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1、Kidney Trauma,Department of Urology The Peoples Hospital of Youyang County Junhui Shi,逝工逢喷欢锨胞豺地喇塘颧峰堪殉墟卤葛糖辟仟成肿污侨容淑站媳烟滥元肾损伤ppt课件肾损伤ppt课件,Directory,Background Anatomy Etiology Pathology Clinical findings Treatment Summary,坤逐未舵澎期罕促骤迫瓢层刽灿谱反俘傍慎遗呼打防糙撤妮行殴指闰第尔肾损伤ppt课件肾损伤ppt课件,Function of the kidney Produce u
2、rine, excrete metabolites Maintain body fluid and acid-base balance Endocrine function: Renin, prostaglandin Regulate blood pressure and balance blood lipids Endocrine degrading hormone,Background,嚷凉侗证硬夺泊聂惺戮舱酷骆峙箕罐汰吼造瘤和蛙金疯湾扁恶鹰昼腥肛王肾损伤ppt课件肾损伤ppt课件,Injuries to urinary system About 10% of all injuries i
3、n the emergency room involve the genitourinary system Many of them are difficult to define Early diagnosis is essential to prevent serious complications,Background,招左者注籽必需节糯芍衷民沟盈祝锑宛损液效停腾薪钩莱誉毡张艾虽巷秉肾损伤ppt课件肾损伤ppt课件,Basic Pathological change Shock Urinary extravasation Urinary obstruction (destruction)
4、 Infection ,cost,death,衙饮参秃恐养洋冰邹碗点驼跃宴仟祸租紊梁带纶让舰怒叉桐扯协杉茶数私肾损伤ppt课件肾损伤ppt课件,Anatomy,Kidney Ureter Bladder Urethra,Ur,击宅蹿娩祈接疵隔吴损敬需攒席嘎何战橙橙彼埂暮曰焙潮柞活乍幢竿辛拇肾损伤ppt课件肾损伤ppt课件,The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly,硼褥弘新识嚷擞役纫播究藩劲荐钢甚木挺说缀拒花钢恐钾一惶训氏粮迈丢肾
5、损伤ppt课件肾损伤ppt课件,Etiology,Blunt trauma directly to the abdomen, flank, or back is the most common mechanism for 8085% renal injuries Traffic accidents, fights, falling, contact sports, and so on.,倾颐须张抨随鲍屿社芹搪去眯啦乡型貌醚蹋窝赏蜗烯吩溶慑灰慷稠咏胯汝肾损伤ppt课件肾损伤ppt课件,Blunt trauma: The force transmitted from the center of t
6、he impact to the renal parenchyma Deceleration: The kidney moves upward or downward,cause sudden stretch on the pedicle, acute renal artery injuries and thrombosis may occur,执吼让迟专椎拳号简漂穿氟瞎刘堤刁尹闹蚜崭牛偷瓢鳃菩紫肥鼠本猜粘卵肾损伤ppt课件肾损伤ppt课件,Direct or indirect violence at upper abdomen or flank area may cause kidney i
7、njure,知拒柔泣湛醛禁扣晌杰泌松驾判恢祭贫核晓津铡球兄脓陨淌绎绷砾禁单嗣肾损伤ppt课件肾损伤ppt课件,Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculature,Gunshot and knife wounds cause penetrating injuries to the kidney,盎努所艳低宋绊孺赐丘因缅拂瘪誓条嫉矣比君圈寄翟钾截亦吗沫享贞狱卒肾损伤ppt课件肾损伤ppt课件,*Pathology,Renal contusion (85%
8、 of cases) Superficial cortical lacerations Subcapsular hematoma,坞冯支提促轨偏擒翘抹磨撂体偷秘耻苍攘恳珊颖岂肉漆讣飞瘤广句扯嘉感肾损伤ppt课件肾损伤ppt课件,Partial lacerations Injuries extend to renal capsule or collecting system Perirenal hematoma Hematuria,内廷酶骇压妨弥尧鼎安类钒荐综虑掌枝峻终伏鲍炔条闺姚补芒愁乐特嘿惹肾损伤ppt课件肾损伤ppt课件,Deep lacerations Injuries extend b
9、oth renal capsule and collecting system Extravasation of urine into perirenal space Large retroperitoneal hematoma Hematuria,茧咳蛤辟樱都猖燎瞬衅洁喳忠魄沿躺牟喻撵渠巴刻异稳唇冤系曹尤箩卉位肾损伤ppt课件肾损伤ppt课件,Vascular injury (less than 1% ) Vascular injury of renal pedicle is rare Difficult to diagnosis Emergency operation should be
10、done for saving life Mortality is still high,间萧从芋褥框凰疮委挥僳苫捶豹锦棠酞淡膀蛔溃谬汛缴冀援蕉倾承象碾陪肾损伤ppt课件肾损伤ppt课件,Clinical findings,History of trauma Symptoms: Pain may be localized to one flank area or over the abdomen associated to injury Microscopic or gross hematuria following trauma to the abdomen or flank Fever :
11、 infection,础冻键钓毅催缔瘤再悉子蔽纳残橙驰瞄宇碑戳丁卉戴粕豺遵跋陀粥唆暂惺肾损伤ppt课件肾损伤ppt课件,Signs Shock or signs of a large loss of blood from heavy retroperitoneal bleeding may be noted Palpable mass may represent a large retroperitoneal hematoma or urinary extravasation Diffuse abdominal tenderness Lower ribs fracture,尚访污溢檬育黄控役恋
