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Campbell 2021 > 90 Upper Urinary Tract Trauma (Campbell 12th) > Flashcards

90 Upper Urinary Tract Trauma (Campbell 12th) Flashcards

1
Q

Most commonly injured urologic organ from external trauma.

A

Kidney

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2
Q

Management of the majority of blunt and select penetrating injuries to the kidney.

A

Non-operative

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3
Q

Absolute indications for immediate renal intervention

A

Hemodynamic instability with no or transient response to resuscitation

Pulsatile or expanding retroperitoneal hematoma

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4
Q

Most important information to obtain in the history of blunt renal injury

A

Mechanism of injury

- the kidney is particularly vulnerable to deceleration injury

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5
Q

What happens to the kidney with significant deceleration?

A
  • tear at the retroperitoneal points of fixation (hilum, upj) –> renal artery thrombosis, renal vein disruption, renal pedicle avulsion, upj disruption
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6
Q

How do high velocity wounds injure the kidneys without directly hitting them?

A

Blast effect –> causing delayed tissue necrosis.

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7
Q

What structures are injured in stab wounds on the anterior axillary line?

A

Renal hilum

Renal pedicle

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8
Q

What structures are injured in stab wounds on the posterior axillary line?

A

Renal parenchymal injury

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9
Q

Indicators of possible renal injury on PE

A 
Flank ecchymoses
Abdominal or flank tenderness
Rib fractures
Significant blow to the flank
Penetrating injuries to the low thorax or flank
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10
Q

How many times does the risk of renal injury increase when there is ipsilateral rib fracture?

A

Threefold

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11
Q

Best indicators of significant urinary system injury

A

Gross and microscopic hematuria (>5 RBC/HPF or positive dipstick finding)

– especially when associated with acceleration/deceleration injury, penetrating trauma, hypotension at the ER (SBP <90)

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12
Q

The degree of hematuria and severity of the renal injury CONSISTENTLY CORRELATE.

True or false?

A

False

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13
Q

How do you collect urine samples in trauma patients?

A

Collect the FIRST ALIQUOT OF URINE OBTAINED BY CATHETERIZATION OR VOIDING.

Later urine samples may be diluted by diuresis from resuscitation fluids.

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14
Q

Will a very faint hint of pink be regarded as gross hematuria in trauma patients?

A

YES.

Any degree of visible blood in the urine is regarded as gross hematuria.

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15
Q

How is microscopic hematuria determined?

A

Dipstick or microanalysis.

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16
Q

Sensitivity and specificity of the dipstick method in determining microhematuria

A

97%

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17
Q

The presence or absence of hematuria should not be the sole determinant in the assessment of a patient with suspected renal trauma.

True or false

A

True

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18
Q

AAST Grade of:

Completely shattered kidney

A

V

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19
Q

AAST Grade of:

Avulsion of renal hilum, devascularizing the kidney

A

V

20
Q

AAST Grade of:

Main renal artery or vein injury with contained hemorrhage

A

IV

21
Q

AAST Grade of :

Parenchymal laceration EXTENDING THROUGH THE RENAL CORTEX, MEDULLA, AND COLLECTING SYSTEM.

A

IV

22
Q

AAST Grade of:

> 1 cm parenchymal depth of renal cortex injury WITHOUT COLLECTING SYSTEM RUPTURE or WITHOUT URINARY EXTRAVASATION

A

III

23
Q

AAST Grade of:

<1 cm parenchymal depth of renal cortex WITHOUT URINARY EXTRAVASATION

A

II

24
Q

AAST Grade of:

NONEXPANDING PERIRENAL HEMATOMA confined to the renal retroperitoneum

A

II

25
Q

AAST Grade of:

Microscopic or gross hematuria but with normal urologic studies

A

I

26
Q

AAST Grade of:

