Kidney Lacerations & Contusions
Rina Parrish & Michelle Jones1 October 2003
AH 322Eval. Of athletic injuries I
Kidneycontusions& lacerations
• Kidneys• Paired solid, bean-shaped organs
located in both RUQ & LUQ near spine(the right kidney is slightly lower than the left )
• Function to help control blood volume• Also remove waste from blood in form
of urine
KidneyContusions & Lacerations
• Usually caused by external force causing abnormal extension
• Degree of injury depends on extent of distension, angle, and force of blow
Kidneycontusions& lacerations
• Kidneys• Signs & symptoms of Kidney injury
• Hematuria• Bloody discharge or inability to void• Flank pain• + Grey-Turner sign - Ecchymosis in flank• No acute abdominal signs• Possible bony crepitus due to rib fx
Kidneycontusions& lacerations
• Signs & symptoms of Kidney injury Cont…• Rigidity of back muscles• High pain in the posterior
costoverterbral angle
Kidneycontusions& lacerations
• Physical Examination• Following vital signs progresses to
• INSPECTION• AUSCULTATION• PERCUSSION• PALPATION & SPECIAL TESTS
Kidneycontusions& lacerations
• Palpation determines• Signs of acute abdomen such as
• Rebound tenderness• Rigidity• Guarding• General & specific areas of tenderness• Location of deformities• Location & extent of swelling
Kidneycontusions& lacerations
• INSPECTION• Observe the following
• Level of consciousness• Skin color• Patient's positions, movements &
signs of guarding or apprehension• Respiratory rate & rhythm for
dyspnea or (shortness of breath)
Kidneycontusions& lacerations
• INSPECTION
• Observe the following• Signs of trauma
• Hemoptysis or (coughing up blood)• Hematemesis or (vomiting up blood)• Ecchymosis• Evidence of mass• Evidence of penetrating trauma• Vomiting
Kidneycontusions& lacerations
• Auscultation, Percussion & Palpation• each quadrant of the abdominal
cavity is affected & should be included in your physical exam
• When examining the abdomen, each quadrant should be auscultated, percussed & palpated
• AUSCULTATION• Conducted to assess
• Normal vs. abnormal chest sounds• Breathing equality• Depth of breaths• Presence or absence of bowel sounds• Abnormal bowel sounds• Abnormal vascular noises
Kidneycontusions& lacerations
Kidneycontusions& lacerations
• AUSCULTATION• Process of listening for sounds produced in
thoracic & abdominal cavity• Stethoscope is used & auscultation is
normally conducted by medical professionals with extensive training & experience in this complex skill
Kidneycontusions& lacerations
• AUSCULTATION• Conducted to assess
• Normal vs. abnormal chest sounds• Breathing equality• Depth of breaths• Presence or absence of bowel sounds• Abnormal bowel sounds• Abnormal vascular noises
Kidneycontusions& lacerations
• PERCUSSION• Listen for normal/abnormal sounds
such as • tympany• dullness• Hyperresonance
Kidneycontusions& lacerations
• PERCUSSION• Listen for normal/abnormal sounds
such as • tympany• dullness• hyperresonance
Kidneycontusions& lacerations
• PERCUSSION• Usually performed by trained medical
professionals• Involves tapping on various parts of the
body to elicit certain sound• Sound produced assists in determining the
presence or absence of certain conditions• To yield informative results, extensive
training & practice are required
Kidneycontusions& lacerations
• PERCUSSION• Listen for normal/abnormal sounds
such as • tympany• dullness• hyperresonance
Kidneycontusions& lacerations
• PALPATION & SPECIAL TESTS• Palpation is process of determining
various abdominal pathologies by pressing with your hands in various quadrants
Kidneycontusions& lacerations
• Palpation determines • Signs of acute abdomen such as
• Bony crepitus (produced by rough edges of fractured bones rubbing together)
• Asymmetry• Air crepitus (produced by air caught in
subcutaneous tissue)• Muscle rigidity
Kidneycontusions& lacerations
• IMMEDIATE REFERRAL• Necessary with following S & S
• Diminished chest movement on the affected side
• Shifting or moving of trachea with each breath
• Suspected rib fracture or costochondral separation
• Severe abdominal pain
Kidneycontusions& lacerations
• IMMEDIATE REFERRAL• Necessary with following S & S
• Difficulty in breathing• Shortness of breath--inability to catch
breath• Severe pain increasing in chest• Vomiting or coughing up blood
Kidneycontusions& lacerations
• IMMEDIATE REFERRAL• Necessary with following S & S
• Prolonged discomfort, sensation of weakness, or pulling in groin
• Superficial protrusion or palpable mass
• Increasing nausea• Vomiting
Kidneycontusions& lacerations
• IMMEDIATE REFERRAL• Necessary with following S & S
• Signs of acute abdomen• Rebound tenderness• Rigidity• Guarding
• Signs of shock• Blood in the urine or stool
Kidneycontusions& lacerations
• IMMEDIATE REFERRAL• Necessary with following S & S
• Presence of fever• Presence of radiating or referred pain• Any doubt regarding the nature and
severity of the abdominal injury
Kidneycontusions& lacerations
• Management• Twenty-four hours in the hospital• Gradual increase of fluid intake• Two weeks bed rest • Refrain from any physical activity• Some cases surgery
Kidneycontusions& lacerations• Return to Play
• When all signs & symptoms are cleared
• No pain associated with the contusion• Sometimes wont return to sports at
all• When return surveillance of athlete• Protected padding