Abdominal Trauma Flashcards
(132 cards)
1
Q
What is the Latin origin of the word ‘Abdomen’?
A
Derived from the Latin word ‘abdere’, meaning ‘to hide’
Often referred to as ‘the black box’.
2
Q
What is the leading cause of death in young people?
A
Trauma
3
Q
What percentage of all major trauma victims require abdominal exploration?
A
25%
4
Q
What is often a challenging component of evaluating trauma?
A
Abdominal evaluation
5
Q
What type of injuries are a potential intra-abdominal injury?
A
Penetrating torso injuries between nipple & perineum
6
Q
What factors determine the priority and best method of assessment in trauma?
A
Mechanism, Force, Location of injury, Hemodynamic status
7
Q
What percentage of all blunt trauma to the abdomen involves road traffic accidents?
A
75%
8
Q
What is the age demographic with the highest incidence of abdominal injury?
A
Males aged 14-30
9
Q
What are the anatomical divisions of the abdomen?
A
Anterior abdomen, Flank, Back
10
Q
What organs are located in the upper peritoneal cavity?
A
- Diaphragm
- Liver
- Spleen
- Stomach
- Transverse colon
11
Q
What structures are found in the retroperitoneal space?
A
- Abdominal Aorta
- Inferior vena cava
- Parts of Duodenum
- Pancreas
- Kidneys
- Ureters
12
Q
What contents are found in the pelvic cavity?
A
- Rectum
- Bladder
- Iliac vessels
- Internal genitalia in women
13
Q
What is the definition of the abdomen?
A
Everything between diaphragm and pelvis
14
Q
How is the abdomen divided for assessment?
A
Into four quadrants by body mid-line and horizontal plane through umbilicus
15
Q
What solid organs are located in the right upper quadrant?
A
- Liver
- Gallbladder
- Stomach (small part)
- Head of Pancreas
- Upper part of Kidney
16
Q
What are the characteristics of solid organs when injured?
A
Bleed heavily and cause shock
17
Q
What is the consequence of hollow organ rupture?
A
Causes spillage, inflammation of peritoneum
18
Q
What can cause severe blood loss in abdominal injuries?
A
Injury to major vascular structures like Aorta and Inferior vena cava
19
Q
What is the most commonly affected organ in penetrating trauma?
A
Liver
20
Q
What are the three peaks of trauma deaths?
A
- 1st Peak: 50% die instantly or very soon
- 2nd Peak: 30% within hours due to severe blood loss
- 3rd Peak: Days to weeks due to infection/multiorgan failure
21
Q
What are the types of penetrating trauma mechanisms?
A
- Energy transmitted to surrounding tissue
- Projectile cavitation and yaw
22
Q
What factors determine the degree of injury from gunshot wounds?
A
- Amount of kinetic energy imparted by the bullet
- Mass of the bullet and the square of its velocity
23
Q
What is the most common cause of blunt abdominal trauma?
A
Motor vehicle accidents (MVA), accounting for 50-75% of cases
24
Q
What is the ‘seat belt sign’ indicative of?
A
Highly correlated with intraperitoneal injury
25
What can cause injuries to hollow organs?
* Rupture from compression due to blunt forces
* Tear due to penetrating trauma
26
What are manifestations of blood loss?
* Hematochezia: blood in stool
* Hematemesis: blood in emesis
* Hematuria: blood in urine
27
What is a common complication of leakage from hollow organs?
Sepsis due to bacteria leakage
28
What may be present in penetrating trauma, despite minimal external appearance?
Internal trauma may be significant
29
What can cause evisceration in trauma cases?
Penetrating trauma to the abdominal wall
30
What is a common symptom of a ruptured spleen?
Pain referred to the left shoulder
## Footnote
This is due to irritation of the diaphragm
31
What type of pain is associated with a pancreatic injury?
Pain radiates to the back
32
How does kidney injury present in terms of pain?
Pain radiates from flank to groin and hematuria
33
What is the referred pain location for liver injuries?
Pain referred to the right shoulder
34
What vascular structures are prone to injury during abdominal trauma?
Abdominal aorta and vena cava
35
What can happen to blood beneath the diaphragm during abdominal injury?
Blood accumulates and irritates muscular structures
36
What physiological response occurs due to blood presence in the abdomen?
Stimulates vagus nerve resulting in slowing of heart rate
37
What is the consequence of injury to the mesentery and bowel?
Leads to ischemia, necrosis, or rupture
38
What may happen if the mesentery tears?
May rupture bowel
39
What causes peritonitis?
Inflammation of the peritoneum due to bacterial or chemical irritation
40
What is a sign of peritoneal irritation?
Rebound tenderness
41
What is the risk associated with pelvic injuries?
