelvis w/ IV cont. if possible

51
Q

what size AAA indicates conservative management?

A

asymptomatic infrarenal AAA <5.5 cm

52
Q

describe the circumstances for elective AAA repair (open or endovascular)

A
  • asymptomatic AAA >5.5 cm
  • rapidly expanding infrarenal AAA; doesn’t cross renal a.
  • associated arterial disease (coexisting iliac, femoral or popliteal a. aneurysms; symptomatic artery disease undergoing revascularization)
53
Q

what is a leading cause of mortality globally?

A

trauma

  • road traffic injuries 18-29 years of age
  • 30% of ICU admissions
54
Q

direct blow causing rupture of hollow organs and bleeding

A

blunt trauma

deceleration causes shearing injuries

55
Q

stab wounds and low velocity GSWs causing tissue damage by lacerating and cutting

high velocity GSWs transfer more kinetic energy to the abdomen viscera, cause increased damage by cavitation

A

penetrating trauma

56
Q

blunt and penetrating

blast injury to lung and hollow viscus from blast overpressure

inhalation injury

A

explosives

57
Q

what mechanism of injury accounts for the majority if abdominal injuries seen in the ED?

A

blunt abdominal trauma (BAT)

58
Q

what are the most commonly injured solid organs in BAT?

A

spleen and liver

kidneys also possible

59
Q

name important MVC historical questoins

A
  • restrained
  • intoxicated
  • location within vehicle
  • vehicle type and velocity
  • air bags
60
Q

what four aspects increase risk of serious injury in MVC?

A
  • unrestrained
  • ejected
  • rolled over by vehicle
  • fatality of another at scene
61
Q

describe ABCDE for critically ill patients

A 
Airway - maintenance w/ C-spine control
Breathing and ventilation
Circulation - w/ hemorrhagic control
Disability/neurologic status
Exposure/Environmental control - completely undress pt, prevent hypothermia
62
Q

in addition to normal abdominal exam (inspect, auscultate, palpate) what other components are important?

A
  • asses pelvic stability

- asses urethral meatus, perineal, rectal, vaginal

63
Q

where is the diaphragm most commonly injured?

A

left side

d/t blunt high impact (MVC); suspect w/ thoraco-abdominal trauma

DO NOT USE TROCHAR when inserting chest tube, may puncture stomach

64
Q

describe situations where you should be concerned about duodenal injuries

A
  • unrestrained drivers
  • bicycle handlebar injury

get CT abd/pelvis w/ IV and oral contrast

65
Q

how do pancreatic injuries occur?

A

direct blow to the pancreas, compressing it against vertebral column

check and trend amylase and lipase; CT abd/pelvis w/ IV and oral contrast

66
Q

describe how one can sustain GU injuries

A

SUSPECT URETHRAL DISRUPTION W/ ANTERIOR PELVIC INJURIES

direct blows to the back or flank
- suspect w/ gross or microscopic hematuria

get CT abd/pelvis w/ IV contrast

67
Q

when should you suspect urethral disruption?

A

anterior pelvic injuries

68
Q

describe how one can sustain hollow viscus injuries

A

sudden deceleration injuries (MVC) or Chance fracture (think duodenal injury)

early CT and US not diagnostic

69
Q

when do patients w/ pelvic fracture have high mortality?

A

if they are hypotensive

  • 1/6 die w/ all types of pelvic fractures
  • 1/4 die w/ closed pelvic fracture and hypotension
  • 1/2 die w/ open pelvic fracture

common: MVC, fall from heights, auto-vs-pedestrian
MOA: disruption pelvic ring tears pelvic venous plexus and occasionally disrupts internal iliac arterial system

70
Q

what will a FAST SCAN reveal?

A

blood / if + need to send to proper care, do not get CT

free intraperitoneal fluid, pericardial fluid, pleural fluid, hemothorax and pneumothorax

71
Q

what imaging is definitive for most intra-abdominal trauma?

A

CT Abd/Pelvis w/ IV

72
Q

all patients with significant trauma need these three basic imaging studies…

A

lateral C spine
CXR
AP pelvis

73
Q

what is the most critical situation which qualifies a patient for a laparotomy?

A

BAT w/ hypotension w/ +FAST SCAN or clinical evidence of intraperitoneal bleeding

74
Q

if a patient has blunt or penetrating abdominal trauma w/ +DPL do they qualify for laparotomy?

A

yes

DPL = diagnostic peritoneal lavage

GI II (5 decks)

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