RPB

Question 1

What are the Zones of the RP?

Answer 1

Zone 1 upper midline RP from hiatus to bifurcation and laterally from hilum to hilum. subdivided into supramesocolic and inframesocolic. Axis, SMA/SMV, distal RV, prox RA, sepraceliac IVC, portal vein.

Zone 2 Lateral perinephric area. infrarenal aorta, infrarenal IVC

Zone 3 Pelvic RP from bifurcation inferiorly

Question 2

What are symptoms of RP hematoma?

Answer 2

non-specific groin/back or lower abdo pain

thigh pain or numbness/weakness from femoral nerve compression

Question 3

What are findings on exam of RP hematoma?

Answer 3

flank ecchymosis/hematoma-grey-turner
umbilicus hematoma-cullens
lower quad fullness on exam
flexion/external rotation of the hip with extension causing pain (from illipsoas spasm)
pain-paresthesias in antero-medial thigh (lat cutaneous branch fem nerve)

Question 4

What is the management?

Answer 4

conservative first
bed rest
reverse anticoagulants

Question 5

What are indications for intervention?

Answer 5

Neuro deficits
hemodynamic instability
ongoing bleeding
severe pain

Question 6

what are interventions?

Answer 6

endovascular, embolization

open evacuation?

Question 7

what are surgical approaches for evacuation?

Answer 7

supra-iguinal

groin

Question 8

what are RF for soon RPB?

Answer 8

HD, anticoagulants, bleeding abnormality

Heparin greater risk then warfarin

Question 9

what is the incidence of spontaneous vs iatrogenic RPB on anticoagulation?

Answer 9

spon 0.6-6% on anticoagulation
iatro 0.15-0.5 with fem cannulation
higher with bigger calibre