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Rosalynn's ABSITE > Retroperitoneal/urinary tract injuries > Flashcards

Retroperitoneal/urinary tract injuries Flashcards

1
Q

what is the weakest portion of the bladder?

A

The dome where the tracheal remnant fixes the bladder to the lower anterior abdominal wall

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2
Q

what parts of the bladder are covered by the peritoneal reflection?

A

dome and posterior bladder (can have intraperitoneal injury here)

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3
Q

which parts of the bladder are protected within the bony pelvis?

A

anterior wall, lateral wall, and base of the bladder (blow out injuries are less frequent, are typically from laceration by bony fragments from pelvic fx)

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4
Q

where are extraperitoneal bladder perforations from?

A

anterior wall, lateral wall, base of the bladder (no true peritoneal lining)

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5
Q

are a majority of bladder injuries blunt of sharp?

A

blunt

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6
Q

is injury to the anterior urethra usually blunt or penetrating?

A

both

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7
Q

is injury to the posterior urethra usually blunt of penetrating

A

blunt

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8
Q

How do you dx bladder trauma?

A

retrograde cystography (CT)

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9
Q

what does an extraperitoneal bladder rupture look like?

A

flame or sunburst contrast pattern

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10
Q

what does an intraperitoneal bladder rupture look like

A

outlining loops or filling the cul-de-sac

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11
Q

what is the treatment for intraperitoneal bladder perforations?

A

immediate repair

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12
Q

what is the treatment for uncomplicated extraperitoneal bladder perforations?

A

foley drainage

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13
Q

what is the treatment for complicated extraperitoneal bladder perforations?

A

repair at time of exploration for other injuries

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14
Q

how do you repair the bladder?

A

two layer, water tight closure, with absorbable sutures, foley drainage

no need for suprapubic tube as long as foley can go in

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15
Q

how should you treat urethral distraction injuries?

A

percutaneous suprapubic tube placement

once stable, can do primary realignment with cystoscopy and foley later

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16
Q

how should you treat penetrating anterior urethral injuries?

A

exploration, primary closure at time of injury with tension-free, watertight closure w/absorbable sutures, foley

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17
Q

how should you treat blunt anterior urethral injuries

A

prompt suprapubic tube placement or foley. Immediate operative repair or debridement is not recommended

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18
Q

when should you get a retrograde cystography after foley placement?

A

10-14 days

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19
Q

what is the MC long term complication of urethral injury?

A

stricture formation

20
Q

where does blood supply to the ureter come from?

A

the great vessels, medially in the abdominal ureter and laterally in the pelvic ureter

21
Q

what is the mc of injury to the ureter?

A

iatrogenic (ureteroscopy, hysteroscopy, colectomy)

22
Q

How do you dx a ureteral/renal injury?

A

IV enhanced CT (with delayed images for ureteral injury) with retrograde filling

23
Q

what is a grade I renal injury?

A

sub capsular hematoma without laceration or contusion

24
Q

what is a grade II renal injury?

A

non expanding perirenal hematoma, or lacerations <1 cm deep without urinary extravasation

25
Q

what is grade III renal injury?

A

parenchymal laceration >1 cm deep without collecting system injury

26
Q

what is a grade IV renal injury

A

laceration extending into the collecting system or vascular injury to the main hisar vessels with contained hemorrhage

27
Q

what is a grade V renal injury?

A

completely shattered parenchyma or avulsion of the renal hilum with devascularized kidney parenchyma

28
Q

Follow up CT for renal trauma should be done for?

A

grade IV-V injuries or w/clinical signs of complications such as fever, increased pain, distention

29
Q

medial hematoma suggests

A

vascular injury

30
Q

medial urinary extravasation suggests

A

ureteropelvic junction avulsion

31
Q

poor renal contrast enhancement suggests

A

artery laceration and or thrombus

32
Q

how do you repair a distal ureteral injury?

A

ureteroneocystostomy with or without posts hitch

33
Q

how do you repair a proximal ureteral injury (short segment)?

A

ureteroureterostomy

34
Q

how do you repair a proximal ureter injury (long segment)?

A

ureteroneocystostomy with posts hitch if possible, can also do Boari flap if ureter cannot be directly reimplanted into the bladder

35
Q

how should injuries at the ureteropelvic junction be managed?

A

dismembered pyeloplasty

36
Q

how to managed a ureteral injury in damage control surgery?

A

ureter can be ligated with post op nephrostomy tube or a ureteral stent can be inserted and externalized to drain urine outside the abdomen

37
Q

what is flank ecchymosis called?

A

Grey Turner sign

38
Q

what is umbilical ecchymosis called?

A

Cullen sign

39
Q

what is proximal thigh ecchymosis called?

A

Fox sign

40
Q

What is scrotal ecchymosis called?

A

Bryant sign

41
Q

How would you access the suprarenal inframesocolic aorta?

A

Left medial visceral rotation (Mattox maneuver)

42
Q

How would you access the infernal aorta?

A

reflect the mesocolon cephalic with evisceration of the small bowel to the right and incising through the retroperitoneum overlying the aorta

43
Q

how to get control of the infra hepatic and suprarenal IVC

A

kocher manuever

44
Q

How to control bleeding at the iliac vein bifurcation

A

division of the right common iliac artery (rare)

45
Q

how to treat an unstable patient with a renal artery transection with normal contralateral kidney?

A

nephrectomy

46
Q

can you do a renal vein ligation without nephrectomy on the left?

A

yes - collateral venous flow

47
Q

can you do a renal vein ligation without nephrectomy on the right?

A

no, must do nephrectomy either at index or second look surgery

Rosalynn's ABSITE (33 decks)

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