Life-threatening hemorrhage and potential injury to pelvic organs
42
What is the leading cause of maternal mortality related to trauma during pregnancy?
Auto collisions
43
What changes occur to the uterus during pregnancy that affect trauma outcomes?
Increasing size and weight compresses inferior vena cava
44
At what stage of gestation is the risk of uterine and fetal injury greatest?
Greatest risk during the 3rd trimester
45
What is a common complication from blunt trauma during pregnancy?
Uterine rupture
46
Why are pediatric patients at higher risk for abdominal injuries?
Poorly developed abdominal musculature and more cartilaginous rib cage
47
What is the primary goal of the clinical assessment in abdominal injury?
To identify that an injury exists
48
What is Kehr's Sign?
Referred pain to the left shoulder due to splenic injury
49
What is the significance of the mechanism of injury in assessing abdominal trauma?
Important for developing a high index of suspicion
50
What does the physical examination of the abdomen assess for?
Tenderness, guarding, rigidity, rebound tenderness
51
What findings are associated with retroperitoneal hematoma?
Cullen sign and Grey Turner sign
52
What is the first step in emergency care for abdominal trauma?
Control external bleeding
53
What is the purpose of fluid resuscitation in abdominal trauma?
To treat hypovolemia and stabilize blood pressure
54
What does AMPLE stand for in secondary survey?
* Allergy
* Medications
* Past surgery
* Last meal
* Event
55
What is the role of bedside ultrasound in trauma management?
To detect free intraperitoneal blood after blunt trauma
56
What is the focus of FAST in trauma assessment?
To identify if the abdomen is the source of hemorrhage
57
What is the purpose of using an ultrasound (FAST) in trauma patients?
To identify if the abdomen is the source of hemorrhage in unstable trauma patients
## Footnote
Primarily looking for fluid in specific locations such as Morison’s pouch, pelvis, and pericardial area.
58
What are the four main locations where fluid is checked during ultrasound in trauma?
* Morison’s pouch (subhepatic)
* Splenorenal recess
* Pelvis (pouch of Douglas)
* Pericardial
## Footnote
Additional areas include subphrenic and paracolic gutter.
59
What does E-FAST examination include?
Views of bilateral hemithoraces and bilateral upper anterior chest walls
## Footnote
To assess for hemothorax and pneumothorax.
60
What is the reliability range for accuracy in ultrasound (FAST)?
86 - 97%
## Footnote
Sensitivity is 88 - 91.7% and specificity is 94.7 - 99%.
61
What are the advantages of using ultrasound in trauma assessment?
* Noninvasive
* Portable
* Speed
* Does not require radiation or contrast
* Useful in resuscitation room or ER
* Can be repeated
* Technique is easy to learn
* Low cost
## Footnote
These advantages make it a preferred choice in emergency situations.
62
What are some disadvantages of using ultrasound for trauma assessment?
* Examiner dependent
* Non-cooperative patients
* Obesity
* Bowel gas
* Subcutaneous air
* Injury to solid parenchyma not well seen
* Insensitive for detecting bowel injury
* Blood cannot be distinguished from ascites
## Footnote
These factors can interfere with image quality.
63
What is considered the 'gold standard' for intra-abdominal diagnosis of injury?
Computerized tomography (CT)
## Footnote
It is sensitive for blood and can diagnose retroperitoneal injury.
64
What are the indications for abdominal CT?
* Hemodynamic stability
* Normal or unreliable physical exam
* Mechanism: Duodenal and pancreatic trauma
## Footnote
These criteria help determine the necessity of a CT scan.
65
What are the contraindications for abdominal CT?
* Clear indication for exploratory laparotomy
* Hemodynamic instability
* Agitation
* Allergy to contrast media
## Footnote
These factors may prevent the safe use of CT.
66
What are the advantages of abdominal CT?
* Adequate assessment of the retroperitoneum
* Better defines organ injury
* Nonoperative management of solid organ injuries
* Noninvasive
* Detects presence, source, and amount of hemoperitoneum
* Active bleeding often detectable
## Footnote
These advantages make CT a valuable tool in trauma assessment.
67
What are the disadvantages of abdominal CT?
* Suboptimal sensitivity for pancreatic, diaphragmatic, bowel, and mesentery injury
* IV contrast needed
* Relatively high cost
* Can be unobtainable or harmful in unstable patients
* Radiation exposure
## Footnote
These limitations must be considered when opting for CT.
68
What is diagnostic peritoneal lavage (DPL) used for?
To assess unexplained shock or hypotension, altered sensorium, or when general anesthesia is needed for extra-abdominal procedures
## Footnote
It helps in identifying intra-abdominal injuries.
69
What are the positive criteria for diagnostic peritoneal lavage?
