Trauma Flashcards
(94 cards)
1
Q
What are etiology of trauma? 4
A
- Medical procedures
- MVA (motor vehicle accident)
- Blunt/penetrating trauma
- FAlls
2
Q
What can we see with trauma? 4
A
- Tissue fractures
- Lacerations
- Capsule tears
- Sub-capsular hematoma
3
Q
Clinical presentation of trauma is dependent on what? 3
A
- Severity of trauma
- Area damaged
- TIme period
4
Q
What are some clinical presentations of trauma? 3
A
- Hemodynamically unstable
- Pain
- Rigid abdomen
5
Q
What is a hematocrit?
A
Percentage by volume of packed red blood cells in whole blood
6
Q
What causes low hematocrits?
A
Loss of blood
7
Q
What are some imaging modalities for correlating hematocrits?
A
CT is the primary screening test for bleeding
8
Q
What is a hematoma/hemorrhage?
A
Localized collection of blood
9
Q
Sonographic appearance of hematomas/ hemorrhage does what with time?
A
Vary
10
Q
What does hematomas/hemorrhages look like less than 24 hours?
A
Echogenic and acute
11
Q
What does a hematoma/hemorrhage look like within the first week?
A
Decreases in echogenicity
12
Q
What does a hematoma/ hemorrhage look like 2-3 week post trauma?
A
Less defined and can be isoechoic to organ tissue
13
Q
What is the treatment options for hepatic, renal and splenic trauma in hemodynamically stable patients?
A
Managed conservatively in hemodynamically stable patients
14
Q
What is the treatment option for ureteric trauma?
A
Nephrostomy or stents
15
Q
What is general treatment option for trauma? 2
A
- Possible surgical repair
- Paracentesis for fluid drainage
16
Q
Liver is susceptible to what with trauma?
A
Hemorrhage
17
Q
Which side of the liver is typically affected by trauma?
A
Right posterior lobe
18
Q
How is imaging used to diagnose liver trauma? 2
A
- Initial assessment with CT
- Serial U/S to monitor healing
19
Q
What are some possible findings of liver trauma? 5
A
- Perivascular laceration
- Sub capsular and peri capsular bleed
- Isolated hematoma
- Liver fracture
- Hemoperitoneum
20
Q
What is the most common trauma seen with the spleen?
A
MVA or rib trauma
21
Q
What is the modality of choice for looking at spleen trauma?
A
CT
22
Q
In terms of trauma of the spleen what does a intact capsule mean?
A
Subcapsular hematoma
23
Q
In terms of spleen trauma, what does a capsule tear mean? (what will we see and where?)
A
Hemoperitoneum LUQ
24
Q
What kind of shapes of fluid collection do we need to look at in terms of spleens? 2
A
- Crescent: Subcapsular
- Irregular: Capsule may be torn
25
If we see a irregular shape of fluid in the spleen, where should we check?
Flanks/ Morison’s pouch
26
What is the most common trauma of the biliary tree/ pancreas?
Percutaneous procedures (post liver biopsy)
27
What are some signs of biliary tree/pancreas trauma? 5
1. Hemobilia
2. Jaundice
3. Pneumobilia
4. Biloma
5. Pseudocysts
28
What causes penumobilia with biliary tree/ pancreas? 3
1. Fistulas
2. Interventional procedures
3. Emphysematous cholecystitis
29
What is the modality of choice to look at urinary tract - kidney trauma?
CT BUT U/S to follow up
30
What usually causes kidney trauma?
Blunt or penetrating injury
31
What is involved in truama of the kidneys?
Parenchyma or extending into collecting system
32
What is seen in the kidney with trauma?3
1. Hematomas
2. Lacerations
3. Perirenal collections
33
What kind of hematomas are seen in the kidney
Subcapsular or intrarenal
34
What are some perirenal collections seen with kidneys? 2
1. Urinomas
2. Hematomas
35
70% of bladder trauma is associated with what?
Pelvic fracture
36
What do we see with bladder trauma? 3
1. Possible rupture
2. Large fluid collections
3. Urinoma
37
What kind of trauma do we see with adrenal glands? 2
1. Spontaneous hemorrhage no common
2. Post traumatic
38
What can lead to spontaneous hemorrhage in the adrenals? 3
1. Anticoaguation therapy
2. Severe stress
3. Blood abnormalities
39
With post traumatic of the adrenal glands, which side is affected more often? What does it look like? What happens if it is bilateral?
1. Medulla, right more than left
2. Echogenic mass that becomes more anechoic and smaller over time
3. Bilateral leads to adrenal insufficiency
40
Can we see adrenals hemorrhage in infant?
Yes, its the most common cause of adrenal mass in neonates
41
When does adrenal hemorrhage usually occur with infants?
2-7th day
42
What causes traumatic adrenal hemorrhage in infants? What side does it affect?
1. Traumatic delivery
2. Bilateral
43
What are signs of adrenal hemorrhage in infants? 3
1. Decreases hematocrit
2. Jaundice- reabsorption of excess hemoglobin
3. Increase in bilirubin
44
In supine, free fluid collects where?
