Abdominal Trauma Overview

Questions and Answers

What types of trauma are classified as penetrating trauma?

Crush injuries and sport injuries

Road traffic accidents and falls from height

Compression injuries and shear injuries

Gunshot wounds and stab wounds (correct)

Which area of the abdomen contains the bladder and rectum?

Intra thoracic abdomen

True abdomen

Pelvic abdomen (correct)

Retroperitoneal abdomen

Which organ is most frequently injured in blunt trauma during laparotomy?

Pancreas

Spleen (correct)

Liver

Small bowel

What mechanism commonly leads to small bowel injuries during sudden deceleration?

Seat belt sign Signup and view all the answers

Which structure is located retroperitoneally?

Duodenum Signup and view all the answers

How are acceleration and deceleration injuries typically categorized?

Differential movements of fixed and non-fixed structures Signup and view all the answers

In patients with gunshot wounds, which organ is most commonly involved?

Large bowel Signup and view all the answers

Which imaging technique is superior for diagnosing internal damage in the context described?

DPL Signup and view all the answers

What finding is associated with duodenal injuries following frontal-impact motor vehicle accidents?

Presence of retroperitoneal air on imaging Signup and view all the answers

What is a Chance fracture primarily associated with?

Flexion-distraction mechanism Signup and view all the answers

What clinical feature is most indicative of a Chance fracture?

Severe back pain Signup and view all the answers

Which statement is true regarding diaphragmatic injury in penetrating trauma?

It can lead to herniation of abdominal viscera. Signup and view all the answers

What does an elevated hemidiaphragm in a chest X-ray typically indicate?

Potential diaphragmatic injury Signup and view all the answers

What is an important consideration when assessing pancreatic trauma?

Early normal serum amylase excludes any trauma. Signup and view all the answers

What type of trauma is characterized by a large defect affecting the diaphragm?

Blunt trauma to the abdomen Signup and view all the answers

What is the main advantage of Diagnostic Peritoneal Lavage (DPL)?

It can confirm or exclude the presence of intraperitoneal bleeding. Signup and view all the answers

Which injury is most commonly missed during blunt trauma assessment?

Diaphragmatic injury Signup and view all the answers

Which of the following is an absolute contraindication for performing DPL?

Patient with obvious surgical abdomen Signup and view all the answers

What finding in a positive DPL indicates the need for laparotomy in hemodynamically abnormal patients?

Free aspiration of blood greater than 10 mL. Signup and view all the answers

Which of the following is true regarding the limitations of DPL?

DPL cannot identify retroperitoneal injuries. Signup and view all the answers

What does a positive FAST indicate in unstable trauma patients?

Laparotomy should be performed without further tests. Signup and view all the answers

What is a key advantage of using FAST in trauma assessment?

It is non-invasive and can be performed at the bedside. Signup and view all the answers

Which of the following is a limitation of the FAST examination?

Obesity can hinder accurate results. Signup and view all the answers

Under which condition is CT abdomen typically indicated?

For identifying and grading solid organ injuries in stable patients. Signup and view all the answers

What is a primary criterion for operative management through laparotomy?

Signs of peritoneal irritation. Signup and view all the answers

What is the purpose of conservative management for patients with abdominal trauma?

To monitor and provide supportive care for stable patients. Signup and view all the answers

What is the primary purpose of a laparotomy in the context of penetrating trauma?

To exclude any hollow viscus injury Signup and view all the answers

In the case of a stable patient with isolated solid organ injury, what is the recommended management approach?

Nonoperative management Signup and view all the answers

Which sign indicates retroperitoneal bleeding associated with abdominal trauma?

Grey-Turner sign Signup and view all the answers

What does the term 'Kehr sign' refer to in trauma assessment?

Left shoulder pain while supine Signup and view all the answers

What should be assessed during the primary survey's 'E' component?

Undress the patient for exposure Signup and view all the answers

What is a significant association of pelvic fractures in trauma patients?

Major force applied to the patient Signup and view all the answers

Which sign is often associated with peritoneal bleeding, particularly from pancreatic hemorrhage?

