hollow viscus injury Flashcards
(23 cards)
management of uncomplicated extraperitoneal bladder injury
foley catheter placement
management of complicated extraperitoneal bladder injury (bladder + gynecologic trauma)
two layer closure of bladder and of vaginal injury
management of duodenal hematoma:
initial nonoperative, NGT decompression, TPN if needed; reevaluate for gastric outlet obstruction at 5-7 days with contrast study
what circumference of involvement in the intestinal wall mandates resection instead of primary repair?
over 50% circumference
which incision provides access to both proximal mainstem bronchi and the trachea?
right anterolateral thoracotomy
what incision best exposes proximal tracheal injury
collar incision
what incision provides access to the distal left mainstem bronchi
left anterolateral thoracotomy
what is the best incision to access the proximal thoracic esophagus?
right posterolateral thoracotomy
gastric perforation may occur after splenectomy due to ligation of which vessels?
short gastrics
management of complex extraperitoneal bladder injuries (involving vagina or rectum, shards of bone, etc):
managed operatively with 2 layer closure of bladder and vaginal injuries with tissue interposition if possible to prevent fistula
first step for blood at the urethral meatus + a pelvic fx:
can attempt foley once, then retrograde urethrogram
what exposure provides access to the distal intrathoracic trachea, proximal bilateral mainstem bronchi, and proximal thoracic esophagus?
right posterolateral thoracotomy
preferred tx of penetrating urethral injury:
primary repair over foley to prevent long term stricture
next step for a posterior urethral injury in which a foley cannot be passed
suprapubic tube
diagnostic imaging modality that will detect a missed ureteral injury:
delayed contrast CT - will show extravasation of contrast from injured ureter
what constitutes a positive DPL:
> 100,000 RBC/mL or >500 WBC/mL
true or false. limited mobilization of the ureter is recommended during dissection to preserve blood supply which is segmental
true
management of ureteral injuries at the uretero-pelvic junction or upper ureter:
reanastomosis
management of mid ureteral injuries:
reanastomosis of short defects; vesico psoas hitch, Boari flap, or transuretero-ureterostomy for long defects
diagnosis of suspected bladder rupture in trauma
CT cystography
how to repair tracheal injury
absorbable suture with strap muscle buttress
management of distal ureteral injuries (in pelvis)
reimplantation into bladder
Use of _____ in patients with an open abdomen is associated with an increased rate of primary fascial closure.
3% hypertonic saline
