Week 6

Question 1

What are the layers of the abdominal wall?

Answer 1

External oblique
external oblique fascia
rectus abdominus muscle
transverse abdominus muscle

Question 2

what are the 9 regions of the abdomen

Answer 2

R hypochondriac - Epigastric - L hypochondriac
R Lumbar - Ubillical - L Lumbar
R Illiac - Hypogastric - L Illiac

Question 3

what is in the retroperitoneal space in the abdominal cavity?

Answer 3

Kidneys, ureters, bladder, reproductive organs, inferior vena cava, abdominal aorta, pancreas

Question 4

what is in the peritoneal space in the abdominal cavity?

Answer 4

Bowel, spleen, liver, stomach, gall bladder

Question 5

what is in the pelvic cavity space in the abdominal cavity?

Answer 5

Rectum, ureters, pelvic vascular plexus, femoral arteries, femoral veins, pelvic skeletal structures, reproductive organs

Question 6

what are the abdominal mechanisms of injury?

Answer 6

Blunt mechanisms:

• Forces
• > compression/shearing/deceleration
• Sources
• > MVA’s/falls/assults/blasts

Penetrating mechanisms:

• Low energy
• High energy

Question 7

What are risk factors of intra-abdominal injuries?

Answer 7

• High speed MVA
• Pedestrian v vehicle
• hypotension <100 at any time
• ## presence of chest or pelvic injuries

Question 8

What are causes of abdo pain?

Answer 8

Visceral pain:
Caused by stretching of fibres in walls/capsules of hollow/solid organs

Parietal pain :
irritation of nerves in the parietal peritoneum, usually anterior abdo wall

Referred pain:
Pain presentign away from noxious stimuli

Question 9

What are the presentations of abdo visceral pain?

Answer 9

Presentation:
steady ache to vague discomfort to excruciating colicky pain
present along midline
may be referred
may have sweating/nausea/vomiting/tachycardia

Question 10

What are the presentations of abdo parietal pain?

Answer 10

aggrivated by respiration, thoracic and abdo movements

Presentation:

• sharp, localised, constant
• guarding, legs raised, decreased mvmt
• localised peritonitis develops, rigidity and tenderness

Question 11

what are some examples of referred abdo pain?

Answer 11

Diaphragm irritation can be shown as shoulder pain

Biliary tract disease can present as - right infrascapular pain

Question 12

What is Kehrs sign?

Answer 12

occurance of acute pain at the shoulder tip due to the presence of blood in the peritoneum, irritating diaphragm when supine.

Left shoulder tip pain is an indication of a ruptured spleen

Question 13

What is left shoulder tip pain in abdo trauma a sign of?

Answer 13

ruptured spleen

Question 14

What are clinical features of abdominal injuries?

Answer 14

Cullens sign - bruising around belly button
Grey Turners sign - bruising on side of body

• distended or irregularly shaped
• bruising of the abdo and flank
• tenderness
• pain
• pain other than injury site
• pain radiating to either shoulder
• guarding
• fetal position
• weak peripheral pulse
• abdo cramping
• rigid/hard abdo

Question 15

what are some abdo injury types?

Answer 15

solid organ
hollow organ
vascular 
abdo evisceration
genitourinary

Question 16

what are considerations around ruptured spleen?

Answer 16

often caused with trauma to ribs 9-11

capsule around spleen can promote slow development of shock

rapid shock onset when capsule ruptures

Question 17

where is the pancrease located?

Answer 17

transversely across lumbar spine

often injured by compression of styeering wheel

Question 18

what is a complication of pancreas rupturing?

Answer 18

bleeds little but leaks pancreatic enzyme which can damage organs

Question 19

what injury can damage kidneys?

Answer 19

direct blow to back, flank of upper abdomen

Suspect in fractures of 10-12 ribs

Question 20

What is a symptom of kidney injury?

Answer 20

hypovolaemia

blood in urine

Question 21

what is a sign of bladder rupture?

Answer 21

blood at urethral opening or signs of trauma to the region

Question 22

what are causes of rectal bleeding?

Answer 22

sexual assult
haemorrhoids
colitis
ulcers
digestive tract

Question 23

What are causes abdominal compartment syndrome?

Answer 23

Direct pressure of

• vascular structures
• the diaphragm
• adbo wall

Causes:
intra-abdo:
- ruptured AAA
- bleed/trauma

Retroperitoneal

• pelvic bleeds
• ruptured AAA

Abdo wall:
- burn eschar

Question 24

What are the types abdominal compartment syndrome?

Answer 24

Primary:
a process involving the abdo itself leading to intra-abdo hypertension. eg. penetrating trauma/haemorrhage

Secondary:
intra-abdo hypertension (without abdo injury)
Strongly related to fluid resus - infusion >3L

Question 25

Signs and symptoms of abdo compartment syndrom?

Answer 25

abdo pain
resp distress
- invreased RR
- fine crackles/wheezes
Abdo distension

Question 26

What are some complications of pelvic fractures?

Answer 26

• bleeding
• urinary and gynaecological injuries
• rectal injuries
• nerve root injuries
• chronic pain
• sexual dysfunctions
• disability

Question 27

What are signs of a pelvic fracture?

Answer 27

crush injuries will produce early bruising and sever pain, not focused on site of injury

• hypovolaemia
• hypovolaemic shock
• pain on leg movement
• tenderness and crepitus

Question 28

what are the types of pelvic fractures?

Answer 28

lateral compression

anteroposterior compression (open book)

Vertical shear

Question 29

What fluid therapy would you use for pelvic fracture

Answer 29

SBP target >70

250ml bolus max 2L

Question 30

what are the 2 things pelvic binders do?

Answer 30

anatomically reduces pelvic vol

stabilises pelvic fracture limiting movement