《腎損傷》ppt課件

1、Kidney TraumaDepartment of UrologyThe Peoples Hospital of Youyang CountyJunhui ShiDirectorylBackgroundlAnatomylEtiology lPathologylClinical findingslTreatmentlSummaryFunction of the kidneylProduce urine, excrete metabolites lMaintain body fluid and acid-base balance lEndocrine function: Renin, prost

2、aglandinl Regulate blood pressure and balance blood lipidslEndocrine degrading hormoneBackgroundInjuries to urinary systemlAbout 10% of all injuries in the emergency room involve the genitourinary systemlMany of them are difficult to definelEarly diagnosis is essential to prevent serious complicatio

3、nsBackgroundlBasic Pathological change Shock Urinary extravasation Urinary obstruction (destruction) Infection ,cost,deathAnatomylKidneylUreterlBladderlUrethraUrlThe kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorlyEtiology lBlunt trauma directly to

4、 the abdomen, flank, or back is the most common mechanism for 8085% renal injurieslTraffic accidents, fights, falling, contact sports, and so on.lBlunt trauma: The force transmitted from the center of the impact to the renal parenchymalDeceleration: The kidney moves upward or downward,cause sudden s

5、tretch on the pedicle, acute renal artery injuries and thrombosis may occurlDirect or indirect violence at upper abdomen or flank area may cause kidney injure lFracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculaturelGunshot and knife wounds cause penetratin

6、g injuries to the kidney* *Pathology lRenal contusion (85% of cases)Superficial cortical lacerationsSubcapsular hematoma lPartial lacerationsInjuries extend to renal capsule or collecting systemPerirenal hematomaHematurialDeep lacerationsInjuries extend both renal capsule and collecting systemExtrav

7、asation of urine into perirenal spaceLarge retroperitoneal hematomaHematurialVascular injury (less than 1% )Vascular injury of renal pedicle is rareDifficult to diagnosisEmergency operation should be done for saving lifeMortality is still highClinical findingslHistory of traumalSymptoms:Pain may be

8、localized to one flank area or over the abdomen associated to injuryMicroscopic or gross hematuria following trauma to the abdomen or flankFever : infectionlSignsShock or signs of a large loss of blood from heavy retroperitoneal bleeding may be notedPalpable mass may represent a large retroperitonea

9、l hematoma or urinary extravasationDiffuse abdominal tendernessLower ribs fracturelLaboratory findingsRed blood cells in urine: hematuriaHematocrit may be normal initially,but a drop may be found with time pastHCT dropping represents persistent retroperitoneal bleeding and development of a large ret

10、roperitoneal hematomalUltrasonographyEasy FastNoninvasiveWell descript the parenchyma and hematoma of kidneyRadiology lIVU(intravenous urography, excretory urography)Function of separate sidesUrinary extravasationlEnhanced CT scanAbdominal CT scan is the most direct and effective means of staging re

11、nal injuriesClearly defines parenchymal lacerations and urinary extravasationFirst choice for diagnosis renal injuriesRadiology Plain scanning periodVenous phasePortal venous phaseArterial phaseExcretory period lPlain scanning periodlVenous phaselArterial phaselExcretory periodlArteriographyDefines

12、major arterial and parenchyma injuriesArterial thrombosis and avulsion of the renal pedicle are best diagnosisInvasive , choose carefullyRadiology lOthersRetrograde urography : dangerous with infection, should not be chosen MRI: noninvasive, as an alternate choice TreatmentlEmergency measuresResusci

13、tation Treatment of shock and hemorrhageEvaluation associated injurieslMinor renal injuries from blunt trauma account for 85% of cases do not require operation Renal contusion Partial laceration*Non-operative treatmentBed rest for 24 weeksWatchful waiting : vital signs, blood, urineHydration and nut

14、rition Antibiotics for prevent infectionSymptomatic therapy：analgesic, sedative, hemostasislOperation indicationsPenetrating injuries: (Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure)Severe blunt injuries: Deep laceration Multiple laceration

15、Renal pedicle injuries Persistent retroperitoneal bleeding , Severe urinary extravasation lOperation indicationsDuring non-operation treatment : Anti-Shock ineffective, or shock occurance againHematuria get more severeMass of abdominal enlarged Hemoglobin and hematocrit keep decreasingSuspicious of Abdominal organ i