《肾损伤》-PPT文档.ppt

Directory,Background Anatomy Etiology Pathology Clinical findings Treatment Summary,Function of the kidney Produce urine, excrete metabolites Maintain body fluid and acid-base balance Endocrine function: Renin, prostaglandin Regulate blood pressure and balance blood lipids Endocrine degrading hormone,Background,Injuries to urinary system About 10% of all injuries in the emergency room involve the genitourinary system Many of them are difficult to define Early diagnosis is essential to prevent serious complications,Background,Basic Pathological change Shock Urinary extravasation Urinary obstruction (destruction) Infection ,cost,death,Anatomy,Kidney Ureter Bladder Urethra,Ur,The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly,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.,Blunt trauma: The force transmitted from the center of the 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,Direct or indirect violence at upper abdomen or flank area may cause kidney injure,Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculature,Gunshot and knife wounds cause penetrating injuries to the kidney,*Pathology,Renal contusion (85% of cases) Superficial cortical lacerations Subcapsular hematoma,Partial lacerations Injuries extend to renal capsule or collecting system Perirenal hematoma Hematuria,Deep lacerations Injuries extend both renal capsule and collecting system Extravasation of urine into perirenal space Large retroperitoneal hematoma Hematuria,Vascular injury (less than 1% ) Vascular injury of renal pedicle is rare Difficult to diagnosis Emergency operation should be done for saving life Mortality is still high,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 : infection,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,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,Ultrasonography Easy Fast Noninvasive Well descript the parenchyma and hematoma of kidney,Radiology,IVU(intravenous urography, excretory urography) Function of separate sides Urinary extravasation,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,Plain scanning period Venous phase Portal venous phase Arterial phase Excretory period,Plain scanning period,Venous phase,Arterial phase,Excretory period,Arteriography Defines major arterial and parenchyma injuries Arterial thrombosis and avulsion of the renal pedicle are best diagnosis Invasive , choose carefully,Radiology,Others Retrograde urography : dangerous with infection, should not be chosen MRI: noninvasive, as an alternate choice,Treatment,Emergency measures Resuscitation Treatment of shock and hemorrhage Evaluation associated injuries,Minor renal injuries from blunt trauma account for 85% of cases do not require operation Renal contusion Partial laceration,*Non-operative treatment Bed rest for 24 weeks Watchful waiting : vital signs, blood, urine Hydration and nutrition Antibiotics for prevent infection Symptomatic therapy：analgesic, sedative, hemostasis,Operation indications Penetrating injuries: (Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure) Severe blunt injuries: Deep laceration Multiple laceration Renal pedicle injuries Persistent retroperitoneal bleeding , Severe urinary extravasation ,Operation indications During non-operation treatment : Anti-Shock ineffective, or shock occurance again Hematuria get more severe Mass of abdominal enlarged Hemoglobin and hematocrit keep decreasing Suspicious of Abdominal organ injury,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,Thank You,