Abdominal examination of a 36-yrs-old man who was hit by a car reveals abdominal tenderness. His sensorium has been altered due to a closed head injury. The CT scanner is not operational. A diagnostic peritoneal lavage is bloody. The most likely organ to have been injured is the.
a. The most common organ to be injured in blunt abdominal injury is spleen followed by liver.
b. The most common organ injured in penetrating injury to abdomen is mesentry of small intestine.
c. CT scanning is the diagnostic imaging modality of choice in all hemodynamically stable patients in whom splenic injury is suspected.
d. The sensitivity and specificity of CT scanning (approaching 100% and 98%, respectively) are superior to both FAST and DPL in detecting significant intra-abdominal injury and determining the need for surgery.
e. The system designed by the Organ Injury Scaling Committee (OISC) of the American Association for the Surgery of Trauma to be quite helpful not only in stratifying the severity of splenic injuries and determining proper therapy but also in providing a standardized and reproducible nomenclature for reporting purposes.
g. Grade I injuries consist of small subcapsular hematomas and capsular tears less than 1 cm in length.
h. Grade II injuries comprise subcapsular hematomas involving less than 50% of the surface area of the spleen and parenchymal lacerations 1 to 3 cm in length that do not involve a trabecular vessel.
i. Grade III injuries consist of any subcapsular hematoma involving more than 50% of the splenic surface, all expanding (or ruptured) subcapsular hematomas, and parenchymal lacerations longer than 3 cm (with or without involvement of trabecular vessels).
j. Grade IV injuries apply to patients with splenic lacerations involving the segmental vessels or with devascularization of more than 25% of the spleen.
Grade V injuries consist of major hilar disruption, devascularization of more than 50% of the spleen, or complete splenic shatter.