Abdominal trauma: Clinical

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Abdominal trauma: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 50-year-old man comes to the emergency department because of a leg injury following a motor vehicle accident. His past medical history is significant for hypertension and hyperlipidemia. Physical examination shows minor contusions and a tibia-fibula compound fracture, requiring surgery. Post-operatively, the patient experiences severe abdominal pain and the passing of an abundance of bright red blood and mucus from his rectum. An emergent abdominal X-ray shows thumb-printing in the colon and dilation of the small intestine. Which of the following is the most likely structure affected?


Content Reviewers

Abdominal trauma is defined as injury anywhere between the nipple line and inguinal creases, and can be blunt, like from motor vehicle accidents, or penetrating, like from stab wounds or gunshot wounds.

As with any trauma, evaluation begins with the primary survey, which includes the ABCDEs; airway, breathing, circulation, disability and exposure.

The main goal of the primary survey is to assess and treat for immediately life-threatening injuries.

Okay, so if the individual is talking to you with a clear voice, their airway is intact. If not, assess their ability to maintain the airway, or if they needed assisted ventilation with a bag-valve mask or even endotracheal intubation.

As for “breathing”, look for tracheal deviation and listen to the breath sounds.

Also, if the individual is hypoxic, provide 100% oxygen using a non-rebreather mask.

Next, look at the heart rate and blood pressure, as tachycardia or hypotension may indicate hemorrhagic shock.

Assess for signs of inadequate end-organ perfusion, such as altered mental status, decrease urine output, cool or pale skin, and delayed capillary refill.

Also, insert two large-bore intravenous lines, and prepare for the need for blood products.

Bedside ultrasound can also be used in the primary survey - and it’s called focused assessment with sonography for trauma, or the FAST exam.

The ultrasound probe explores the pericardial cavity, then the right flank, also called the hepatorenal recess or Morison’s pouch, and then the left flank which looks for perisplenic fluid, and finally the suprapubic region to look for fluid around the bladder.

When views are added to look for a pneumothorax, hemothorax, or cardiac tamponade, it’s called an extended FAST or E-FAST.


Abdominal trauma is a serious injury to the abdomen, which can involve the abdominal wall, internal organs, or the vasculature within the abdominal cavity. Abdominal trauma is usually divided into two categories depending on the mechanism of injury. First, there is blunt abdominal trauma caused by a blunt object such as a blow to the abdomen, a car crash, or a fall on bicycle handlebars. In blunt abdominal trauma, the spleen is the most injured organ. There is also penetrating abdominal trauma, which occurs when a sharp object penetrates and injures various parts of the abdomen. These include abdominal stab injuries and gunshot wounds. Common symptoms of abdominal trauma include pain, swelling, bruising, and symptoms of hemorrhagic shock such as confusion and pallor.


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