230 - GU trauma Flashcards Preview

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Flashcards in 230 - GU trauma Deck (17)
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1

What is the best test to assess a bladder injury?

Cystogram

Helps distinguish between intra and extraperitoneal bladder injury

 

Repair intraperitoneal, catheterize and observe if extraperitoneal

2

What is the best first diagnostic test if a patinet presents with blood at the urethral meatus?

Retrograde urethrogram (RUG)

3

When should retrograde urethography (RUG) be performed?

If there is blood at the urethral meatus

 

Do this before attempting catheterization following urethral trauma

4

What is the best imaging method to evaluate the testis?

Ultrasound

5

What is the possible complication following penetrating penile trauma?

Stricture development

6

What is the appropriate management of anterior urethral injury following blunt trauma?

What about posterior urethral injury??

  • Anterior
    • Immediate repair
  • Posterior
    • Place a suprapubic catheter
    • Delay repair

 

Surgical exploration + repair indiciated following any penetrating trauma 

7

What is the appropriate managment of intraperitoneal bladder injury?

What about extraperitoneal?

Intraperitoneal -> repair!

Extraperitoneal -> Catheter drainage, let it heal
Unless:
Surgery if injury to bladder neck, vaginal, rectum, bone fragments, or large defect

 

Use cystogram to differentiate between the two

8

After suspected renal trauma, is further imaging warranted in this case?

 

Microscopic hematuria in a 6 year old, hemodynamically stable pt following a bicycle accident

Yes

 

Imaging with any hematuria in pediatric patients

9

What is the most common cause of ureteral injury?

Penetrating injury (80-90% due to gunshot wound)

Blunt injury due to MVA

 

Ureteral injury is generally rare, and if it happens there are usually other life-threatinging things to deal with first

10

What is the appropriate management if penile fracture is suspected?

Surgical exploration (promptly!)

 

US or MRI only needed if dignosis is unclear after history and physical

11

What is the most significant risk factor for posterior urethral injury?

Pelvic fracture

 

Fractured pubic bone and anchored prostate tear away from membranous urethra

12

What is the best imaging method for evaluating suspected ureteral injurY?

CT with IV contrast

 

Note: These pts will usually have other life-threatening injuries bc ureteral trauma is usually caused by severe deceleration injury or penetrating injury (ex: gunshot wound)

13

What is the appropriate management of suspected testis rupture?

Surgical exploration and repair

 

Imaging only if diagnosis unclear after history and physical

14

What are the aboslute indicateions for renal exploration following trauma?

Note: Renal exploration saves the person, not the kidney

  • Life threatening bleeding
  • UPJ Rupture
  • Renal pedicle avulsion
  • Expanding retroperitoneal hematoma

 

 

Thank you @Ben Gastevich!

 

15

After suspected renal trauma, is further imaging warranted in this case?

 

Penetrating tauma, but no hematuria

Yes

 

Do imaging with ANY penetrating trauma

16

After suspected renal trauma, is further imaging warranted in this case?

 

No gross or microscopic hematuria following a MVA in which the pts car crashed into a highway barrier

Yes

 

Do imaging following any deceleration injury

17

After suspected renal trauma, is further imaging warranted in this case?

 

Microhematuria, hemodynamically stable afer blunt trauma

No