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Y4R4 - Surgery II 👨‍⚕️ > L6: Upper Urinary Tract Trauma > Flashcards

L6: Upper Urinary Tract Trauma Flashcards

1
Q

Renal Arterial Supply

A
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2
Q

Protection of the kidney against trauma

A
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3
Q

Remember “ABCDE” priorities, In this order of importance

A
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4
Q

Incidence of Upper Urinary Tract Trauma

A
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5
Q

Predisposing Factors for Renal trauma

A
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6
Q

why is Renal trauma more common in children?

A

More common in children, why?
- Weak support.
- Relative larger sized kidney.

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7
Q

Types of Renal trauma

A
  • Blunt
  • Penetrating
  • Iatrogenic
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8
Q

Mechanism of Blunt Renal Trauma

A
  1. Direct transmission of kinetic energy (blow): Sports, assaults.
  2. Rapid deceleration forces: Falling from a height, Motor car accident
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9
Q

Criteria of Blunt Renal Trauma

A
  1. Usually of minor degree.
  2. Conservative ttt is usually successful.
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10
Q

Sites of Blunt Renal Trauma

A

Major renovascular injuries occur at the point of fixation in the retroperitoneum:

  • Renal pedicle.
  • UPJO.
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11
Q

Results of Blunt Renal Trauma

A
  • Renal artery thrombosis.
  • Disruption of the renal vein.
  • or Avulsion of the renal pedicle.
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12
Q

Causes of Penetrating Renal Trauma

A

Gunshot (majority of penetrating trauma), and stab wound.

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13
Q

Criteria of Penetrating Renal Trauma

A
  • Higher degree of renal damage.
  • Usually associated with other organ injuries.
  • Surgical exploration is usually necessary.
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14
Q

Penetrating Renal Trauma

  • Stab Wounds
A
  • Induce both renovascular and parenchymal injuries.
  • Common entry sites of stabs:
    A. Flank.
    B. Upper abdomen.
    C. Lower chest.
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15
Q

Iatrogenic Injuries

  • Causes
A
  • Open Surgery: Nephrolithotomy.
  • Endoscopic: PCNL
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16
Q

Grading of Renal Trauma

  • Based on
A

contrast-enhanced CT

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17
Q

Grading of Renal Trauma

  • Grade I
A

Contusion or Nonexpanding subcapsular hematoma.

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18
Q

Grading of Renal Trauma

  • Grade II
A

1) Non-expanding perirenal haematoma.

2) Cortical laceration:
- Grade Il
- < 1 cm depth.
- No urinary extravasation.

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19
Q

Grading of Renal Trauma

  • Grade III
A

Cortical laceration:
- > 1 cm depth.
- No urinary extravasation.

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20
Q

Grading of Renal Trauma

  • Grade IV
A
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21
Q

Grading of Renal Trauma

  • Grade V
A
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22
Q

Grading of Renal Trauma

  • Major Trauma
A

Major trauma → (Grade IV and V).

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23
Q

Grading of Renal Trauma

  • Illustration
A
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24
Q
A
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25
Q

Complications of Renal Trauma

A
  • Early
  • Late
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26
Q

Complications of Renal Trauma

  • early
A

1) Hemorrhagic shock.

2) Perienal urinoma or heamatoma.

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27
Q

Complications of Renal Trauma

  • Late
A
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28
Q

CP of Renal Trauma

A
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29
Q

CP of Renal Trauma

  • Hx
A

1) Trauma to back / flank / lower thorax / upper abdomen.
2) Falling from height, Motor car accident.
3) Gun shot, stab.

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30
Q

CP of Renal Trauma

  • Symptoms
A

1) Hematuria: in 90% of cases.
2) Flank pain.
3) Shock.

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31
Q

CP of Renal Trauma

  • Signs
A

1) Signs of hemorrhagic shock.
2) Contusions over the flanks.
3) Fracture of the last rib.
4) Diffuse abdominal tenderness.
5) Flank mass (Hematoma, urinoma, other masses).

