Trauma Flashcards
How many classes of renal injury are there?
5 (I - V)
What is class I renal injury
Haematoma, subcapsular, non-expanding, no parenchyman laceration
What is class II renal injury
Laceration <1cm perenchymal depth witjout urinary extravasation
What is class III renal injury
> 1cm depth, no collecting system rupture or extraversion
What is class IV renal injury
Laceration through cortex, medulla and collecting system, main arterial/venous injury with contained haemorrhage
What is class V renal injury
Shattered kidney, avulsion of hilum, devascularising kidney
What are some indications for CT with contrast in suspected renal injury
- 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
How are most cases of renal injury managed?
Angiography/embolisation (Non-surgical)W
What are some indications for surgery in renal injury?
- Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma
- Urinary extravasion, non-viable tissue, incomplete staging
What is the most common cause of bladder trauma?
Pelvic fracture
How will bladder injury usually present?
- Suprapubic/abdominal pain + inability to void
- Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds
What investigations are required in bladder injury?
Urinalysis
Retrograde urethrogram
CT cystography
What will be seen on CT cystography in extra-peritoneal injury?
Flame-shaped collection of contrast in the pelvis
How is bladder injury managed?
- Large-bore catheter
- Antibiotics
- Repeat cystogram in 14 days
- Immediate surgical repair indicated in some cases e.g. intraperitoneal injury, penetrating injury
What are some indications for immediate surgical repair in bladder injury?
Intraperitoneal injury
Penetrating injury
What is the most common cause of posterior urethral injury?
Fracture of the pubic rami
What part of the posterior urethral is most vulnerable to trauma?
Post. urethra fixed at urogenital diaphragm and puboprostatic ligaments, so bulbomembranous junction most vulnerable
Junction where bulbous urethra and membranous urethra meet
How does urethral injury present?
- Blood at meatus
- Inability to urinate
- Palpably full bladder
- ‘High-riding’ prostate
- Butterfly perineal haematoma
What is the main investigation used in urethral injury?
Retrograde urethrogram
What are some indications for immediate surgical repair of urethral injury?
- 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
How is urethral injury usually managed?
- Suprapubic catheter
- Delayed reconstruction after at least 3 months
What is the most common cause of penile fracture?
Typically happens during intercourse - buckling injury when penis slips out of vagina and strikes pubis
How will penile fracture present?
- Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
- 20% evidence of urethral injury (frank haematuria/blood at meatus)
How is penile fracture managed?
- Prompt exploration and repair
- Circumcision incision with degloving of penis to expose all 3 compartments
How will testicular injury usually present?
- Usually presents with pain and nausea
- Swelling/bruising variable
What investigations are required in testicular injury?
USS to assess integrity/vascularity
How is testicular injury managed?
Early exploration/repair - better outcome
