Trauma 3 Abdomen

Question 1

What abdominal organ is most frequently injured by blunt trauma?

Answer 1

Spleen. Then liver

Question 2

What are the three diaphragmatic openings?

Answer 2

T8: IVC
T10: esophagus
T12: aorta

I 8 10 eggs after 12

Question 3

What abdominal organs are retroperitoneal?

Answer 3

Proximal duodenum, pancreas, kidneys, ureters, ascending and descending colon, abdominal aorta, IVC, renal and splenic vessels

Question 4

Abdominal peritoneal organs

Answer 4

Liver, spleen, stomach, small bowel minus the proximal duodenum, sigmoid and transverse colon

Question 5

Cullen’s sign indicates what type of bleed

Answer 5

Intraperitoneal

Question 6

Grey Turners sign indicates what type of bleed?

Answer 6

Retroperitoneal

Question 7

Kehr’s sign

Answer 7

Left should or neck pain due to splenic rupture, due to diaphragm irritation

Question 8

Criteria for positive diagnostic peritoneal lavage

Answer 8

> 10 ml of blood on initial aspiration, > 100,000 RBCs, > 500 WBCs, Gram stain with bacteria or vegetable matter, amylase > 20 IU/L, presence of bile. Positive DPL means to OR for ex lap

Question 9

What abdominal organ is most frequently injured by penetrating trauma?

Answer 9

Liver

Question 10

Blood supply to liver

Answer 10

75% portal vein, 25% hepatic artery

Question 11

Management of liver injury

Answer 11

Penetrating traumas will generally require operative management. Blunt trauma might be able to be observed depending on extent.

Question 12

Pringle maneuver

Answer 12

Occlusion of portal triad during liver surgery. Max time is 20 min. If still bleeding despite this, consider possible injury to retro hepatic IVC

Question 13

Best test to assess splenic injury

Answer 13

CT scan

Question 14

How to determine viability of bowel in the OR.

Answer 14

Inject fluorescin dye IV. Use Woods lamp to inspect the bowel. Non viable bowel will appear patchy or no fluorescence.

Question 15

Duodenal hematoma

Answer 15

From MVC. Also associated with child abuse. Presents with signs of SBO, need CT/ upper GI series to dx. Tx is non operative and includes NGT decompression, TPN, and re evaluate with upper GI series in one week.

Question 16

Rectal injury features

Answer 16

Majority are caused by gun shot wound. 1/3 have associated bladder injury. Treatment is colostomy, which can be closed in 3-4 months.

Question 17

Wirsung duct

Answer 17

Main duct of pancreas. Traverses length of gland and joins common bile duct.

Question 18

Santorini duct

Answer 18

Accessory duct of pancreas. Branch from the main duct that has its own entry to the CBD

Question 19

How much pancreas can be resected without causing endocrine or exocrine dysfunction?

Answer 19

80%

Question 20

Four zones of retroperitoneum vascular structures

Answer 20

Zone 1: middle- aorta, proximal SMA, proximal renal artery, SMV, IVC. zone 2: upper lateral- renal artery and vein.
Zone 3: pelvic- iliac arteries and veins
Zone 4: portal-retrohepatic- portal vein, hepatic artery, IVC

Question 21

Outcomes of abdominal vascular injury

Answer 21

High mortality. Can have vasculoenteric fistula complication

Question 22

What test should be performed on a patient with suspected urethral disruption BEFORE foley placement?

Answer 22

Retrograde urethrogram (KUB)

Question 23

What is a renal fracture?

Answer 23

Shattered kidney. Complete separation of renal parenchyma from collecting system, usually causing uncontrolled hemorrhage and requiring surgery.

Question 24

What is the narrowest part of the CHILD’s airway?

Answer 24

Below the vocal cord, at the level of the cricoid. Therefore ETT size is based on the size of the cricoid ring rather than the glottic opening

Question 25

Equation for ETT size for children

Answer 25

ETT size = (age + 16) / 4

Question 26

What’s a trick for remembering what the systolic BP should be for a child?

Answer 26

Systolic BP = 80 + 2* age in years

Question 27

Pediatric GCS

Answer 27

Insert table here

Question 28

What is adequate urine output for an infant? For a child? For an adolescent?

Answer 28

Infant 2 cc/kg/hr
Child 1.5 cc/kg/hr
Adolescent 1 cc/kg/hr