Abdominal Trauma Assessment Quiz
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Questions and Answers

What specific mechanism causes blunt trauma from seat belts to abdominal organs?

  • The seat belt causes a rapid deceleration, leading to organ shearing.
  • The seat belt forces the intestine and pancreas against the spinal column. (correct)
  • The seat belt cuts into the abdominal wall causing lacerations.
  • The seat belt compresses the diaphragm leading to rupture.
  • What is indicated by 'guarding and splinting' of the abdominal wall?

  • Retroperitoneal hemorrhage
  • Hypovolemic shock
  • Intraabdominal bleeding
  • Peritonitis (correct)
  • What is the clinical significance of Cullen's sign and Grey Turner's sign?

  • They are indicative of retroperitoneal hemorrhage. (correct)
  • They both imply traumatic injury to the spleen.
  • They suggest a rupture of the diaphragm.
  • They indicate arterial damage.
  • What auscultation finding would be most indicative of arterial damage after trauma?

    <p>Bruits (D)</p> Signup and view all the answers

    An unresponsive patient arrives with suspected abdominal trauma. What is the first priority?

    <p>Assess circulation, airway, and breathing (B)</p> Signup and view all the answers

    Which type of abdominal injury is MOST likely to result in hypovolemic shock?

    <p>Laceration of the liver. (A)</p> Signup and view all the answers

    What is the next step, after controlling external bleeding, in the initial emergency management of a responsive patient with abdominal trauma?

    <p>Establish IV access with appropriate fluids (C)</p> Signup and view all the answers

    A patient presents with a contusion across the lower abdomen after a motor vehicle accident. Which of the following is MOST indicated by this finding?

    <p>Internal organ trauma resulting from the seat belt. (A)</p> Signup and view all the answers

    When is it contraindicated to insert a urinary catheter in a patient with abdominal trauma?

    <p>If the patient shows blood at the meatus, pelvic fracture, or boggy prostate (D)</p> Signup and view all the answers

    Which of the following BEST describes a 'shearing' injury in the context of blunt abdominal trauma?

    <p>A rapid deceleration causing some tissues to move while others remain stationary. (C)</p> Signup and view all the answers

    In the context of abdominal trauma, what is the purpose of maintaining patient warmth?

    <p>To counteract hypothermia that can occur with hypovolemic shock (B)</p> Signup and view all the answers

    What is the primary risk associated with the spillage of contents from a hollow abdominal organ into the peritoneal cavity?

    <p>Peritonitis due to the presence of foreign contents. (C)</p> Signup and view all the answers

    Which diagnostic study is performed in all patients with abdominal trauma?

    <p>Urinalysis (B)</p> Signup and view all the answers

    Which of the following is NOT a typical cause of blunt abdominal trauma?

    <p>Stabbing. (B)</p> Signup and view all the answers

    Which of these is the correct initial intervention for protruding abdominal organs?

    <p>Cover with a sterile saline dressing (B)</p> Signup and view all the answers

    What is the MOST likely cause of respiratory failure in a patient with abdominal compartment syndrome?

    <p>Restriction of ventilation due to high intra-abdominal pressure. (A)</p> Signup and view all the answers

    What is a primary consequence of decreased perfusion to the kidneys due to increased abdominal pressure?

    <p>Renal failure. (C)</p> Signup and view all the answers

    A patient with abdominal trauma is at risk for both hypovolemic shock AND peritonitis. Which combination of injuries would MOST likely explain this?

    <p>Ruptured stomach and urinary bladder. (D)</p> Signup and view all the answers

    Which of these is a possible result of decreased venous return caused by abdominal compartment syndrome?

    <p>Decreased cardiac output (D)</p> Signup and view all the answers

    What is the MOST effective method to identify the full extent and location of injuries that occur from blunt abdominal trauma?

    <p>Careful assessment in conjunction with diagnostic imaging techniques (A)</p> Signup and view all the answers

    In the early stages of abdominal trauma, why might a patient with significant bleeding still present with normal hemoglobin and hematocrit levels?

    <p>Fluids are lost at a proportional rate to red blood cells, maintaining concentration. (D)</p> Signup and view all the answers

    What is the primary reason for performing a type and crossmatch in a patient with abdominal trauma?

    <p>To prepare for a potential need for blood transfusions. (B)</p> Signup and view all the answers

    When is it considered safe to remove an impaled object from a patient with abdominal trauma?

    <p>When skilled care is readily available and prepared for potential complications. (B)</p> Signup and view all the answers

    What is the most appropriate initial management for a hypotensive patient with abdominal trauma?

