Abdominal and pelvic trauma, organ by organ

Raised liver transaminases after blunt trauma in a child point to liver injury and are part of pediatric screening for intra-abdominal injury; with abdominal pain, they support CT even when vital signs are normal.

CK rises with muscle injury from the impact; it does not point to a solid-organ injury in the abdomen.

Stress leukocytosis is common after any injury and does not localize to the abdomen.

Stress hyperglycemia reflects catecholamine release, not a specific organ injury.

A leaking bowel repair causes fever, tachycardia, peritonitis, or enteric drainage, not a sudden pink gush through the midline after a cough.

A sudden gush of salmon-colored serosanguineous fluid after a cough, often with a popping feeling, is the classic warning of fascial dehiscence in the first week or two after laparotomy. The nurse covers the wound with a sterile moist dressing, flexes the knees, and notifies the surgeon before evisceration follows.

A seroma is a contained pocket of clear-yellow fluid that drains slowly; a large salmon-colored gush triggered by a cough is a fascial failure, and calling it a seroma delays repair.

Normal incisional drainage tapers within the first days; a new large volume on day 6 is abnormal, and treating it as routine misses an impending evisceration.

Operating because of a high grade is an outdated reflex; current EAST and WSES guidance offers nonoperative care to stable patients regardless of grade, and a needless laparotomy adds harm.

A grade IV laceration can bleed late or leak bile, so it needs inpatient monitoring; discharge confuses being stable now with being out of danger.

Hemodynamic stability, not injury grade, decides management: stable patients with even grade IV–V liver injuries are managed nonoperatively with serial exams, hemoglobin checks, and ICU-level monitoring. Angioembolization is added only for a contrast blush or ongoing bleeding.

Embolization is for an active blush or continued hemorrhage; without extravasation it risks hepatic necrosis and abscess with nothing to gain.

The stomach is intraperitoneal, so a gastric perforation usually shows free air under the diaphragm rather than air confined to the retroperitoneum next to the duodenum.

Retroperitoneal air beside the duodenum after an epigastric blow means the duodenal wall has ruptured; because most of the duodenum is retroperitoneal, air tracks there instead of under the diaphragm. Back pain is typical, and repair is surgical.

The pancreas sits beside the duodenum and is hurt by the same steering-wheel mechanism, but a contusion does not create gas; air means a hollow organ has opened.

A ruptured renal pelvis leaks urine into the perirenal space, seen on delayed CT images; it does not put air next to the duodenum.

Gastroenteritis does not explain a hematoma on CT; the bilious vomiting comes from duodenal obstruction by the clot, not infection.

Short falls in young children rarely cause serious abdominal injury; accepting the story ignores the mismatch between mechanism and injury.

A duodenal hematoma takes a forceful blow to the upper abdomen, typically a punch or kick in a toddler; a fall from a couch onto carpet cannot deliver that energy. A history that does not fit the injury is the key red flag, and the nurse must report the concern.

Duodenal atresia causes bilious vomiting within days of birth and a double-bubble image, not a hematoma in a 2-year-old.

Pyelonephritis causes fever and flank pain, but it does not produce a new tender flank mass five days after a high-grade laceration.

An injured collecting system can leak urine into the perirenal space, forming a urinoma days later with a flank mass, ileus, and low-grade fever. Stable vital signs and hemoglobin argue against bleeding; a ureteral stent is placed if it persists.

A new tender mass with ileus and fever is a complication to image and drain; calling it expected delays treatment of a collection that can become infected.

Delayed bleeding from a pseudoaneurysm or AV fistula shows as gross hematuria, a falling hemoglobin, or hypotension, none of which are present.

Packing is damage control for active hemorrhage in an unstable patient; with stable vital signs and hemoglobin, an open operation is not needed.

Fever with a collection needs source control; watching without drainage lets an abscess or bile leak progress to sepsis.

Embolization treats arterial bleeding or a pseudoaneurysm; it does nothing for an infected or bile-filled collection.

Fever, right upper quadrant pain, and a perihepatic collection days into nonoperative care suggest a biloma or abscess. In a stable patient, image-guided percutaneous drainage, with antibiotics if infected, is first-line; surgery is kept for failure.

Nothing requires a delay after a normal RUG, and withholding drainage gives up accurate urine output monitoring in a trauma patient.

