Module 7 : Trauma

Question 1

what is the clinical presentation of patients with trauma

Answer 1

• dependent on severity, area, time line
• hemodynamically unstable (shock)
• pain and tenderness over area
• rigid abdomen

Question 2

what is a correlating lab test

Answer 2

• hematocrit

Question 3

what is hematocrit

Answer 3

• volume of red blood cells in whole blood sample

- loss of blood causes a low hematocrit

Question 4

what is the primary modality to see bleeds

Answer 4

CT

Question 5

how does timing affect US look of hemorrhage or hematoma

Answer 5

• acute = echogenic (debris)
• within 1st week = decreased in echogenicity
• 2-3 weeks post trauma = less defined

Question 6

what is the treatment for trauma

Answer 6

• hepatic, renal, splenic trauma managed conservatively in hemodynamically stable patients
• ureteric trauma = nephrostomy stents
• surgical repair
• paracentisis

Question 7

is the liver susceptible to hemorrhage what lobe most affected

Answer 7

• yes

- right posterior segment

Question 8

how is liver trauma treated

Answer 8

• conservatively is not in shock

Question 9

what are 5 findings of liver trauma

Answer 9

• perivascular laceration
• sub capsular and pericapsular bleed
• isolated hematoma
• liver fracture
• hemoperitoneum

Question 10

what is the most common cause of spleen trauma

Answer 10

• MVA or rib trauma

Question 11

which organ is most commonly affected by trauma

Answer 11

• spleen

Question 12

what does the shape of the fluid collection around the spleen tell you

Answer 12

• crescent shape = sub capsular
• irregular = perisplenic
• check flanks and morissons pouch

Question 13

what is the most common cause of biliary tree and pancreas trauma

Answer 13

• percutaneous procedures and liver biopsies

Question 14

what 5 things usually result form biliary or panc trauma

Answer 14

• hemobilia
• jaundice
• pneumobilia
• biloma
• pseudocysts

Question 15

what can kidney trauma be caused by

Answer 15

• blunt or penetrating injury

Question 16

what might be involved in kidney trauma

Answer 16

• parenchyma or extend into collecting system

Question 17

what are the 2 types of kidney hematoma

Answer 17

• subcapsular

- intrarenal

Question 18

what are kidney lacerations

Answer 18

• linear defects

Question 19

what are perirenal collections

Answer 19

• urinomas

- hematomas

Question 20

what is 70% of bladder trauma associated with

Answer 20

• pelvic fracture
• rupture
• look for large fluid collections

Question 21

is spontaneous hemorrhage of adrenal common or uncommon

Answer 21

• not common

Question 22

what three things could cause spontaneous hemorrhage of adrenal

Answer 22

• anticoagulation
• stress
• blood abnormalities

Question 23

characteristics of post traumatic hemorrhage of adrenal gland

Answer 23

• predominantly in medulla
• right more than left
• bright ehcogenic mass more anechoic and smaller over time

Question 24

what does bilateral trauma of adrenal gland put you at risk for

Answer 24

• adrenal insufficiency

Question 25

what is the most common cause of adrenal mass in neonates

Answer 25

- adrenal hemorrhage

Question 26

characteristics of adrenal hemorrhage in infants

Answer 26

- traumatic delivery - bilateral - decreased hematocrit increased bilirubin - jaundice

Question 27

where is hematoma localized to in GI tract

Answer 27

- submucosa

Question 28

where does free fluid collect in peritoneum in supine

Answer 28

- pelvis - paracolic gutters - free fluid conforms to surrounding organs

Question 29

what are the two types of free fluid in peritoneum

Answer 29

- transudative and exudative

Question 30

what is a FAST scan

Answer 30

- focused assessment with sonography - screening for intra abdominal injuries - free fluid detection suggests significant injury, patient goes for laparotomy

Question 31

what are 4 traumatic injuries to the retroperitoneum

Answer 31

- hematomas = psoas muscle, perinephric space - abscesses = perinephric - urinomas = interventional procedures, hypo echoic collection - lymphocytes = post surgery, anechoic

Question 32

why do hernias occur

Answer 32

- weakening in the abdominal wall muscles | - viscera protrudes through

Question 33

what are the two types of hernias

Answer 33

congenital | - aquired

Question 34

what are the 2 acquired hernias

Answer 34

- gastroschisis | - omphalocele

Question 35

what are the risk factors for getting an acquired hernias

Answer 35

- elderly - excessive weight gain or loss - surgery - pregnancy - heavy lifting - chronic constipation - sudden twists - pulls or muscle strains

Question 36

what are the signs and symptoms of hernias

Answer 36

- asymptomatic - palpable mass or buldge - pain or burning - heaviness around scrotum

Question 37

what is a reducible hernia

Answer 37

can be pushed back into place

Question 38

what is an incarcerated hernia

Answer 38

- irreducible | - trapped

Question 39

what is a strangulated hernia

Answer 39

- blood supply cut off/tisssue swells | - medical emergency

Question 40

what are 8 locations of hernia

Answer 40

- umbilical - epigastric - inguinal - spigelian - lumbar - ventral - femoral - incisional

Question 41

where do epigastric hernias occur

Answer 41

- widest part of the lineament alba

Question 42

what is the most common location of hernias

Answer 42

- inguinal | - if unilateral on the right

Question 43

what are the 2 types of inguinal hernias

Answer 43

- direct | - indirect

Question 44

what is a direct inguinal hernia

Answer 44

- acquired - older men - due to weakened canal floor - medial to inferior epigastric artery

Question 45

what is an indirect inguinal hernia

Answer 45

- congenital - most common - exits via deep inguinal ring - passes through length of canal

Question 46

what is a spigelian hernia

Answer 46

- spontaneous lateral abdominal wall

Question 47

is a lumbar hernia common or uncommon

Answer 47

- uncommon

Question 48

what is a femoral hernia

Answer 48

- groin pain | - mass medial to femoral vein

Question 49

what are the 3 surgical interventions for hernia s

Answer 49

- herniorrhapy = large incision muscle sewn over defects - hernioplasty = incision , prosthetic mesh inserted - laparoscopic - small incision

Question 50

what are 5 causes of rectus sheath hematoma

Answer 50

- trauma - surgery - vigorous abdominal contractions - intense straining g - spontaneous