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Renal Truma Flashcards

1
Q

Most common GU organ involves in truma

A

65% kidneys

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2
Q

By which mechanism renal trauma?

A

Blunt trauma
Penetrating injuries ( abdomen back flank )
Deceleration injury

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3
Q

What you have see in
Hx
Ex
Investigation
Of renal trauma pt?

A

Hx: hematuria + flank pain

Ex: superficial wound
Ecchymosis on flank
Tenderness on abdomen or flank

Investigation:
x ray /
May show fracture in lower ribs or thoraco lumber
Hematocrit and urinalysis
CT / in high grade truma

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4
Q

Degree of heamaturia in 95% of pt?

A

> 5 rbc/hbf

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5
Q

25% of pt with gross hematuria have ?

A

Minor injuries

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6
Q

40% of serious renal injuries have ?

A

No hematuria

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7
Q

Stagging of renal trauma
How many grade ?

A

Grade 1 ,11, 111, 1V , V

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8
Q

Grade 1

A

• Sub capsular non expanding hematoma
• Renal contusion

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9
Q

Grade 11

A

•Perirenal hematoma non expanding
•Lacerations < 1 cm in renal cortex only
• No urinary extravasation

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10
Q

Grade 111

A

• Lacerations > 1cm involve renal paranchyma
• Intact collecting system
• No urinary extravasation

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11
Q

Grade 1V

A

• Lacerations: renal cortex, renal medulla , collecting system, renal pelvic .
• Extravasation of urine
• PUJ distribution
• Vascular injury ( segmental renal artery/ vein ) with haemorrhage

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12
Q

Grade V

A

• Shattered kidney
• Avulsion of renal hilum ( pedicle)
• Devasculrizes kidney

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13
Q

What’s are indications for renal imaging in renal trauma?

A

1) penetrating truma
2) gross hematuria
3) microscopic hematuria (>5-3 RBC / HPF) with heamodynamic instability (<90 SBP)
4) presistance microscope hematuria
5) sever deceleration injury
6) child with blunt trauma ( urinalysis >50 RBC /HPF)

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14
Q

Child look normotensive even in significant blood loss ?

A

Because they maintain a higher vascular tone and remain normotensive.

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15
Q

Imaging techniques and its advantages?

A

1) contrast enhanced CT :
Best and more accurate

2) IVP :
In operation room to show the function of contralateral kidney in hemodynamicaly un stable pt.

3) angiography:
In renal vascular injury
Therapeutic for embolism or stent injures arteries

4) US :
To look for free fluid in both kidneys

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16
Q

Management of renal trauma

A

We have two :
- emergency T ( ABCD , IV line , maintenance circulations, blood type cross matching)

  • definitive T :
    • conservative ( bed rest until hematuria resolv , monitoring of vital signs and hematocrit

• surgical

17
Q

Type of management of each grade?

A

Grade 1, 11 ( conservative)
Grade 111 , 1V ( if stable conservative, if not -> surgery)
Grade V ( surgery)

18
Q

Absolute indications for Surgery??

A

• Uncontrollable renal hemorrhage (hemorrhage
requires multiple blood transfusion)
• Multiply lacerated, shattered kidney
• Main renal vessels avulsed
• Penetrating injuries (usually)

19
Q

What are Types of ureteric injury?

A

1) itrogenic injury ( like pelvic operation, abdomen hysterectomy, uretroscopy)
2) penetrating injuries

20
Q

Complications of Renal Injuries!

A

1) Early complications : (within first six weeks)
❑ Hemorrhage/shock
❑ Sepsis/abscess
❑ ATN
2) Late complications :
❑ Renovascular hypertention

21
Q

Staging of Ureteric Injury

A

Grade I : Contusion or hematoma without devascularization

Grade II : laceration (< 50% transection)

Grade III : laceration ( 50% or more transection)

Grade IV : laceration (complete transection with < 2 cm devascularization)

Grade V : Avulsion from renal hilum with > 2 cm devascularization

22
Q

How could treat ureteric injury?

A

According to injury:

• For minor injuries (contusions or partial transections), percutaneous nephrostomy tube or
ureteric stent is needed.

• For major injuries (complete transection or avulsion), surgical repair by reconstructive
techniques is needed and it may include :
Ureteral reimplantation
End to end anastomosis over a stent
Boari flap, psoas hitch
ileal loop interposition
transuretero-ureterostomy
Autotransplantation

23
Q

Mechanisms of Urinary Bladder Trauma!