* Lavage fluid appears in chest or bladder catheter
* Gross blood
* RBC count >100,000/μl (in penetrating >50,000)
* WBC >500
* Amylase >175
* Obvious feces or bile
## Footnote
These criteria indicate significant intra-abdominal injury.
70
What are some complications of peritoneal lavage?
* Installation of fluid to extra peritoneal tissue
* Bowel perforations
* Trauma to iliac vessels
* Bladder perforations
## Footnote
These complications highlight the risks associated with DPL.
71
What are the most commonly injured organs in the abdomen?
* Liver
* Spleen
* Pancreas
* Kidneys
* Ovaries
## Footnote
These organs are frequently affected in abdominal trauma.
72
What is the management approach for hemodynamically stable patients after initial resuscitation?
* Continue monitoring for 48 hours
* Surgical team immediately available
* Adequate ICU support and transfusion services available
* Admission for observation, serial hematocrit measurement, and repeat imaging
## Footnote
This protocol ensures safety and timely intervention if needed.
73
What are the indications for non-operative management of blunt abdominal injury?
* Abdominal distention with hypotension
* Gross blood from stomach or rectum
* Positive diagnostic test for an injury requiring operative repair
* Peritonitis
* Pneumoperitonium or Pneumoretroperitonium
* Evidence of diaphragmatic defect
## Footnote
These criteria guide the decision for non-operative management.
74
What is the classification of abdominal organs based on injury type?
* Solid: Liver, Spleen, Pancreas, Kidneys, Ovaries
* Hollow: Stomach, Small intestine, Large intestine, Gall bladder, Urinary bladder, Uterus
## Footnote
Solid organs bleed heavily, while hollow organ rupture causes spillage and inflammation.
75
What is the management for liver injury in stable patients?
* CT is the investigation of choice
* Non-operative management is preferred
* Surgery required only in specific cases
## Footnote
These cases include hemodynamic instability or failure of non-operative management.
76
What are the common causes of splenic injury?
* Motor vehicle crashes
* Falls or sports injuries impacting lower left chest or upper left abdomen
## Footnote
Kehr’s Sign refers to referred pain from splenic injury.
77
What should be monitored following a splenectomy?
* Check CBC
* Consider vaccination
* Watch for complications such as portal vein thrombosis and OPSI syndrome
## Footnote
These measures help prevent post-splenectomy complications.
78
Which organs are commonly injured by penetrating trauma?
* Stomach
* Duodenum
* Colon
* Small intestine
## Footnote
These organs are at high risk during penetrating injuries.
79
What is a common diagnostic tool for diaphragmatic injuries?
CT scan
## Footnote
It is the best method for diagnosing injuries in the diaphragm.
80
What cushions the organs in the abdominal cavity?
Layer of adipose tissue
81
Which structure partially protects the abdominal organs?
Lower rib cage
82
What may result from injuries to the abdominal organs?
Fracture and laceration, resulting in hemorrhage, extravasation, or both
83
How do contusions usually heal?
Self-limiting: Heal with bed rest and forced fluids
84
What may be required for fractures and lacerations?
Surgical repair
85
What are the ureters classified as?
Hollow organs
86
How often are ureters injured in blunt trauma?
Rarely injured due to their flexible structure
87
What causes injury to the ureters?
Penetrating abdominal or flank wounds (e.g., stab wounds, firearm injuries)
88
What type of organ is the pancreas?
Solid organ in retroperitoneal space
89
What usually causes blunt injury to the pancreas?
Crushing injury between spine and a steering wheel, handlebar, or blunt weapon
90
What is the most common cause of pancreatic injuries?
Penetrating trauma
91
Where does the duodenum lie?
Across lumbar spine
92
Why is the duodenum seldom injured?
Due to its location in the retroperitoneal area
93
What are the mechanisms of pelvic organ injury?
Blunt or penetrating trauma, pelvic fracture
94
What increases the likelihood of bladder rupture?
Bladder being distended at the time of injury
95
In which patients should bladder injury be suspected?
Inebriated patients subjected to lower abdominal trauma
96
What type of injury is extremely rare in the rectum?
Blunt injury
97
What may intraabdominal arterial and venous injuries lead to?
Life threatening conditions
98
What is the 'deadly triad' in damage control surgery?
Hypothermia, acidosis, coagulopathy
99
What are the two goals of damage control surgery?
* Stopping any active surgical bleeding
* Controlling any contamination
100
What are the stages of damage control surgery?
* Stage I: Control of hemorrhage and contamination
* Stage II: Resuscitation in intensive care unit
* Stage III: Definitive surgery
* Stage IV: Abdominal closure
101
What should be done for unstable patients with intra-abdominal bleeding?
