Retroperitoneal hemorrhage: Difference between revisions
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*bleeding into retroperitoneal space | *bleeding into retroperitoneal space | ||
*difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners) | *difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners) | ||
*can accumulate 4L blood before tamponade | *can accumulate 4L blood before tamponade | ||
===Etiologies=== | ===Etiologies=== | ||
| Line 19: | Line 17: | ||
==Diagnosis== | ==Diagnosis== | ||
''Must have high clinical suspicion to make diagnosis'' | |||
*CT scan abdomen/pelvis | *CT scan abdomen/pelvis | ||
**FAST and DPL do not evaluate retroperitoneal space | |||
==Management== | ==Management== | ||
*Address A, B, C's | *Address A, B, C's | ||
| Line 28: | Line 29: | ||
==Disposition== | ==Disposition== | ||
*ICU | *ICU | ||
==See Also== | ==See Also== | ||
Revision as of 04:33, 6 June 2015
Background
- bleeding into retroperitoneal space
- difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners)
- can accumulate 4L blood before tamponade
Etiologies
- Trauma
- Leaking/ruptured AAA
- Iatrogenic (colonoscopy, cardiac catheterization)
- Spontaneous (coagulopathy)
- Hemorrhagic pancreatitis
Clinical Features
- May present with abdominal, flank or back pain
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Diagnosis
Must have high clinical suspicion to make diagnosis
- CT scan abdomen/pelvis
- FAST and DPL do not evaluate retroperitoneal space
Management
- Address A, B, C's
- Resuscitation with blood products
- Reverse coagulopathy
- Treat underlying etiology
Disposition
- ICU
See Also
External Links
References
- CURRENT Diagnosis and Treatment Emergency Medicine 7th ed