1-Genitourinary-tract-trauma(ppt文档)

There may be total avulsion of artery and vein or partial avulsion of the segmental branches of these vessels.
Clinic findings
Shock Hematuria. Pain. Flank Mass. fever
Surroundings of the kidney
Injuries to the kidney Penetrating trauma
Gunshot and knife wounds cause most penetrating injuries to the kidney .
Injuries to the kidney blunt trauma
Flank Mass
a palpable mass may represent a large retroperitoneal hematoma or perhaps urinary extravasation.
if the retroperitoneum has been torn, free blood may be noted in the peritoneal cavity and no palpable mass will be evident. The abdomen may be distended and bowel sounds absent.
Genitourinary tract trauma
The affiliated hospital of TaiShan medical college
. Genitourinary tract trauma Introduction
About 10%of all injuries seen in the emergence room involve the genitourinary system .many of them are subtle and difficult to define and require great diagnostic expertise. Early diagnosis is essential to prevent serious complications
Injuries to the kidney Etiology.
Protect mechanism Penetrating trauma blunt trauma
Injuries to the kidney Protect mechanism
The kidney is well protected by heavy lumbar muscle ,vertebra bodies, ribs and the viscera, renal capsule .perirenal fat and renal fascia
(1).blunt trauma directly to the abdomen , flank ,or back is the most common mechanism , account for 80-85%of all renal injuries
Injuries to the kidney blunt trauma
diagnosBiblioteka Baidus
History or evidence of trauma , usually local Symptoms Signs Laboratory finding Imaging studies
Ultrasonography CT. Excretory urography
Treatment
Surgical measures
Some of the blund injuries penetrating injuries Penetrating trauma
Treatment of late complication
Perinephric abscess hypertension due to renal ischemia
Trauma. pelvic fractures. Iatrogenic. gynecologic
hernia repairs transurethral operations.
Pathology
Intraperitoneal rupture Extraperitoneal rupture
Injuries to the ureter Etiology and Pathology
Pelvic operation ,Ligation and cutting endoscopic manipulation radiotherapy Trauma
Injuries to the ureter Clinical findings
Injuries to the kidney Pathology.
Minor renal trauma(85% of cases) Major renal trauma(15% of cases) Vascular injury (about 1% of all blunt trauma
Injuries to the kidney blunt trauma
(3).Kidneys with existing pathologic conditions such as hydronephrosis or malignant tumors are more readily rupture from mild trauma
Clinic findings Hematuria
Catheterization usually reveals hematuria Microscope or gross hematuria.
Pain
pain may be localized to one flank area or over the abdomen.
(2).Trauma may result from motor vehicle accidents, falls, contact sports. Vehicle collisions at high speed may result in major renal trauma from rapid deceleration and cause major vascular injury. Fractured ribs may penetrate the renal parenchyma or vasculature
Treatment
Emergency measures. Conservative measures Surgical measures.
Treatment
Emergency measures
the objective of early management are prompt treatment of shock and hemorrhage, complete resuscitation ,and evaluation of associated injuries.
Associated injuries such as ruptured abdominal vescera or multiple pelvic fractures also cause acute abdominal pain and may obscure the presence of renal injury.
Injuries to the anterior urethra Etiology and pathology
Straddle injuries Iatrogenic
Injuries to the anterior urethra
Clinic findings Diagnosis. Treatment
Superficial cortical lacerations are also considered minor trauma.
These injuries rarely require surgical exploration.
Major renal trauma
Deep cortico- medullary laceration may extend into the collecting system, resulting in extravasation of urine into the perirenal space and blood in urine.
Intraperitoneal rupture.
filled to near capacity a direct blow to the lower abdomen the reflection of the pelvic peritoneum covers
the dome of the bladder Urine flow into the abdominal cavity urine is sterile or infected
cases)
Minor renal trauma
Renal contusion or bruising of the parenchyma is the most common lesion. subcapsular hematoma in association with contusion is also noted.
Multiple laceration may cause complete destruction of the kidney.
Vascular injury
It is rare but may occur, usually from blunt trauma.
Stretch on the main renal artery without avulsion may result in renal artery thrombosis.
anastomosis enlargement
Injuries to the posterior urethra Etiology and pathogenesis
Pelvic fracture the membranousurethra can be transected
Injuries to the bladder Diagnosis
Be filled with 300 mL of contrast medium.
Injuries to the bladder treatment
Emergency measures Conservative measures Surgical measures
Hematuria Seeping of Urine Fistula of urine obstruction .
Treatment
Anastomoses. Double- J stent. F6 After 3-4 weeks removed .
Injuries to the bladder Etiology
Extraperitoneal rupture
pelvic fracture.
Injuries to the bladder Clinical findings
Shock Belly pain Hematuria and difficulty of passing urine Fistula of urine