In pelvis and paracolic gutters
45
How does peritoneum fluids look like?
Transudative and exudative fluids which conforms to surrounding structures
46
What does FAST stand for?
Focused assessment with sonography trauma
47
What is FAST used for? 2
1. Screening fro intra-abdominal injuries
2. Free fluid detection from laparotomy
48
What are some things seen as result of trauma in the retroperitoneum? 4
1. Hematomas
2. Abscesses
3. Urinomas
4. Hydroceles
49
Where are hematomas in the retroperitoneum?
Psoas muscle and perineprhic space
50
What is the nature of retroperitoneum abscesses?
Perineprhic
51
How would someone get Urinomas in the retroperitoneum? What do these collection look like echogenicity wise? 2
1. Interventional procedures
2. Hypoechic collections
52
How would someone get lymphoceles in the retroperitoneum? What is the echogenicity? 2
1. Post surgery
2. Anechoic
53
What is a hernia?
Weakening in the abdominal wall muscles, which cause viscera to protrude through
54
How can someone get a hernia?
Acquired or congenital
55
What are some Congential hernias? 3
1. Gastroscisis
2. Omphalocele
3. Indirect inguinal hernia
56
What are risk factors for acquired hernias? 7
1. Elderly
2. Excessive weight gain or loss
3. Surgery
4. Pregnancy
5. Heavy lifting
6. Chronic constipation
7. Sudden twists, pulls or muscle strains?
57
What are s/s for hernias? 4
1. Asymptomatic
2. Palpable mass or “bulge”
3. Pain, burning sensation
4. Heaviness around scrotum (males)
58
Palpable masses for hernias increase and decrease in what positions?
1. Increase while standing
2. Decreased in supine
59
What is a reducible hernia?
Ability to be pushed back into place
60
What does a incarcerated hernia look like? 2
1. Irreducible
2. Trapped
61
What is a strangulated hernia? What is the urgency of this type of hernia?
1. Blood supply cut off/ tissue swells
2. Medical emergency
62
What are locations for hernias? 2
1. Umbilical
2. Epigastric (Through the linea alba)
63
What are two types of inguinal hernias?
1. Direct
2. Indirect
64
What is a direct inguinal hernia?
Tissue passes through a weakened canal floor
65
Who is affected most with inguinal hernias?
Older males
66
How does someone get a direct hernia
Acquired
67
What is a indirect hernia?
Herniated tissue passes through the deep inguinal ring
68
What is the most common type of inguinal hernia?
Indirect
69
How does someone get a indirect hernia?
Congenital
70
Both direct and indirect hernias can extend where?
Into the scrotum
71
Can u/s differentiate between direct and indirect hernias?
No
72
What is a spingelian hernia? And how is it diagnosed ?
1. Spontaneous/ Lateral wall
2. CT diagnosed most of the time
73
How common is lumbar hernias?
Uncommon and acquired
74
Lumbar hernias are asymptomatic or symptomatic?
Asymptomatic
75
Who is affected with Lumbar hernias? And why?
Females due to wider pelvis
76
How is lumbar hernias diagnosed?
CT
77
What are ventral hernias? What are two examples?
Congenital ventricle hernias: Omphalocele, gastroschisis
78
What does a femoral hernia look like?
Mass medial to femoral vein
79
What are femoral hernia s/s?
1. Groin pain
2. +/- Palpable mass
80
How does someone get a incisional hernial?
Post surgical
81
What are s/s of incisional hernias?
Pain and palpable masses
82
When scanning for a hernia what type of tranducer would we use?
High frequency transducer
83
What does a patient need to do for a hernia exam?
Valsalva
84
What do we need to do in terms of a U/S exam for documentation? 2
1. 2 planes
2. Document size, changes with pressure
85
What does a hernia generally look like on U/S?
Interruption of peritoneal line
86
What do we need to look for with hernias on u/s?
Look for peristalsis, fat or fluid
87
What are criteria’s for hernias with u/s? 4
1. Abdominal wall defect
2. Presence of bowel loops or fat
3. Increase in mass size with valsalva
4. Decrease in mass size with transducer pressure
88
What are three surgical intervention for hernias?
1. Herniorrhaphy
2. Hernioplasty
3. Laparoscopic method
89
What is a herniorrhaphy? 2
1. Large incisions
2. Muscle sewn over defect
90
What is a hernioplasty?
Incision/ prosthetic mesh inserted
91
What is a laparoscopic method for hernias?
Tiny incisions
92
What are complications for surgical interventions for hernias? 4
1. Infection
2. Hematoma
3. Epididymitis
4. Ischemic Orchitis
93
What are rectus sheath hematoma causes? 5
1. Trauma
2. Surgery
3. Vigorous abdominal contractions
4. Intense straining
5. Spontaneous
94
How can someone get spontaneous rectus sheath hematomas?
Anticoagulation therapy
