RPB Flashcards
What are the Zones of the RP?
Zone 1 upper midline RP from hiatus to bifurcation and laterally from hilum to hilum. subdivided into supramesocolic and inframesocolic. Axis, SMA/SMV, distal RV, prox RA, sepraceliac IVC, portal vein.
Zone 2 Lateral perinephric area. infrarenal aorta, infrarenal IVC
Zone 3 Pelvic RP from bifurcation inferiorly
What are symptoms of RP hematoma?
non-specific groin/back or lower abdo pain
thigh pain or numbness/weakness from femoral nerve compression
What are findings on exam of RP hematoma?
flank ecchymosis/hematoma-grey-turner
umbilicus hematoma-cullens
lower quad fullness on exam
flexion/external rotation of the hip with extension causing pain (from illipsoas spasm)
pain-paresthesias in antero-medial thigh (lat cutaneous branch fem nerve)
What is the management?
conservative first
bed rest
reverse anticoagulants
What are indications for intervention?
Neuro deficits
hemodynamic instability
ongoing bleeding
severe pain
what are interventions?
endovascular, embolization
open evacuation?
what are surgical approaches for evacuation?
supra-iguinal
groin
what are RF for soon RPB?
HD, anticoagulants, bleeding abnormality
Heparin greater risk then warfarin
what is the incidence of spontaneous vs iatrogenic RPB on anticoagulation?
spon 0.6-6% on anticoagulation
iatro 0.15-0.5 with fem cannulation
higher with bigger calibre