32
Q

Causes of Renal Trauma without hematuria

A

1) Superficial Injury.
2) Thrombosed renal artery
3) Ureter obstruction by clot.
4) Avulsed renal pedicle.

33
Q

Precautions for Children in Renal Trauma

A
  • Children with sustained blunt trauma should be evaluated thoroughly.
  • Children secrete high catecholamine in response to trauma.
  • This maintains the ABP until nearly 50% of the blood volume has been lost.
34
Q

Dx of Renal Trauma

A
  • CT Scan (Pre & Post Contrast)
  • IVU
  • Angiography
  • US
35
Q

Dx of Renal Trauma

  • CT Scan
A
36
Q

CT scan in Renal Trauma

  • What is the study of choice?
A

CT is the study of choice (Gold standard) in renal trauma.

37
Q

CT scan in Renal Trauma

  • Advantages
A
38
Q

CT scan in Renal Trauma

  • what does Imaging Show
A
39
Q

CT scan in Renal Trauma

  • Findings suggestive of major injury
A
40
Q

IVU in Renal Trauma

A
41
Q

IVU in Renal Trauma

  • Sensitivity in penetrating injury
A

Very Poor

42
Q

IVU in Renal Trauma

  • Limitations
A
43
Q

IVU in Renal Trauma

  • Single shot IVP
A
44
Q

Selective renal artery angiography & embolization in Renal Trauma

A
45
Q

Selective renal artery angiography & embolization in Renal Trauma

  • Indications
A
46
Q

Renal US in Renal Trauma

A
47
Q

Renal US in Renal Trauma

  • Indications
A
48
Q

TTT of Renal Trauma

A
  • Emergency TTT
  • Conservative TTT
  • Surgical TTT
49
Q

TTT of Renal Trauma

  • Emergency Measures
A
50
Q

TTT of Renal Trauma

  • Actual TTT
A
51
Q

TTT of Renal Trauma

  • conservative TTT
A
52
Q

Conservative TTT of Renal Trauma

  • Indications
A
53
Q

Conservative TTT of Renal Trauma

  • Method
A
54
Q

Surgical TTT of Renal Trauma

A
55
Q

Surgical TTT of Renal Trauma

  • Indications
A
56
Q

Surgical TTT of Renal Trauma

  • Surgical Options
A
57
Q

Technique for renorrhaphy

A
58
Q

Grade-Guided TTT of Renal Trauma

A
59
Q

Grade-Guided TTT of Renal Trauma

  • Grade I,II,III
A

Conservative treatment is usually successful.

60
Q

Grade-Guided TTT of Renal Trauma

  • Grade IV
A
  • Conservative: if hemodynamically stable.
  • Surgery: if unstable or due to penetrating trauma.
61
Q

Grade-Guided TTT of Renal Trauma

  • Grade V
A

Surgery

62
Q

90% Rule in Renal Trauma

A
63
Q

Types of Ureteral Trauma

A
64
Q

Types of Ureteral Trauma

  • Iatrogenic
A
65
Q

Types of Ureteral Trauma

  • Traumatic
A
66
Q

CP of Ureteral Trauma

A
67
Q

CP of Ureteral Trauma

  • intraoperative
A

Urine leakage in the operative field (clear fluid).

68
Q

CP of Ureteral Trauma

  • Early post-operative
A
69
Q

CP of Ureteral Trauma

  • Late postoperative
A
  1. Urinary fistula.
  2. Hydronephrosis due to ureteric stricture.
  3. Renal function impairment.
70
Q

Complictions of Ureteral Trauma

A
71
Q

INVx for Ureteral Trauma

A
72
Q

INVx for Ureteral Trauma

  • CT
A
73
Q

INVx for Ureteral Trauma

  • IVU
A
  1. Hydroureteronephrosis.
  2. No contrast excretion.
  3. Contrast extravasation.
74
Q

INVx for Ureteral Trauma

  • retrograde ureterography
A
75
Q

TTT of Ureteral Trauma

A
76
Q

Summary of Upper Urinary tract Trauma

A

Y4R4 - Surgery II 👨‍⚕️ (21 decks)

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