A suprapubic tube is for urethral disruption on RUG or a failed catheter attempt; a normal study does not call for an invasive bypass.

Blood at the meatus requires a retrograde urethrogram before any catheter; once the RUG shows an intact urethra, a gentle transurethral catheter may be placed. Any resistance stops the attempt and urology is called.

The study has already excluded urethral injury; repeating it adds contrast and delay without new information.

Bilateral internal iliac embolization can cut flow to the gluteal arteries, causing gluteal muscle and skin necrosis with severe buttock pain and dusky, blistering skin. It needs urgent surgical evaluation and sometimes debridement.

A pressure injury forms over the sacrum or another bony point and evolves gradually; painful necrosis over both buttocks two days after embolization points to ischemia.

Sciatic compression causes radiating pain, numbness, or foot drop, not dusky, blistering skin over both buttocks.

Contrast reactions appear within minutes to hours as hives or angioedema, not as localized skin necrosis two days later.

Deflating an aortic balloon reperfuses ischemic tissue below it, washing potassium, lactate, and acid into the circulation while afterload suddenly falls. The team deflates slowly with blood products, calcium, and vasopressors ready.

Hypertension above the balloon is an effect of inflation; deflation removes that afterload and drops the pressure.

Lactate rises after deflation as acid stored in ischemic tissue re-enters the circulation; clearance comes later with resuscitation.

Renal perfusion may improve later, but the immediate effect of reperfusion is hemodynamic instability and acidosis, not a diuresis.

An intoxicated, drowsy patient has an unreliable abdominal exam, and a seat-belt sign raises the risk of bowel and mesenteric injury. A negative FAST does not exclude these, so a stable patient needs contrast CT.

Serial FAST can catch growing free fluid but is poor at finding hollow-viscus injury; relying on it alone gives false reassurance.

Waiting for sobriety ignores a high-risk mechanism; a bowel or mesenteric injury can perforate while the exam is still unreliable.

DPL is invasive and has been largely replaced by CT in stable patients; it is reserved for unstable patients when FAST is unavailable or equivocal.

A collapsed, sealed dressing shows the vacuum is working; the worrying sign would be a lost seal or a dressing that balloons.

Low-volume serosanguineous drainage is expected from an open abdomen and only needs trending.

Brisk bright red output into the canister signals active bleeding into the open abdomen; the surgeon is called at once while the nurse checks vital signs, hemoglobin, and blood availability.

Mild edge discomfort calls for analgesia and a skin check, not urgent surgical action.

Local wound exploration answers whether the fascia was penetrated; with bowel outside the wound that is already known, and discharge is unsafe.

Pushing eviscerated bowel back at the bedside contaminates the peritoneum and hides injury; the bowel stays covered and moist until surgery.

Serial exams suit selected stable stab wounds without evisceration or peritonitis; protruding bowel removes that option.

Bowel protruding through a stab wound is an indication for laparotomy even in a stable patient without peritonitis: the peritoneum is clearly breached and the exposed bowel may be injured. The nurse covers it with sterile saline-moistened dressings and prepares for the OR.

A RUG is for suspected urethral injury, such as blood at the meatus with a pelvic fracture; microscopic hematuria alone is not an indication.

Cystoscopy is not a first-line trauma test; suspected bladder injury is studied with CT or conventional cystography when gross hematuria and a pelvic fracture coexist.

Delayed images look for collecting-system injury when the criteria for imaging are met; using them for low-risk microscopic hematuria adds contrast and radiation without benefit.

Renal imaging after blunt trauma is indicated for gross hematuria, microscopic hematuria with SBP below 90 mm Hg, or a rapid-deceleration or direct flank mechanism. A stable adult with microscopic hematuria after a fall from standing meets none of these.

More imaging delays surgery in a patient who already has peritonitis; oral contrast rarely changes the decision when the exam is this clear.

Peritonitis with persistent tachycardia, plus free fluid without a solid-organ source, points to a hollow-viscus or mesenteric injury that FAST and CT can miss. Clinical peritonitis is itself an indication for laparotomy.

Serial exams are useful until the findings declare themselves; rigidity with tachycardia is that declaration, and more waiting raises sepsis and mortality.

Embolization controls arterial bleeding from solid organs or the pelvis; it cannot repair a perforated bowel or torn mesentery.