Subcapsular, nonexpanding hematoma without parenchymal laceration

A

I

27
Q

5 indications for renal imaging in trauma (AUA and EAU 2014 based pa tong sa Campbell)

A
  1. Penetrating trauma with a likelihood of renal injury (abdomen, flank, ipsilateral rib fracture, significant flank ecchynmosis, or low chest entry/exit wound) who are hemodynamically stable enough to have a CT.
  2. All patients with BLUNT TRAUMA with significant acceleration/deceleration mechanism of injury (specifically rapid deceleration), as would occur in a high speed MVA or fall from heights
  3. Blunt trauma + gross hematuria
  4. Blunt trauma + microhematuria AND hypotension (SBP <90 at any time during evaluation and resuscitation)
  5. ALL pediatric patients >5 RBC/HPF
28
Q

Preferred imaging test for renal trauma

A

Abdominal/pelvic CT using IV contrast with immediate and delayed images.

29
Q

Can patients with microscopic hematuria be observed only?

A

Yes. As long as they don’t or didn’t have hypotension.

30
Q

True or false:

Penetrating injuries of ANY DEGREE OF HEMATURIA should be imaged.

A

True.

31
Q

Why do children have higher risk for renal trauma?

A 
Larger kidney size
Less perirenal fat
Non-ossified bones
Less relative rib coverage
Higher proportion of congenital renal abnormalities (severe hydronephrosis or UPJO)
32
Q

Why do children often do not become hypotensive with major blood loss?

A

Children have a high catecholamine output after trauma, which maintains blood pressure until approximately 50% of blood volume has been lost.

33
Q

What does lack of uptake of contrast material in the parenchyma suggest in the context of renal trauma?

A

Arterial thrombosis or transection

34
Q

How many seconds after contrast injection is the nephrogenic phase?

A

80 seconds

35
Q

In what phase of the CT scan can one identify parenchymal and collecting system injuries?

A

Delayed phase (10-15 mins after injection of contrast)

36
Q

CT findings that may indicate major renal injuries

A
  1. Medial hematoma - vascular injury
  2. Medial urinary extravasation - renal pelvis or UPJ avulsion
  3. Global lack of parenchymal enhancement - renal artery occlusion
  4. Combination of two or more of the following:
    - large hematoma greater than 3.5 cm
    - medial renal laceration
    - vascular contrast extravasation (brisk bleeding)
37
Q

Major limitation of CT in renal injury imaging

A

Inability to define a renal venous injury adequately

38
Q

How do you spot venous injury in CT scans of renal injury patients?

A

Normal arterial perfusion
Normal parenchyma
Normal delayed phase (collecting system)

but with medial hematoma

39
Q

Scenario where a “one shot IVP” is warranted

A

When the surgeon encounters an UNEXPECTED RETROPERITONEAL HEMATOMA surrounding a kidney during ex-lap in an UNSTABLE trauma patient, WITHOUT a previous CT — AND, are contemplating renal exploration or nephrectomy.

40
Q

The main purpose of the one shot IVP

A

To assess the presence of a functioning contralateral kidney.

41
Q

Explain the one shot IVP technique

A

A single film is taken 10 minutes after IV push of 2 mL/kg of contrast material.

42
Q

Dose of contrast material in one-shot IVP

A

2 mL/kg

43
Q

FAST is limited in what situations?

A

Obese patients
Subcutaneous emphysema
Prior abdominal oeprations

44
Q

What grades of renal injuries can nonoperative management be done in patients who are hemodynamically stable?

A

I to IVa

45
Q

If “carefully staged and selected” can grade IV and V renal injuries be observed?

A

Yes.

46
Q

What type of stab or gunshot wounds to the kidney can be managed nonoperatively?

A

Those isolated only to the kidney only.

47
Q

The only absolute intraoperative indication for kidney exploration

A

A pulsatile and expanding retroperitoneal hematoma that suggests a life-threatening renal artery laceration.

Campbell 2021 (3 decks)

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