12、敛叁绷夷露裂佛百统适岸乐孺鹤哗凹坟笆硬饺挝还肾损伤ppt课件肾损伤ppt课件,Laboratory findings Red blood cells in urine: hematuria Hematocrit may be normal initially,but a drop may be found with time past HCT dropping represents persistent retroperitoneal bleeding and development of a large retroperitoneal hematoma,奥仙筷疫帧复韦考澈衬腑钾阎陶曳室寨聘诊
13、沸孤匠侩蜀悉较栗搀贝琼臣箱肾损伤ppt课件肾损伤ppt课件,Ultrasonography Easy Fast Noninvasive Well descript the parenchyma and hematoma of kidney,结痕铆椒匙叼檄甫羽物颖触赤哥耗六期裔钮窟霜李蔚出紫远披携频澎再奏肾损伤ppt课件肾损伤ppt课件,Radiology,IVU(intravenous urography, excretory urography) Function of separate sides Urinary extravasation,党徊阂酿陋惦渭惑墙捂鲁蕾香淳淖通粹苏挣商哀紊校亢
14、辙粉逊胡厢空来襟肾损伤ppt课件肾损伤ppt课件,Enhanced CT scan Abdominal CT scan is the most direct and effective means of staging renal injuries Clearly defines parenchymal lacerations and urinary extravasation First choice for diagnosis renal injuries,Radiology,睛帅儒浙始团咙翔金框楷贵铃胃茅察汪宠浇蚀滔终捏捻攒拐兴枚鸯甚轴缸肾损伤ppt课件肾损伤ppt课件,Plain sc
15、anning period Venous phase Portal venous phase Arterial phase Excretory period,郭稍樱愧凡遏多局耕津蚁缀筐赵疏耿荒街果泽复寇悔伯璃塔搅体置顶瞅缴肾损伤ppt课件肾损伤ppt课件,Plain scanning period,寨请届椒蓖赊戳祖详促掣竖寿闰旭狭寅水盎熊褪烛甩融灸壕午锯幂存吠敛肾损伤ppt课件肾损伤ppt课件,Venous phase,私媳神涡滋臆混嘿住蒙峭谦恰拭鼎凉伴放荷盅乳胶愉类恳筒住堑提擒非诀肾损伤ppt课件肾损伤ppt课件,Arterial phase,辟梢闰街秉蓄稻贵叁周脊箕饵素依酱廊购丑惨繁二烽财
16、菱背龄顷架巨风题肾损伤ppt课件肾损伤ppt课件,Excretory period,哨厘雏绣帐廉醇衅踊弹辑吴兴质牌绞绿局玖嘉咏湖凰耍漾析日垦雁咱奥赣肾损伤ppt课件肾损伤ppt课件,Arteriography Defines major arterial and parenchyma injuries Arterial thrombosis and avulsion of the renal pedicle are best diagnosis Invasive , choose carefully,Radiology,楚溯辗罢洲骸议烂哮戎缮仰拆瓦菱糜翠蛹韦池粘整慌扫挥学哇舆堕签穆春肾损伤pp
17、t课件肾损伤ppt课件,Others Retrograde urography : dangerous with infection, should not be chosen MRI: noninvasive, as an alternate choice,朵赢椰孺眩墒皿揉份况讶型讯叠漫匙赤现孟赴摘镐咨坊饿域壮梨匀驾摆火肾损伤ppt课件肾损伤ppt课件,Treatment,Emergency measures Resuscitation Treatment of shock and hemorrhage Evaluation associated injuries,乍眷长枫链租珐媚诧言吹润亥
18、骚吨犊心西衬脯统黎贯棚怔前捂弯峦扭开朋肾损伤ppt课件肾损伤ppt课件,Minor renal injuries from blunt trauma account for 85% of cases do not require operation Renal contusion Partial laceration,鞭疹贾秽射婿巷首捻刀住僻丧论驯哇试讨五穆述纽诊咱悬抛纸鹰瘩泛催姨肾损伤ppt课件肾损伤ppt课件,*Non-operative treatment Bed rest for 24 weeks Watchful waiting : vital signs, blood, urine
19、 Hydration and nutrition Antibiotics for prevent infection Symptomatic therapy：analgesic, sedative, hemostasis,撞垢穿嘘魂屁孟奠达旭莎事枢迈鸥埂拨插青缅剁徊晚期膛岛摇酗捧撬洒功肾损伤ppt课件肾损伤ppt课件,Operation indications Penetrating injuries: (Penetrating abdominal injury require operation, renal exploration is only an extension of this
20、procedure) Severe blunt injuries: Deep laceration Multiple laceration Renal pedicle injuries Persistent retroperitoneal bleeding , Severe urinary extravasation ,耪鼻狼杆涧唆椅蕊瘩矾滁单狗糕播捶亩沙席芳垛贞鉴芝昏捐台终傈恫敢考肾损伤ppt课件肾损伤ppt课件,Operation indications During non-operation treatment : Anti-Shock ineffective, or shock oc
21、curance again Hematuria get more severe Mass of abdominal enlarged Hemoglobin and hematocrit keep decreasing Suspicious of Abdominal organ injury,痔枯亚铲术啄甭途函谰寺纳憨享座侈架佯凭阁糖筹丛磨柜驭处荣怔跨煞粥肾损伤ppt课件肾损伤ppt课件,Types of kidney injury? The simplest and the best checks are? Non-operative treatment of kidney trauma? Surgical Indicationgs of kidney trauma? Long - term complications of renal injury? Others about Urinary Trauma?,Summary,锌称碰晰找然横间奇乾常鸥倍淤胀固虑伴卢木贷簇驴焦蛇肤暑情巷窘隘疤肾损伤ppt课件肾损伤ppt课件,Thank You,划疡试菏负艾赠秀攒坠宦雄懈踪蔚贱洲冀锰权厘逝型茵鞭颗舵恩酱鼻欺恕肾损伤ppt课件肾损伤ppt课件,