《肾损伤》ppt课件

Enhanced CT scan
➢ Abdominal CT scan is the most direct and effective means of staging renal injuries
➢ Clearly defines parenchymal lacerations and urinary extravasation
➢ Invasive , choose carefully
Others
➢ Retrograde urography : dangerous with infection, should not be chosen
➢ MRI: noninvasive, as an alternate choice
Summary
1. Types of kidney injury? 2. The simplest and the best checks are? 3. Non-operative treatment of kidney trauma? 4. Surgical Indicationgs of kidney trauma? 5. Long - term complications of renal injury? 6. Others about Urinary Trauma?
Thank You
Severe blunt injuries:
Deep laceration Multiple laceration Renal pedicle injuries
[ Persistent retroperitoneal bleeding , Severe urinary extravasation ]
Traffic accidents, fights, falling, contact sports, and so on.
Blunt trauma: The force transmitted from the center of the impact to the renal parenchyma
Operation indications During non-operation treatment : Anti-Shock ineffective, or shock occurance
again Hematuria get more severe Mass of abdominal enlarged Hemoglobin and hematocrit keep decreasing Suspicious of Abdominal organ injury
Kidney Trauma
Department of Urology The People's Hospital of Youyang County Junhui Shi
Directory
Background Anatomy Etiology Pathology Clinical findings Treatment Summary
Treatment
Emergency measures Resuscitation Treatment of shock and hemorrhage Evaluation associated injuries
Minor renal injuries from blunt trauma account for 85% of cases do not require operation
Clinical findings
History of trauma Symptoms: ➢ Pain may be localized to one flank area or
over the abdomen associated to injury ➢ Microscopic or gross hematuria following
Deep lacerations ➢ Injuries extend both
renal capsule and collecting system ➢ Extravasation of urine into perirenal space ➢ Large retroperitoneal hematoma ➢ Hematuria
*Pathology
Renal contusion (85% of cases)
➢ Superficial cortical lacerations
➢ Subcapsular hematoma
Partial lacerations ➢ Injuries extend to renal
capsule or collecting system ➢ Perirenal hematoma ➢ Hematuria
Background
Function of the kidney Produce urine, excrete metabolites Maintain body fluid and acid-base balance Endocrine function: Renin, prostaglandin… Regulate blood pressure and balance blood
lipids Endocrine degrading hormone
Background
Injuries to urinary system About 10% of all injuries in the emergency
room involve the genitourinary system Many of them are difficult to define Early diagnosis is essential to prevent serious
Ur
The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly
Etiology
Blunt trauma directly to the abdomen, flank, or back is the most common mechanism for 80~85% renal injuries
Deceleration: The kidney moves upward or downward,cause sudden stretch on the pedicle, acute renal artery injuries and thrombosis may occur
Direct or indirect violence at upper abdomen or flank area may cause kidney injure
hemostasis
Operation indications Penetrating injuries:
(Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure)
trauma to the abdomen or flank ➢ Fever : infection
Signs ➢ Shock or signs of a large loss of blood from
heavy retroperitoneal bleeding may be noted ➢ Palpable mass may represent a large
Vascular injury (less than 1% ) ➢ Vascular injury of renal
pedicle is rare ➢ Difficult to diagnosis ➢ Emergency operation
should be done for saving life ➢ Mortality is still high
➢ Renal contusion ➢ Partial laceration
*Non-operative treatment Bed rest for 2~4 weeks Watchful waiting : vital signs, blood, urine Hydration and nutrition Antibiotics for prevent infection Symptomatic therapy：analgesic, sedative,
Venous phase
Arterial phase
Excretory period
Radiology Arteriography ➢ Defines major arterial and
parenchyma injuries ➢ Arterial thrombosis and
avulsion of the renal pedicle are best diagnosis
Gunshot and knife wounds cause penetrating injuries to the kidney
Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculature
➢ First choice for diagnosis renal injuries
Plain scanning period Venous phase Portal venous phase Arterial phase Excretory period
Plain scanning period