surgery 6th year, tutorial (dr. aso omar)

Your kidneys are generally well protected by muscles of the back and ribcage but injuries can occur as a result of blunt or penetrating trauma. The following information should help explain why timely evaluation and

proper management are critical for the best outcomes.

What happens under normal conditions?

What happens under normal conditions? The kidneys are paired, bean-shaped solid organs located deep in the abdomen, protected by strong back muscles and separated from the

front of the abdomen by the organs of the gastrointestinal tract.

What types of trauma can occur?

• The kidney is the most common organ in the urinary tract to be injured by severe trauma. "Trauma" is injury caused by an external force that may be either blunt—such as a car accident—or

• penetrating—such as a gunshot wound. Blunt trauma injuries to the kidney may show no evidence of external injury or bruises may appear over the back or abdomen where the kidney is located. Penetrating kidney injury may also be difficult to detect. For example, the external point of entry of the bullet may be small and at a distance far enough away from the location of the kidney for it not to be a consideration.

TRUMA TYPE

MINOR 85% MAJOR 15%

Classification of renal injury

0

10

20

30

40

50

60

70

80

90

1st Qtr

EastWestNorth

o Isolated or associated o Major or minoro Grads of injuryo Haematuria, Delay haematuria, Meteorismo Paino Swellingo Woundo Acute abdomeno Shock

• History & physical examination

• X-Ray- of abdomen

• U/S –of abdominal

• Excretory Urography

• Angiography

• CT

• MRI

Bradley R. Davis, USAF

ABCRest 1-week

Sedatives& analgesiaChart-Vital signs

AntibioticsUrine checking

IVU.Surgery; indications?

• Haematuria

• Hydronephrosis

• HTN

• Aneurysm of renal artery

• Sepsis

• Renal failure

• Recognised at the time of operation

• Not recognised at the time of the operation

• Unilateral or bilateral

• ANASTAMOSIS; end to end• Bladder hitched up• Boaries flap• End to side implantation• Ileal replacement• Nephrectomy