TNCC Abdominal Trauma 2 — Questions and Answers
Question 1: A patient with blunt abdominal trauma has a positive FAST exam showing free fluid in the hepatorenal space. Which structure is most commonly injured with right upper quadrant fluid on FAST?
- Spleen
- Liver (Correct answer)
- Right kidney
- Ascending colon
Correct answer: Liver
The hepatorenal space (Morrison's pouch) collects fluid from liver injuries, making the liver the most commonly injured organ when fluid is seen in that location.
Question 2: Which mechanism of injury is most associated with hollow viscus (bowel) perforation in blunt abdominal trauma?
- Lateral impact motor vehicle collision
- Lap belt restraint without shoulder harness (Correct answer)
- Direct blow to the epigastrium
- Rear-impact collision
Correct answer: Lap belt restraint without shoulder harness
Lap belt–only restraint causes a classic pattern of bowel perforation and lumbar spine fracture (Chance fracture) because the bowel is compressed against the spine.
Question 3: A trauma patient develops sudden hypotension 2 hours after a seat belt injury. Initial FAST was negative. What should be the priority diagnostic consideration?
- Tension pneumothorax
- Delayed hollow viscus injury with peritonitis (Correct answer)
- Neurogenic shock from spinal injury
- Cardiac tamponade
Correct answer: Delayed hollow viscus injury with peritonitis
A negative initial FAST does not exclude bowel injury; delayed hollow viscus perforation can present with peritonitis and hemodynamic deterioration hours after injury.
Question 4: Which physical finding is most specific for diaphragmatic rupture in a patient with left-sided blunt thoracoabdominal trauma?
- Absent breath sounds on the left
- Bowel sounds auscultated in the left chest (Correct answer)
- Subcutaneous emphysema over the chest wall
- Paradoxical chest wall movement
Correct answer: Bowel sounds auscultated in the left chest
Bowel sounds in the chest are pathognomonic for diaphragmatic rupture with herniation of abdominal contents into the thoracic cavity.
Question 5: During the secondary survey of a stab wound patient, you note evisceration of small bowel through the abdominal wound. What is the correct initial management?
- Push the bowel back into the abdomen and apply a pressure dressing
- Cover with a sterile, moist dressing and do not attempt to reinsert the bowel (Correct answer)
- Apply a dry sterile dressing and wrap tightly with an elastic bandage
- Leave uncovered to allow visual monitoring during transport
Correct answer: Cover with a sterile, moist dressing and do not attempt to reinsert the bowel
Eviscerated bowel should be covered with a sterile, moist (saline-soaked) dressing to prevent desiccation without attempting to reduce the bowel.
Question 6: A patient with penetrating abdominal trauma has a gunshot wound to the right flank. Which retroperitoneal structure is at greatest risk of injury in this trajectory?
- Spleen
- Right kidney (Correct answer)
- Descending colon
- Pancreas
Correct answer: Right kidney
The right kidney is a retroperitoneal organ located in the right flank and is highly vulnerable to penetrating injuries in that region.
Question 7: Which lab finding is the earliest indicator of significant intra-abdominal hemorrhage in a hemodynamically stable patient?
- Elevated serum creatinine
- Elevated serum lactate (Correct answer)
- Decreased serum albumin
- Elevated alkaline phosphatase
Correct answer: Elevated serum lactate
Elevated serum lactate reflects anaerobic metabolism from inadequate tissue perfusion and is an early marker of occult hemorrhagic shock before hemodynamic instability becomes apparent.
TNCC Abdominal Trauma 2
A patient with blunt abdominal trauma has a positive FAST exam showing free fluid in the hepatorenal space.
Which structure is most commonly injured with right upper quadrant fluid on FAST?