Help with Digestive Injuries and Disorders - Anatomy

Card 1 of 20

0
Didn't Know
Knew It
0
1 of 2019 left
Question

A 47-year old woman is brought by ambulance to the trauma bay after being involved in a high-speed motor vehicle collision. She is unresponsive, with a blood pressure of 78/42 and pulse 132. She is immediately intubated and breath sounds are confirmed. Her heart sounds are normal and peripheral pulses are intact. There is no obvious bleeding and two large bore IVs are started. Abdominal ultrasound reveals a fluid collection in the left upper quadrant. She continues to deteriorate and is brought emergently to the OR for exploratory laparotomy, where packing of the abdomen reveals extensive bleeding in the left upper quadrant. What do you expect is the cause of this bleeding?

Tap to reveal answer

Answer

Blood collecting in the left upper quadrant would suggest a splenic laceration.

The spleen is one of the most commonly injured organs with blunt abdominal trauma. It can and will bleed enough to make a patient hemodynamically unstable. Ultrasound performed in the trauma bay looks at four potential spaces of fluid collection: Morrison's pouch (right upper quadrant/liver), splenorenal recess (left upper quadrant/spleen), subxiphoid (heart), and the pouch of Douglas (suprapubic/pelvis). The liver is located in the right upper quadrant of the abdomen and the spleen in the left upper quadrant

This patient's ultrasound showed fluid collection in the perisplenic space as well as extensive bleeding, which would suggest a splenic laceration as the cause of the patient's condition.

The liver is in the right upper quadrant. The right and left iliac arteries are in the right and left lower quadrants, respectively. Bladder laceration would result in fluid collection in the pelvis.

← Didn't Know|Knew It →