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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
Complications of **Renal Trauma**
- Early - Late
26
Complications of **Renal Trauma** - early
1) Hemorrhagic shock. 2) Perienal urinoma or heamatoma.
27
Complications of **Renal Trauma** - Late
28
CP of **Renal Trauma**
29
CP of **Renal Trauma** - Hx
1) Trauma to back / flank / lower thorax / upper abdomen. 2) Falling from height, Motor car accident. 3) Gun shot, stab.
30
CP of **Renal Trauma** - Symptoms
1) Hematuria: in 90% of cases. 2) Flank pain. 3) Shock.
31
CP of **Renal Trauma** - Signs
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
Causes of Renal Trauma without hematuria
1) Superficial Injury. 2) Thrombosed renal artery 3) Ureter obstruction by clot. 4) Avulsed renal pedicle.
33
Precautions for Children in **Renal Trauma**
- 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
Dx of **Renal Trauma**
- CT Scan (Pre & Post Contrast) - IVU - Angiography - US
35
Dx of **Renal Trauma** - CT Scan
36
CT scan in **Renal Trauma** - What is the study of choice?
CT is the study of choice (Gold standard) in renal trauma.
37
CT scan in **Renal Trauma** - Advantages
38
CT scan in **Renal Trauma** - what does Imaging Show
39
CT scan in **Renal Trauma** - Findings suggestive of major injury
40
IVU in **Renal Trauma**
41
IVU in **Renal Trauma** - Sensitivity in penetrating injury
Very Poor
42
IVU in **Renal Trauma** - Limitations
43
IVU in **Renal Trauma** - Single shot IVP
44
**Selective renal artery angiography & embolization** in **Renal Trauma**
45
**Selective renal artery angiography & embolization** in **Renal Trauma** - Indications
46
**Renal US** in **Renal Trauma**
47
**Renal US** in **Renal Trauma** - Indications
48
TTT of **Renal Trauma**
- Emergency TTT - Conservative TTT - Surgical TTT
49
TTT of **Renal Trauma** - Emergency Measures
50
TTT of **Renal Trauma** - Actual TTT
51
TTT of **Renal Trauma** - conservative TTT
52
Conservative TTT of **Renal Trauma** - Indications
53
Conservative TTT of **Renal Trauma** - Method
54
Surgical TTT of **Renal Trauma**
55
Surgical TTT of **Renal Trauma** - Indications
56
Surgical TTT of **Renal Trauma** - Surgical Options
57
Technique for renorrhaphy
58
Grade-Guided TTT of **Renal Trauma**
59
Grade-Guided TTT of **Renal Trauma** - Grade I,II,III
Conservative treatment is usually successful.
60
Grade-Guided TTT of **Renal Trauma** - Grade IV
- Conservative: if hemodynamically stable. - Surgery: if unstable or due to penetrating trauma.
61
Grade-Guided TTT of **Renal Trauma** - Grade V
Surgery
62
90% Rule in **Renal Trauma**
63
Types of **Ureteral Trauma**
64
Types of **Ureteral Trauma** - Iatrogenic
65
Types of **Ureteral Trauma** - Traumatic
66
CP of **Ureteral Trauma**
67
CP of **Ureteral Trauma** - intraoperative
Urine leakage in the operative field (clear fluid).
68
CP of **Ureteral Trauma** - Early post-operative
69
CP of **Ureteral Trauma** - Late postoperative
1. Urinary fistula. 2. Hydronephrosis due to ureteric stricture. 3. Renal function impairment.
70
Complictions of **Ureteral Trauma**
71
INVx for **Ureteral Trauma**
72
INVx for **Ureteral Trauma** - CT
73
INVx for **Ureteral Trauma** - IVU
1. Hydroureteronephrosis. 2. No contrast excretion. 3. Contrast extravasation.
74
INVx for **Ureteral Trauma** - retrograde ureterography
75
TTT of **Ureteral Trauma**
76
Summary of **Upper Urinary tract Trauma**

Y4R4 - Surgery II 👨‍⚕️ (33 decks)

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