A

Blunt trauma : represent up to 85% of cases.
70-95% of patients with bladder injuries have pelvic fractures,
6-10% of patients with pelvic fractures have bladder injuries.

• Penetrating trauma

• Iatrogenic trauma : like in cystoscopy, cesarean section and hystroctomy.

24
Q

Types of rupture in bladder trauma?

A

• Extraperitoneal rupture :
It is the most common type of bladder rupture
It is associated with pelvic fracture in 89-100%

• Intraperitoneal rupture :
There is extravasation of urine into the abdomen, it can
result in urinary ascites.
This rupture can occur following steering wheel trauma
and a direct blow.

25
Symptoms of bladder injury?
Symptoms of bladder injury may include : 1) Lower abdominal pain 2) Gross hematuria in 98% of the cases 3) Inability to void 4) Acute Abdomen may occur in case of intraperitoneal bladder rupture.
26
the gold standard for the diagnosis of rupture of bladder? Other investigations?
Cystography: is the gold standard for the diagnosis of rupture of bladder .................................. Plain X-Ray: may show fractures of pelvis • CT scan : has the advantage of evaluating concomitant intra- abdominal injuries and pelvic fractures. CT Cystography : better than plain film cystography in evaluating small bladder perforations.
27
Staging of Bladder Injury?
Grade I : Contusion, partial thickness Grade II : Laceration extraperitoneal < 2cm Grade III : Laceration extraperitoneal > 2cm intraperitoneal < 2cm Grade IV : Intraperitoneal > 2cm Grade V : Laceration into bladder neck or trigone
28
Treatment of bladder rupture?
A. Emergency measures B. Definitive management : ▪ Extra-Peritoneal rupture : is treated conservatively by insertion of urethral catheter for 10 days. ▪ Intra-peritoneal rupture : Requires surgical repair by trans-peritoneal Approach.
29
Mechanism of urethral Injury?
• Most urethral injuries are due to blunt trauma • Often associated with pelvic fractures. • Rarely caused by penetrating trauma. • Occasionally iatrogenic.
30
Anatomy of urethra based on urogenital diaphragm?
Posterior : prostatic & membranous Anterior: bulbous & penile
31
Classified the urethral injury?
✔️ They are classified as ( contusion , partial distribution or complete disruption) ✔️ Or classified according to location anterior or posterior urethral disruption.
32
Note ممكن تجي mcq
Posterior Urethral disruption : • 80-90% occur in combination with pelvic fracture. • 10-25% of pelvic ring fractures disrupt posterior urethra as puboprostatic ligaments are torn or stretched. • Associated with bladder injuries and vaginal lacerations. Anterior Urethral Disruption : • Usually due to direct blunt force trauma such as straddle injury • Does not cause high riding prostate as injury is below the urogenital diaphragm • Urethral injury is present in 10-38% of penile fractures (rupture of one or both tunica albuginea, fibrous covering of corpus cavernosa)
33
Symptoms and signs of urethral injury?
Symptoms // • Abdominal/Perineal Pain • Difficult urination : females can present with incontinence Posterior : unable to urinate Anterior : urinate small amount of urine with pain Signs // • Gross hematuria • Blood at urethral meatus • Perineal swelling/ecchymosis • Vaginal lacerations in females • Inability to pass urinary catheter (gentle attempt) • Abnormal prostate exam : Absent High riding X rays // • Pelvic Fractures
34
What is the gold standard for diagnosis of urethral injury?
Retrograde urethrogram
35
What is the treatment of urethral injury and complications?
1) urethral catheterization : in case of contusion 2) suprapupic cystostomy and primary anastomosis in case of partial or complete disruptions Complications: Strictures,impotence,incontinence
36
Mechanism of testicular truma?
Penetrating truma Blunt truma
37
Symptoms of testicular trauma?
Symptoms : • pain • Nausea (particularly in cases of testicular torsion) • Bruising, swelling or discoloration of the scrotum • Blood in urine • Difficult urination • Fever
38
What is the diagnostic tool for testicular trauma and what the manegment?
Diagnosis : Color flow Doppler ultrasound Management : • Contusion : conservative management by rest, ice application, analgesia • Laceration, dislocation, rupture : operative management

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