    <p>Administration of intravenous volume expanders or blood products. (B)</p> Signup and view all the answers

    What is a key characteristic used to describe chronic abdominal pain, as mentioned in the content?

    <p>A dull, aching, or diffuse pain that is often difficult to pinpoint. (D)</p> Signup and view all the answers

    Besides abdominal structures, chronic abdominal pain might be referred from a site with what characteristic?

    <p>A site with the same or similar nerve supply. (D)</p> Signup and view all the answers

    Which diagnostic tool is mentioned that can identify blood, bile, intestinal contents, or urine in the peritoneal cavity?

    <p>Diagnostic peritoneal lavage (D)</p> Signup and view all the answers

    What is the primary purpose of using an NG tube with low suction in a patient with abdominal trauma?

    <p>To decompress the stomach and prevent aspiration. (C)</p> Signup and view all the answers

    What is the primary factor that determines the course of treatment for chronic abdominal pain?

    <p>The identified underlying cause of the pain. (A)</p> Signup and view all the answers

    When is a patient deemed stable enough to undergo an abdominal CT scan after experiencing trauma?

    <p>After stabilization of hemodynamic parameters. (B)</p> Signup and view all the answers

    Flashcards

    Blunt Abdominal Trauma

    Injuries to the abdomen resulting from direct force, such as a blow, fall, or compression from a seatbelt. It often occurs in motor vehicle accidents.

    Penetrating Abdominal Trauma

    Injuries to the abdomen caused by a penetrating object, such as a gunshot or stabbing, creating an open wound.

    Abdominal Compartment Syndrome

    A serious condition where high pressure in the abdomen restricts ventilation, decreases cardiac output, and reduces blood flow to organs, potentially leading to respiratory failure and organ damage. It can be caused by factors like bleeding or swelling in the abdominal cavity.

    Hypovolemic Shock

    A life-threatening situation caused by excessive blood loss, usually from injured organs like the liver or spleen. It leads to a decrease in blood volume and inadequate oxygen delivery to tissues.

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    Peritonitis

    A condition that occurs when the lining of the abdomen becomes inflamed, usually due to the leakage of contents from hollow organs like the bladder, stomach, or intestines.

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    Diaphragm Rupture

    A tear or rupture in the diaphragm, the muscle that separates the chest and abdomen. It can be caused by blunt or penetrating trauma and often impairs breathing.

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    Lacerated Liver

    A tear or laceration in the liver, a vital organ that plays a crucial role in digestion and detoxification.

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    Ruptured Spleen

    A rupture or tear in the spleen, a vital organ that filters blood and helps fight infections. It can cause significant internal bleeding.

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    Mesenteric Artery Tears

    A tear in the mesentery, the membrane that holds the intestines in place. It can lead to severe internal bleeding.

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    Renal Injury

    Injury to the kidneys, essential organs responsible for filtering waste from the blood and producing urine. This type of injury can lead to decreased kidney function.

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    Intra-abdominal bleeding

    Bleeding within the abdominal cavity.

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    Hematuria

    Blood in the urine.

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    Hematemesis

    Blood in the vomit.

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    Cullen sign

    A sign of retroperitoneal hemorrhage, characterized by bruising around the umbilicus.

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    Grey Turner sign

    A sign of retroperitoneal hemorrhage, characterized by bruising on the flanks.

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    Diagnostic peritoneal lavage

    A procedure to evaluate for internal bleeding in the abdomen.

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    ABC assessment

    The ABCs of emergency care: Airway, Breathing, Circulation.

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    What is peritonitis?

    The peritoneum is the lining of the abdomen. Inflammation of the peritoneum, often due to leakage from hollow organs like the bladder, stomach, or intestines, is called peritonitis.

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    What is a diaphragmatic rupture?

    A diaphragmatic rupture is a tear in the diaphragm, the muscle separating the chest and abdomen. It can be caused by blunt or penetrating trauma and often impairs breathing.

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    What is hypovolemic shock?

    Hypovolemic shock is a life-threatening condition caused by significant blood loss, often from injured organs like the liver or spleen. It leads to a decrease in blood volume and inadequate oxygen delivery to tissues.

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    What is a mesenteric tear?

    The mesentery is the membrane that holds the intestines in place. A mesenteric tear can lead to severe internal bleeding.

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    What is a renal injury?

    Damage to the kidneys, essential organs responsible for filtering waste from the blood, is called renal injury. This can lead to decreased kidney function.

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    What is an NG tube?

    An NG tube, or nasogastric tube, is inserted through the nose and down into the stomach. It can be used to decompress the stomach and prevent aspiration.

