hollow viscus injury

Question 1

management of uncomplicated extraperitoneal bladder injury

Answer 1

foley catheter placement

Question 2

management of complicated extraperitoneal bladder injury (bladder + gynecologic trauma)

Answer 2

two layer closure of bladder and of vaginal injury

Question 3

management of duodenal hematoma:

Answer 3

initial nonoperative, NGT decompression, TPN if needed; reevaluate for gastric outlet obstruction at 5-7 days with contrast study

Question 4

what circumference of involvement in the intestinal wall mandates resection instead of primary repair?

Answer 4

over 50% circumference

Question 5

which incision provides access to both proximal mainstem bronchi and the trachea?

Answer 5

right anterolateral thoracotomy

Question 6

what incision best exposes proximal tracheal injury

Answer 6

collar incision

Question 7

what incision provides access to the distal left mainstem bronchi

Answer 7

left anterolateral thoracotomy

Question 8

what is the best incision to access the proximal thoracic esophagus?

Answer 8

right posterolateral thoracotomy

Question 9

gastric perforation may occur after splenectomy due to ligation of which vessels?

Answer 9

short gastrics

Question 10

management of complex extraperitoneal bladder injuries (involving vagina or rectum, shards of bone, etc):

Answer 10

managed operatively with 2 layer closure of bladder and vaginal injuries with tissue interposition if possible to prevent fistula

Question 11

first step for blood at the urethral meatus + a pelvic fx:

Answer 11

can attempt foley once, then retrograde urethrogram

Question 12

what exposure provides access to the distal intrathoracic trachea, proximal bilateral mainstem bronchi, and proximal thoracic esophagus?

Answer 12

right posterolateral thoracotomy

Question 13

preferred tx of penetrating urethral injury:

Answer 13

primary repair over foley to prevent long term stricture

Question 14

next step for a posterior urethral injury in which a foley cannot be passed

Answer 14

suprapubic tube

Question 15

diagnostic imaging modality that will detect a missed ureteral injury:

Answer 15

delayed contrast CT - will show extravasation of contrast from injured ureter

Question 16

what constitutes a positive DPL:

Answer 16

> 100,000 RBC/mL or >500 WBC/mL

Question 17

true or false. limited mobilization of the ureter is recommended during dissection to preserve blood supply which is segmental

Answer 17

true

Question 18

management of ureteral injuries at the uretero-pelvic junction or upper ureter:

Answer 18

reanastomosis

Question 19

management of mid ureteral injuries:

Answer 19

reanastomosis of short defects; vesico psoas hitch, Boari flap, or transuretero-ureterostomy for long defects

Question 20

diagnosis of suspected bladder rupture in trauma

Answer 20

CT cystography

Question 21

how to repair tracheal injury

Answer 21

absorbable suture with strap muscle buttress

Question 22

management of distal ureteral injuries (in pelvis)

Answer 22

reimplantation into bladder

Question 23

Use of _____ in patients with an open abdomen is associated with an increased rate of primary fascial closure.

Answer 23

3% hypertonic saline