Warm operating theater and rapid admission to OR
102
What is the purpose of the 'sandwich technique' in temporary abdominal closure?
To restore body temperature and optimize oxygen delivery
103
What is the definition of abdominal compartment syndrome (ACS)?
Sustained IAP ≥20 mmHg associated with new organ dysfunction/failure
104
What are causes of increased intra-abdominal pressure?
* Tissue edema
* Trauma
* Paralytic ileus
* Tense ascites
105
What is the effect of raised intra-abdominal pressure on renal function?
Increase in renal vascular resistance, leading to reduction in glomerular filtration rate
106
What is the most common method for measuring intra-abdominal pressure?
Using a urinary catheter
107
What should be avoided to maintain optimal organ function under increased IAP?
Excessive fluid resuscitation
108
What technique is used to achieve temporary abdominal closure?
Opsite® sandwich technique
109
What is the definition of hypertonic fluids?
Fluids that have a higher osmolarity than blood plasma
## Footnote
Hypertonic fluids can be used to treat certain medical conditions by drawing water out of cells.
110
What is the purpose of hemodialysis/ultrafiltration?
To remove waste products and excess fluid from the blood
## Footnote
This is often used in patients with kidney failure.
111
What is the target mean arterial pressure (MAP) to maintain with vasopressors?
60 mmHg
## Footnote
Maintaining MAP is crucial for organ perfusion.
112
What is the simplest technique for temporary abdominal closure (TAC)?
Opsite® sandwich technique
## Footnote
This technique is used during surgical management of intra-abdominal pressure.
113
What is the common infection type associated with an open abdomen?
Polymicrobial infection
## Footnote
Prophylactic antibiotics are often required to prevent infection.
114
In children, how are most splenic injuries managed?
Non-operatively
## Footnote
Non-operative management is often preferred to avoid unnecessary surgery.
115
What type of injuries are associated with pancreatic damage?
Duodenal injuries
## Footnote
These injuries require careful assessment and management.
116
How are small bowel injuries typically managed in damage control surgery?
Resected and stapled off
## Footnote
This approach minimizes further complications.
117
What is the common management for rectal injuries?
Initial management with a defunctioning colostomy
## Footnote
This approach helps to divert fecal matter and reduce contamination.
118
What are the three killers in severely traumatized patients?
Hypothermia, coagulopathy, and acidosis
## Footnote
Aggressive prevention of these conditions is key in trauma care.
119
What is the mortality rate associated with thoracic injuries?
25% of trauma-related mortality rate
## Footnote
Thoracic injuries can be life-threatening and require prompt assessment.
120
What is the first step in assessing a patient with suspected thoracic injury?
Inspect the chest for bruising, deformity, and motion during respiration
## Footnote
This physical examination can provide critical information.
121
What is the treatment for open pneumothorax?
Apply a bandage taped on 3 sides to allow air escape
## Footnote
This prevents air from being sucked back into the chest.
122
What occurs in tension pneumothorax?
Air enters the pleural space but does not escape
## Footnote
This can lead to severe respiratory distress and cardiovascular instability.
123
What are the classic signs of tension pneumothorax?
Chest pain, respiratory distress, shock, decreased breath sounds, jugular venous distension, cyanosis, tracheal deviation
## Footnote
These signs are critical for diagnosis.
124
What defines a flail chest?
Three or more consecutive ribs fractured at two sites
## Footnote
This condition leads to paradoxical movement of the chest wall.
125
What is a common treatment for flail chest?
Maximizing oxygenation and effective pain control
## Footnote
Treatment may include positive pressure ventilation and judicious fluid management.
126
What characterizes a massive hemothorax?
1500 mL of blood in the chest cavity
## Footnote
This typically results from disruption of major blood vessels.
127
What is the treatment for massive hemothorax?
Evacuation of blood with a large-bore chest tube
## Footnote
This may be followed by fluid and blood replacement.
128
What is cardiac tamponade?
Increased blood in the pericardium compressing the heart
## Footnote
This condition can lead to pump failure and requires urgent intervention.
129
What are the clinical signs of cardiac tamponade?
Shock refractory to fluids, jugular venous distension, muffled heart sounds
## Footnote
These signs indicate significant compromise to cardiac function.
130
What is the initial treatment for cardiac tamponade?
Immediate pericardiocentesis or pericardial window
## Footnote
This can relieve pressure on the heart and improve hemodynamics.
131
What should be done for any patient without a pulse after CPR?
Assess with defibrillator paddles or a cardiac monitor
## Footnote
This is crucial for detecting and treating unstable arrhythmias.
132
What constitutes an indication for a resuscitative thoracotomy?
Witnessed loss of vital signs associated with penetrating thoracic injury
## Footnote
This allows for direct intervention on intrathoracic bleeding.