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    What are some causes of chronic abdominal pain?

    Chronic abdominal pain can be a symptom of various conditions, including IBS, ulcers, pancreatitis, and adhesions. It's often described as dull, aching, or diffuse.

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    What is diagnostic peritoneal lavage?

    Diagnostic peritoneal lavage (DPL) is a procedure used to look for blood, bile, intestinal contents, or urine in the abdominal cavity.

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    How is a focused abdominal ultrasound used in abdominal trauma?

    A focused abdominal ultrasound is a non-invasive imaging technique used to assess the abdominal organs.

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    Why is a CT scan important in abdominal trauma?

    An abdominal CT scan is a common diagnostic tool used to get detailed images of the abdominal organs, but patients must be stable for this procedure.

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    Study Notes

    Abdominal Trauma: Etiology and Pathophysiology

    • Injuries are often from blunt or penetrating trauma.
    • Common injuries include liver lacerations, spleen rupture, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, and injuries to the kidneys, pancreas, stomach, and intestines.
    • Blunt trauma can occur from motor vehicle accidents, direct blows, or falls. Often no open wound is present. Injuries can be from compression or shearing forces.
    • Penetrating trauma occurs from gunshot or stabbing wounds. These injuries present as open wounds.
    • Bleeding from injured solid organs (liver, spleen) can lead to hypovolemic shock.
    • Leakage from hollow organs (bladder, stomach, intestines) can cause peritonitis.
    • Abdominal compartment syndrome, a condition with excessively high pressure in the abdomen, can develop. This pressure can restrict ventilation and decrease cardiac output. Decreased perfusion to kidneys can lead to renal failure.

    Clinical Manifestations

    • Careful assessment is important in identifying the type and severity of injury.
    • Symptoms can include rib fractures, fractured pelvis, spinal injury, or thoracic injury.
    • Contusion or abrasion across the lower abdomen may suggest injury from a seat belt.
    • Manifestations can include: guarding, splinting of the abdominal walls, a hard or distended abdomen, decreased or absent bowel sounds, and abrasions/bruising.
    • Pain, hematemesis, hematuria, and signs of hypovolemic shock can be present.
    • Cullen sign (bruising around the umbilicus) and Grey Turner sign (bruising around the flanks) may indicate retroperitoneal hemorrhage.
    • Loss of bowel sounds suggests peritonitis. If the diaphragm is ruptured, bowel sounds may be heard in the chest.
    • Arterial damage can be detected by the presence of bruits (unusual sounds) during auscultation.

    Diagnostic Studies

    • Baseline CBC (complete blood count) and urinalysis.
    • Hemoglobin and hematocrit may be normal initially during bleeding, but abnormalities will become apparent with fluid resuscitation.
    • Blood in the urine may indicate kidney or bladder damage.
    • Additional lab work includes arterial blood gases, blood clotting tests, electrolytes, and renal function tests (BUN and creatinine).
    • A crossmatch for blood transfusions will often be done.
    • Imaging studies such as CT scans and ultrasound are often used.
    • Diagnostic peritoneal lavage may identify blood, bile, or other fluids in the abdominal cavity.

    Interprofessional/Nursing Care

    • Emergency management is crucial and outlined in Table 47.13 (which is not provided in this document).
    • Volume expanders or blood may be given if the patient is hypotensive.
    • A nasogastric tube (NG tube) on low suction can help reduce stomach volume.
    • Frequent assessment (including vital signs, fluid status, and deterioration of condition) is essential.
    • Removal of impaled objects should only be done by skilled professionals.

    Chronic Abdominal Pain

    • Chronic abdominal pain can originate in abdominal structures or be a referred pain.
    • Causes of chronic abdominal pain include IBS, peptic ulcer disease, chronic pancreatitis, hepatitis, pelvic inflammatory disease, adhesions, and vascular insufficiency
    • A patient history, specific characteristics of the pain (such as severity, location, duration, onset), frequency of pain episodes and factors that exacerbate or alleviate the pain (e.g., eating, defecation, activities) are all part of a full assessment.
    • Endoscopy, CT scan, MRI, laparoscopy, and barium studies can be utilized for diagnosis.
    • Treatment is determined by the underlying cause.

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    Abdominal Trauma Past Paper PDF

    Description

    Test your knowledge on the mechanisms, signs, and initial management of abdominal trauma. This quiz covers key concepts such as mechanisms of injury, clinical signs like Cullen's and Grey Turner's signs, and the priorities in emergency treatment. Perfect for medical students and healthcare professionals involved in trauma care.

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