What is the role of laparoscopy in trauma? Laparoscopy can be a useful adjunct to assess for diaphragmatic injuries or when penetration of the abdominal fascia cannot be ascertained. The classic example is a stab wound to the left upper quadrant, where CT or US might not be helpful.
Do all penetrating injuries to the abdomen require laparotomy? No. In the era of CT scanning, a hemodynamically stable patient with a negative CT can be observed. Many stab wounds and low-velocity firearm injuries are tangential and do not penetrate the abdominal fascia. However, observation in the setting of multiple trauma can be time-consuming and …
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What should be the first imaging study obtained ? An acute abdominal series consists of an upright, supine, and lateral decubitus abdominal film. It is quick and inexpensive, yet can provide vital information. Upright chest radiograph may reveal free air under the diaphragm or suggest a pulmonary process. Free air may also be seen over …
How does urinalysis help in the assessment? White blood cells in the urine may indicate urinary tract infection. Hematuria may suggest ureteral stones or tumor. Glucose or ketones may reveal diabetic ketoacidosis. An inflamed appendix abutting an adjacent ureter may lead to the finding of white or red blood cells in the analysis.
What is Kehrs sign? Pain in the left upper quadrant radiates to the top of the left shoulder secondary to diaphragmatic irritation. Kehr’s sign often indicates hematoma from splenic injury or can be seen in perforated peptic ulcer. The eponym is attributed to Johannes Kehr, a German surgeon who also developed a biliary T-tube.
What are the psoas and obturator signs? Inflammation of the psoas muscle causes pain on hip flexion-extension, whereas inflammation of the internal obturator muscle causes pain on internal rotation and flexion of the hip. A retrocecal appendicitis or, on occasion, diverticulitis may be responsible for these signs.
What is the most important part of the abdominal examination? Palpation is a key component of the abdominal examination, which permits assessment of localized tenderness, guarding, or diffuse peritonitis. One should attempt to begin palpation away from the area of expected maximal tenderness. A rectal examination is also essential. A pelvic examination can also be …
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