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Flashcards in Upper Urinary Tract Trauma Deck (59)
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1

The best indication of significant urinary system injury is gross hematuria. However, the absence of hematuria does/does not exclude a significant GU injury.

gross hematuria

does not

2

 2. Evaluation of urologic trauma in children differs from adults in that children: (3).

(1) are at greater risk for renal trauma,

(2) often do not become hypotensive with major blood loss, 

(3) have a higher propensity for renal anomalies.

3

Rapid deceleration from a fall from height or a high-velocity impact may result in injuries at points :

RAPID DECELERATIOn

points of fixation such as the ureteral pelvic junction and the renal hilum (renal artery intimal disruption).

4

. The degree of hematuria and the severity of renal injury are/are not consistently correlated. 

The degree of hematuria and the severity of renal injury are not consistently correlated. 

5

Criteria for radiologic imaging include (5)

 

 

(1) all penetrating trauma,

(2) high-impact rapid deceleration trauma,

(3) all blunt trauma with gross hematuria,

(4) all blunt trauma with microhematuria and hypotension, and

(5) pediatric patients with hematuria.

6

TF Adult patients with microscopic hematuria without shock may be observed without imaging studies.
 

true microscopic hematuria

7

 Findings suggestive of a major renal injury on CT include: (5)

1. MEDIAL LACERATION

2. PERINEPHRIC HEMATOMA SIZE

3. INTRAVASCULAR CONTRAST EXTRAVASATION

4. MEDIAL URINARY EXTRAVASATION

5. DEVITALIZED RENAL FRAGMENTS

8

TF Nonoperative management for renal injuries is preferred in the hemodynamically stable patient, particularly with grades I to III renal injuries.

TRUE

9

Exploration of low-velocity renal gunshot wounds is not mandatory in selected cases. Such patients with isolated __ with stable and contained h___ who are hemodynamically stable, with no ____ injury, may be observed expectantly.

renal parenchymal lacerations

hematomas

no intra-abdominal organ injury

10

 10. Absolute indications for renal exploration are: (4)

 

(1) hemodynamic instability with shock

(2) expanding or pulsatile hematoma,

(3) suspected renal pedicle avulsion, 

(4) uncontained retroperitoneal hematoma.

11

relative indications for intervention for renal trauma:   perinephric ___ size, intravascular ___, ___ renal fragments, arterial ___, and ___ contrast extravasation

Perinephric hematoma size, intravascular contrast extravasation, devitalized real fragments, renal thrombosis

12

__ is the management technique of immediate control of bleeding, and fecal and urinary leak only, in the unstable patient. ___ is deferred until the patient is stable and fully resuscitated. For ureter injuries this entails __,__, __ and __.

 

At a staged/planned laparotomy, the ureter is __

“Damage control” is the management technique of immediate control of bleeding, and fecal and urinary leak only, in the unstable patient. Definitive reconstruction is deferred until the patient is stable and fully resuscitated. For ureter injuries this entails ligation and nephrostomy, externalizing, or stenting. At a staged/planned laparotomy, the ureter is later repaired.

13

___ - Hypertension from renal parenchymal injury

PAGE KIDNEY- Hypertension from renal parenchymal injury

14

When repairing ureteral injuries, the ureteral tissue should be debrided back to a __ to remove all ___.

When repairing ureteral injuries, the ureteral tissue should be debrided back to a bleeding-edge to remove all traumatized microvascular damaged tissue. 

15

 T/F Placement of vascular graft aneurysms in proximity of the ureter may cause a periureteral inflammatory reaction and ureteral injury/stenosis.

TRUE,be cautious when placing vascular grafts near ureter!!!

16

Ureteral injuries to the proximal and mid ureter can often be managed by __. The gap being bridged is based on ureter ___ and ___.

URETROURETEROSTOMY

MOBILIZATION AND ITS ELASTICITY

17

In the stable trauma patient, distal ureteral injuries should be ___ into the bladder. In select cases, a ___ can be considered. If the gap is large, then __ or ___ is the better management.

In the stable trauma patient, distal ureteral injuries should be reimplanted into the bladder. In select cases, a ureteroureterostomy can be considered. If the gap is large, then psoas hitch or Boari bladder flap is the better management.

18

For delayed ureteral injury, the best diagnostic radiographic test (in the stable patient) to confirm injury, is a ___

RETROGRADE UROGRAM

19

Ureteral transections should be repaired ___ of the injury, or the repair should be delayed for___

WITHIN A WEEK

6 weeks or more

20

It is prudent to isolate the ureteral repair from other injured organs (such as colon) with  __ and __

OMENTUM OR PERITONEUM

21

Ureteral injury noted during ureteroscopy should be managed by ___. When a stent cannot be placed or inadequately diverts the urine, then a ___should be placed.
 

ureteral stent placement

nephrostomy tube

22

Ureteral injury occurring during vascular surgery should be repaired and ___ from the graft with normal tissue such as __.

Ureteral injury occurring during vascular surgery should be repaired and isolated from the graft with normal tissue such as omentum.

23

The basic mechanisms for arterial hypertension as a complication of trauma are (1) renal vascular injury, leading to stenosis or occlusion of the ___ or one of its branches (__ kidney)

(2) compression of the renal parenchyma with extravasated blood or urine (___ kidney); 

(3) post-trauma ___ fistula.

In these instances, the ___ axis is stimulated by ___, resulting in hypertension

GOLDBLATT KIDNEY -> stenosis or occlusion of the MAIN RENAL ARTERY or one of its branches

PAGE KIDNEY--> Compression of the renal parenchyma with extravasated blood or urine

Post trauma arteriovenous fistula

In these instances, the reninangiotensin axis is stimulated by partial renal ischemia, resulting in hypertension

 

24

40 / M Blunt injury, noted hematuria (microscopic) then on BP <90 SBP--> abdominal exloration done, on assesment of retroperitoneal hemtoma noted pulsatile hematoma --> next process

RENAL EXPLORATION INDICATED

25

 The indications are uncommon for shot ivp is uncommon, such as
surgeon encounters an ___ hematoma surrounding a kidney during abdominal exploration in an ___ patient without a ___, and are contemplating renal exploration or nephrectomy.

unexpected retroperitoneal

UNSTABLE TRAUMA

CT SCAN

26

The main purpose of the one-shot IVP is to assess the presence of a functioning contralateral kidney.

functioning contralateral kidney

27

ONE SHOT IVP Only a single film is taken 10 minutes after IV injection (IV push) of 2 mL/kg of contrast material. The study can also be helpful in assessing for ____extravasation. If the study is normal, exploration of the injured side may ___. If findings are not near normal, ___  is recommended or the kidney explored to complete the ___

10 minutes

2 mL/kg of contrast material

may be avoided

further imaging

staging of the injury

28

Anterior axillary line injury --> possible damage to : ___

(renal hilum and pedicle)

29

•Posterior axillary line --> __

parenchymal renal injury

30

<1 cm parenchymal depth laceration of renal cortex without urinary extravasation on bilateral kidneys

grade 3! Grade 2 ang injury but...

ALWAYS ADVANCE ONE STAGE FOR BILATERAL INJURIES