Cullen sign Signup and view all the answers

During the physical exam for abdominal trauma, which method is used to check for free fluid?

Percussion Signup and view all the answers

Study Notes

Etiology of Abdominal Trauma

Two primary types: penetrating trauma and blunt trauma.

Penetrating Trauma

Common causes include stab wounds, gunshot injuries, and blast injuries.

Blunt Trauma

Common causes include motor vehicle accidents (MVA), falls from height (FFH), crush injuries, sports injuries, and violence.

Anatomical Considerations

Abdomen divided into four regions:
- Intra-thoracic abdomen: Contains diaphragm, liver, spleen, stomach, and transverse colon.
- True abdomen: Includes the small bowel, ascending colon, descending colon, and sigmoid colon.
- Pelvic abdomen: Houses rectum, bladder, iliac vessels, and internal reproductive organs (in women).
- Retroperitoneal abdomen: Encloses abdominal aorta, IVC, duodenum, pancreas, kidneys, ureters, and aspects of ascending & descending colon.

Mechanisms of Injury

Acceleration and deceleration injuries occur in FFH and MVA.
Differential movements can cause lacerations of fixed and non-fixed structures (e.g., liver and spleen).
Compression, crush, or shear injuries lead to organ deformation and potential ruptures.

Common Injury Patterns

In laparotomy for blunt trauma, most commonly injured organs:
- Spleen (40-55%)
- Liver (35-45%)
- Small bowel (5-10%)
In gunshot wounds, frequently affected organs include the small bowel, large bowel, liver, and vascular structures.

Specific Injuries

Duodenum: Often injured in frontal-impact MVAs; indicators include bloody gastric aspirate and retroperitoneal air on imaging.
Small Bowel Injury: Sudden deceleration injuries often implicated; seat belt sign indicates potential underlying trauma.
Pancreas: Suspected with direct blows to the epigastric region; normal serum amylase does not rule out major trauma.
Diaphragm: Injury suggested by penetrating wounds below the nipple or significant blunt trauma; often missed in blunt trauma evaluations.

Diagnosis

No single standard investigation; rely on imaging and physical findings.
Key signs include:
- Grey-Turner sign: Bruising on flanks indicating retroperitoneal bleeding.
- Cullen sign: Bruising around the umbilicus indicating peritoneal bleeding.
- Kehr sign: Left shoulder pain from diaphragmatic irritation.
- Balance sign: Dull percussion in left upper quadrant indicating splenic injury.

Investigations

Laboratory tests: Full blood count (FBC), serum amylase, urinalysis, baseline tests.
Radiological investigations: Chest X-ray and abdominal ultrasound (FAST).
- FAST evaluates for hemoperitoneum in blunt trauma; positive result indicates the need for laparotomy.

Diagnostic and Treatment Procedures

Diagnostic Peritoneal Lavage (DPL): Used when there’s suspicion of intra-abdominal bleeding; positive DPL indicates need for laparotomy.
CT Abdomen: Helps identify and grade solid organ injuries in stable patients but less effective for bowel/diaphragmatic injuries.
Diagnostic Laparoscopy: Quick assessment of stab wounds and diaphragmatic injuries.

Management Options

Conservative Management: For stable patients with mild to moderate injuries, must rule out hollow viscous injuries.
- Requires monitoring and possible exploration if clinical deterioration occurs.
Operative Management: Laparotomy indicated for signs of peritoneal irritation, unexplained shock, or significant injuries needing surgical intervention.

Initial Assessment and Management

Primary survey includes assessment of airway, breathing, circulation, disability, exposure, and environment.
Trauma protocol involves immobilization, oxygen administration, intravenous access, and imaging studies.

Physical Examination

Essential for detecting signs of trauma, such as distension, tenderness, and specific signs like seat belt sign, Grey-Turner sign, and Cullen sign.
Percussion and auscultation help in identifying free fluid and bowel sounds, respectively.

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Description

This quiz covers the etiology and types of abdominal trauma, including both penetrating and blunt trauma. Focus areas include stab wounds, gunshot injuries, and various causes of blunt trauma such as road accidents and falls. Test your knowledge on the anatomical considerations of abdominal injuries.