Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery M4 part 1 > Solid Organ Trauma > Flashcards

Solid Organ Trauma Flashcards

1
Q

What are the neck zones?

A

Zone 1: from the clavicle to cricoid cartilage
Zone 2: from cricoid cartilage to the
angle of mandible
Zone 3: above the angle of mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the indications for neck exploration?

A 
1-expanding hematoma 
2- uncontrolled external hemorrhage 
3- decreased carotid pulse at C6
4- stridor, hoarseness, dysphonia, hemoptysis
5- severe dysphagia, odynophagia
6- blood in oropharynx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General clinical features of penetrating injuries

A

1- Features of shock: pallor, tachycardia, hypotension, cold periphery, sweating, oliguria
2- abdominal distention
3- pain, tenderness, guarding and rigidity, dullness in flank on percussion
4- respiratory distress, cyanosis depending on amount of blood loss
5- bruising over skin of abdominal wall
6- Features of specific individual organ injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of ultrasound is used to identify blood in abdomen?

A

FAST can identify more blood more than 100ml
It is not reliable for bowel or penetrating injuries
It needs to be repeated frequently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the procedure of choice for a physiologically unstable blunt abdominal injury patient ?

A

Diagnostic peritoneal lavage (DPL)

  • subumbilical lavage catheter
  • infuse one liter of normal saline/ ringer’s lactate into peritoneal cavity
  • change positions of patient and move from side to side
  • aspirate fluid content to assess the content
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we conclude that the patient should undergo exploratory surgery after a DPL?

A
  • 10ml or more of gross blood
  • more than 100 000/cu mm of RBC
  • more than 500/cu mm of WBC
  • more than 175 IU/dl of amylase
  • presence of bile, bacteria, food particles, foreign bodies

+ DPL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the contraindications for DPL?

A

1- history of previous surgery (adhesions)
2- when laparotomy is indicated definitely
3- pregnancy
4- obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the procedure of choice in stable trauma patients?

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When do we use diagnostic laparoscopy (DL)?

A

In stable patients to verify the diagnosis and make sure nothing is wrong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for emergency laparotomy?

A
  • frank haemoperitoneum
  • significant diagnostic peritoneal lavage
  • haemodynamically unstable patients
  • US or CT scan shows significant intra-abdominal injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most commonly injured organ?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is the liver the most commonly injured organ?

A
  • friable parenchyma, thin capsule, fixed position
  • right lobe is more prone to injury from the ribs
  • complaint ribs
  • transmitted force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the mechanisms of liver injury?

A
  • Compression against ribs or spine
  • ligamentous attachment to diaphragm and posterior abdominal wall will tear due to shear forces during deceleration injury
  • high-velocity bullet injuries (Burst injuries)
  • low-velocity penetrating injury
    ~ Stab wounds
    ~ percutaneous biopsy
    ~ cholangiography
    ~ biliary drainage
    ~ TIPS
    ~ capsular tears, hematoma, bile leaks, arteriobiliary fistula, hemoperitoneum, & arterial aneurysms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

> 3cm deep parenchymal laceration and subcapsular hematoma >3cm in diameter
OR
50% of surface area or expanding is which grade?

A

Grade III liver or splenic trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Grade II liver or splenic trauma diagnosis?

A

parenchymal laceration 1-3cm deep
Subscapular hematoma 1-3cm thick
OR
10 - 50% supscapular nonexpanding hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Grade I diagnosis of liver or splenic trauma?

A

Subcapsular hematoma <1cm
Superficial laceration <1cm deep
OR
< 10% subcapsular non expanding hematoma

17
Q

Grade IV hepatic or splenic trauma?

A

Parenchymal/subcapsular hematoma > 10cm in diameter
Lobar destruction
OR
ruptured intraparenchymal hematoma with active
Segmental or hilar vessels producing >25% devascularization of spleen

18
Q

Grade V hepatic or splenic injury?

A

global destruction or devascularization of liver
OR
Completely shattered or avulsed spleen
Hilar vascular injury that devascularizes entire spleen

19
Q

What incision should be done for liver trauma exploratory surgery?

A

Midline incision

20
Q

Liver injury diagnosis and management

A

CT
PUSH (direct compression) - Pringle: occluding portal triad at foramen Winslow with fingers
Plug by embolisation
Pack the liver bed

21
Q

Complications of liver trauma?

A
  • recurrent bleeding
  • hemobilia
  • perihepatic abscess
  • biliary fistula
  • intrahepatic hematoma
  • pulmonary complications
  • coagulopathy
  • hypoglycemia
22
Q

why is the spleen commonly injured?

A

because of its mobility

23
Q

mechanisms of splenic injury

A

stab wounds and gun shots
blunt trauma
LUQ abdominal surgery

24
Q

when should we salvage the spleen?

A

in children

25
Q

what are the contraindications for splenic salvage?

A
  • SHOCKED patient
  • patient with severe injury
  • patient has protracted hypotension
  • delay is anticipated in spleen repair attempt
26
Q

elective splenectomy pre operative preparations?

A
  • vaccinations

- platelets & blood transfusion

27
Q

types of splenectomy

A
  • complete
  • partial (in a patient with good general condition)
  • laparoscopic
  • open
28
Q

Post operative early complications of splenectomy (several hours)

A 
- hemorrhage 
LUNG
- atelectasis 
- pleural effusion 
- subphrenic abscess 
STOMACH 
- acute gastric dilatation (loss of all peristaltic waves)
- vomiting 
- hematemesis 
- perforation 
- fistula 
PANCREAS
- abscess 
- pancreatitis (accidental ligation of tail of pancreas) 
- fistula 
HAEMATOLOGICAL 
- increase in platelet count & WBC leading to thrombosis 
POSTSPLENECTOMY SEPTICAEMA 
- H.influenza 
- Strep pneumonia
- N. meningitides
29
Q

late complications (7-10 days) of splenectomy

A
  • overwhelming postsplenectomy infection (OPSI)
    post splenectomy sepsis syndrome
  • nonspecific flu like symptoms
30
Q

what is Cullen’s sign? in splenic injury

A

inter peritoneal hemorrhage

bluish coloration around the umbilicus

31
Q

What is Ballance sign?

A

dullness in left hypochondrium with no shifting

32
Q

What is Kehr’s sign?

A

referred pain to the left shoulder due to fluid collection below the diaphragm

Surgery M4 part 1 (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions