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Renal > Trauma > Flashcards

Trauma Flashcards

1
Q

How many classes of renal injury are there?

A

5 (I - V)

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2
Q

What is class I renal injury

A

Haematoma, subcapsular, non-expanding, no parenchyman laceration

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3
Q

What is class II renal injury

A

Laceration <1cm perenchymal depth witjout urinary extravasation

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4
Q

What is class III renal injury

A

> 1cm depth, no collecting system rupture or extraversion

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5
Q

What is class IV renal injury

A

Laceration through cortex, medulla and collecting system, main arterial/venous injury with contained haemorrhage

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6
Q

What is class V renal injury

A

Shattered kidney, avulsion of hilum, devascularising kidney

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7
Q

What are some indications for CT with contrast in suspected renal injury

A
  • Frank haematuria in adult
  • Frank or occult haematuria in a child
  • Occult haematuria and systolic <90 mmHg at any point
  • Penetrating injurt with any degree with contrast
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8
Q

How are most cases of renal injury managed?

A

Angiography/embolisation (Non-surgical)W

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9
Q

What are some indications for surgery in renal injury?

A
  • Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma
  • Urinary extravasion, non-viable tissue, incomplete staging
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10
Q

What is the most common cause of bladder trauma?

A

Pelvic fracture

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11
Q

How will bladder injury usually present?

A
  • Suprapubic/abdominal pain + inability to void
  • Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds
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12
Q

What investigations are required in bladder injury?

A

Urinalysis
Retrograde urethrogram
CT cystography

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13
Q

What will be seen on CT cystography in extra-peritoneal injury?

A

Flame-shaped collection of contrast in the pelvis

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14
Q

How is bladder injury managed?

A
  • Large-bore catheter
  • Antibiotics
  • Repeat cystogram in 14 days
  • Immediate surgical repair indicated in some cases e.g. intraperitoneal injury, penetrating injury
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15
Q

What are some indications for immediate surgical repair in bladder injury?

A

Intraperitoneal injury
Penetrating injury

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16
Q

What is the most common cause of posterior urethral injury?

A

Fracture of the pubic rami

17
Q

What part of the posterior urethral is most vulnerable to trauma?

A

Post. urethra fixed at urogenital diaphragm and puboprostatic ligaments, so bulbomembranous junction most vulnerable

Junction where bulbous urethra and membranous urethra meet

18
Q

How does urethral injury present?

A
  • Blood at meatus
  • Inability to urinate
  • Palpably full bladder
  • ‘High-riding’ prostate
  • Butterfly perineal haematoma
19
Q

What is the main investigation used in urethral injury?

A

Retrograde urethrogram

20
Q

What are some indications for immediate surgical repair of urethral injury?

A
  • Intraperitoneal injury
  • Penetrating injury
  • Inadequate drainage or clots in urine
  • Bladder neck injury
  • Rectal or naginal injury
  • Open pelvic fracture
  • Pelvic fracture requiring open reduction/fixation
  • Patients undergoing laparotomy for other reasons
  • Bone fragments projecting into the bladder
21
Q

How is urethral injury usually managed?

A
  • Suprapubic catheter
  • Delayed reconstruction after at least 3 months
22
Q

What is the most common cause of penile fracture?

A

Typically happens during intercourse - buckling injury when penis slips out of vagina and strikes pubis

23
Q

How will penile fracture present?

A
  • Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
  • 20% evidence of urethral injury (frank haematuria/blood at meatus)
24
Q

How is penile fracture managed?

A
  • Prompt exploration and repair
  • Circumcision incision with degloving of penis to expose all 3 compartments
25
Q

How will testicular injury usually present?

A
  • Usually presents with pain and nausea
  • Swelling/bruising variable
26
Q

What investigations are required in testicular injury?

A

USS to assess integrity/vascularity

27
Q

How is testicular injury managed?

A

Early exploration/repair - better outcome

Renal (41 decks)

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