GI & GU Injuries

Question 1

Organs commonly found in RUQ

Answer 1

Liver
Gallbladder
Duodenum
Small portion of pancreas

Question 2

Organs commonly found in LUQ

Answer 2

Stomach
Spleen
Pancreas

Question 3

Organs commonly found in RLQ

Answer 3

Portions of small and large intestines
Transverse colon
Appendix

Question 4

Organs commonly found in LLQ

Answer 4

Large intestines
Small intestines
Descending colon
Left half of transverse colon

Question 5

Hollow organs

Answer 5

Stomach
Gallbladder
Intestines
Ureters
Urinary bladder

Question 6

Solid organs

Answer 6

Liver
Spleen
Pancreas
Kidneys

Question 7

Pneumoperitoneum

Answer 7

Air in the peritoneal cavity. May occur as a result of ruptured hollow organ, perforated peptic ulcer, recent abd sx, or ruptured abscess.

Question 8

Compression injuried

Answer 8

Deform hollow organs, increasing the pressure within the abd cavity. Can cause rupture of small intestine or diaphragm due to dramatic change in pressure.
Ex : typically poorly placed lap belt or run over/rolled over by vehicles or objects

Question 9

Which organs are at the highest risk of injury with crush injuries?

Answer 9

Solid organs - kidneys, liver, spleen

Question 10

Crush injuries

Answer 10

Result of external factors at the time of impact

Question 11

Deceleration injuries

Answer 11

When a person or vehicle strikes a large immovable mass. Injuries can occur before impact.

Question 12

Kehr sign

Answer 12

Left shoulder pain caused by blood in the peritoneal cavity due to rupture of the spleen

Question 13

Signs and symptoms of closed abd injuries

Answer 13

Pain
Tachycardia
Tachypnea
Hypotension
Shallow respirations
Distention
Bruises
Crepitus in lower ribs
Guarding
Firmness of palpation

Question 14

Pain that follows the angle from the lateral part of the hip to the midline of the groin can be result of damage to :

Answer 14

Kidneys or ureters

Question 15

Pain primarily located in RLQ indicates

Answer 15

Inflamed or ruptured appendix

Question 16

Pain from ___ due to direct injury or inflammation can be found just under the margin of the ribs on the right side or between the shoulder blades.

Answer 16

gallbladder

Question 17

Grey Turnery sign

Answer 17

bruises in RUQ, LUQ, or flank and suggest injury to liver, spleen, or kidney.

Question 18

Cullen sign

Answer 18

Bruising around umbilicus. Sign of significant internal abdominal bleeding.

Question 19

Correct position of seat belt

Answer 19

Below the anterior superior iliac spines of the pelvis and against the hip joints

Question 20

Gunshot wounds most commonly involve injury to

Answer 20

small bowel, colon, liver, and vascular structures

Question 21

Stab wounds most frequently injure

Answer 21

Liver, small bower, diaphragm, and colon

Question 22

Suspect kidney damage if the patient has a hx or physical evidence of :

Answer 22

Abrasion, laceration, contusion, or hematoma to flank region.
Penetrating wound below rib cage and above the hip or upper abdomen.
Fx on either side of lower rib cage or lower thoracic or upper lumbar vertebrae

Question 23

Suspect liver puncture when :

Answer 23

Lower right ribs are fractured, especially 7th-9th

Question 24

Suspect spleen laceration when :

Answer 24

Fx of 9th-10th ribs on left side are present or reports of LUQ tenderness, hypotension, tachycardia.

Question 25

Symptoms of pancreatic injuries

Answer 25

Vague upper and midabdominal pain that can radiate to the back.

Question 26

Due to delayed presentation and variable symptoms, maintain a high suspicion for duodenal injury in :

Answer 26

High-speed deceleration crashes Child thrown from bicycle Child strikes abd on handlebars

Question 27

s/s of stomach rupture

Answer 27

Burning epigastric pain Rigidity Rebound tenderness

Question 28

s/s of duodenal injury

Answer 28

Abdominal pain N/V Fever All may not develop for hours to days

Question 29

Bladder injuries are usually associated with :

Answer 29

pelvic fx from MVC, falls from heights, and physical assault to lower abd.

Question 30

Testicular injuries present following trauma to :

Answer 30

thighs, buttocks, penis, lower abd, and pelvic.

Question 31

Vascular structures found in the retroperitoneal space include :

Answer 31

Descending aorta and its branches Superior inferior phrenic arteries Inferior vena cava Mesenteric vessels

Question 32

Signs of bleeding in abdomen

Answer 32

Abdomen rigidity Cullen sign Signs of shock

Question 33

Clues to intra-abdominal trauma include

Answer 33

sxs of shock not proportional to obvious external evidence or estimated blood loos

Question 34

Hypotension, tachycardia, and confusion may not develop until the patient has lost more than ____.

Answer 34

40% of circulating blood volume

Question 35

Somatic pain

Answer 35

Pain from skin and muscles, joint ligaments, and tendons. Described as sharp and localized are of injury. Pain usually respond well to medications such as opioids and NSAIDS

Question 36

Visceral pain

Answer 36

Pain from organs inside the body w/ injury or illness. Often described as a deep ache w/ cramping. Can radiate to other locations such as back and chest.

Question 37

Three main areas where visceral pain is felt :

Answer 37

Thorax Abdomen Pelvis

Question 38

Management of closed/blunt abdominal injuries

Answer 38

``` Spinal immobilization Supplemental oxygen via NRB or positive pressure ventilation via BVM if needed Establish IV Treat for shock Keep warm Prompt transport to ED ```

Question 39

General procedure for care of blunt abd wound :

Answer 39

Inspect pt's back and sides for exit wounds Apply a dry, sterile dressing to all open wounds If penetrating object is still in place, apply bulking dressings and secure w/ stabilizing bandage. Establish two 18-gauge IV lines and administer isotonic crystalloid solutions to maintain systolic BP of 80-90 mmHG.

Question 40

General rules for treatment of injuries involving external male genitalia :

Answer 40

Make pt as comfortable as possible. Use sterile, moist compresses to cover areas that have been stripped of skin. Apply direct pressure with dry, sterile gauze dressings to control bleeding. Always identify and take avulsed part to hospital. Label bag w/ pt's name

Question 41

Management of female genitalia injuries

Answer 41

Treat any lacerations, abrasion, and avulsion w/ moist, sterile compresses. Local pressure to control bleeding and diaper-type bandage to hold dressing in place. Leave any FB in place and stabilize w/ bandages.