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RENAL INJURY

الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة محمد رضا جودي عبود جلو       17/12/2015 18:33:19
RENAL INJURY:
In civilian life, either:
*blows or falls on the loin.
*crushing injury to the abdomen, in RTA.
Haematuria after trivial injury, suggest pre existing renal disease as renal stone, hydronephrosis, T.B.
Closed renal injury is usually extra peritoneal, but in young children may leak blood to peritoneum.

Clinical feature of closed renal injury:
There is local pain and tenderness.
*Haematuria:
Sign of damaged kidney. May not appear until some time after injury, may cause clot colic
*sever delayed haematuria between third day and the third week. Caused by clot dislodgment.
*Meteorism: abdominal distension 24-48 hours after renal injury result from retroperitoneal haematoma implicating the splanchnic nerves.
TYPE OF CLOSED RENAL TRAUMA:
A: sub capsular hematoma.
B: laceration.
C: avulsion of one pole.
D: avulsion of the pedicle.

Management and treatment:
*conservative watchful treatment of closed renal trauma, the injury to the other organs must be considered at any age.
*blood preparation, and transfusion if there is evidence of hypovolaemic shock or continuing hemorrhage.
-Stay in bed and close follow up till a week after the urine clear.
Analgesia as morphine.-
Hourly chart for pulse blood pressure
Anti biotecs should be given to prevent infection of the haematoma.
-each sample of urine should be checked for haematuria.

Intravenous urography (IVU)
Intra venous urography. Or contrast enhanced CT scan should de perfumed urgently to show and assess the damage to the kidney and to see the other kidney is normal.
Blood should be sent for grouping and serum saved for cross matching.

Surgical exploration:
Necessary in les that 10% of closed renal injuries. But if there is a sign of progressive blood lose or expanding mass in loin.
The aim of surgery is to stop bleeding, may do embolisation.
The possibility of damage to other abdominal organs is checked during a transperitoneal approach.
Nephrectomy is indicated when the kidney irretrievably ruptured.
Small tear can be sutured.
Partial nephrectomy in sometime.
But solitary kidney must be repaire


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .