最新《肾损伤》课件.ppt

1、肾损伤肾损伤ppt课件课件Function of the kidneylProduce urine,excrete metabolites lMaintain body fluid and acid-base balance lEndocrine function:Renin,prostaglandinl Regulate blood pressure and balance blood lipidslEndocrine degrading hormoneBackgroundInjuries to urinary systemlAbout 10%of all injuries in the e

2、mergency room involve the genitourinary systemlMany of them are difficult to definelEarly diagnosis is essential to prevent serious complicationsBackgroundlBasic Pathological change Shock Urinary extravasation Urinary obstruction(destruction)Infection,cost,deathAnatomylKidneylUreterlBladderlUrethraU

3、rlThe kidney is well protected by heavy lumbar muscles,vertebral bodies,ribs,and the viscera anteriorlyEtiology lBlunt trauma directly to 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 t

4、ransmitted from the center of the impact to the renal parenchymalDeceleration:The kidney moves upward or downward,cause sudden stretch 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

5、 and transverse vertebral processes may penetrate the renal parenchyma or vasculaturelGunshot and knife wounds cause penetrating injuries to the kidney*Pathology lRenal contusion (85%of cases)Superficial cortical lacerationsSubcapsular hematoma lPartial lacerationsInjuries extend to renal capsule or

6、 collecting systemPerirenal hematomaHematurialDeep lacerationsInjuries extend both renal capsule and collecting systemExtravasation of urine into perirenal spaceLarge retroperitoneal hematomaHematurialVascular injury(less than 1%)Vascular injury of renal pedicle is rareDifficult to diagnosisEmergenc

7、y operation should be done for saving lifeMortality is still highClinical findingslHistory of traumalSymptoms:Pain may be 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

8、a large loss of blood from heavy retroperitoneal bleeding may be notedPalpable mass may represent a large retroperitoneal hematoma or urinary extravasationDiffuse abdominal tendernessLower ribs fracturelLaboratory findingsRed blood cells in urine:hematuriaHematocrit may be normal initially,but a dro

9、p may be found with time pastHCT dropping represents persistent retroperitoneal bleeding and development of a large retroperitoneal hematomalUltrasonographyEasy FastNoninvasiveWell descript the parenchyma and hematoma of kidneyRadiology lIVU(intravenous urography,excretory urography)Function of sepa

10、rate sidesUrinary extravasationlEnhanced CT scanAbdominal CT scan is the most direct and effective means of staging renal injuriesClearly defines parenchymal lacerations and urinary extravasationFirst choice for diagnosis renal injuriesRadiology Plain scanning periodVenous phasePortal venous phaseAr

11、terial phaseExcretory period lPlain scanning periodlVenous phaselArterial phaselExcretory periodlArteriographyDefines major arterial and parenchyma injuriesArterial thrombosis and avulsion of the renal pedicle are best diagnosisInvasive,choose carefullyRadiology lOthersRetrograde urography:dangerous

12、 with infection,should not be chosen MRI:noninvasive,as an alternate choice TreatmentlEmergency measuresResuscitation Treatment of shock and hemorrhageEvaluation associated injurieslMinor renal injuries from blunt trauma account for 85%of cases do not require operation Renal contusion Partial lacera

13、tion*Non-operative treatmentBed rest for 24 weeksWatchful waiting:vital signs,blood,urineHydration and nutrition Antibiotics for prevent infectionSymptomatic therapy：analgesic,sedative,hemostasislOperation indicationsPenetrating injuries:(Penetrating abdominal injury require operation,renal explorat

14、ion is only an extension of this procedure)Severe blunt injuries:Deep laceration Multiple laceration Renal pedicle injuries Persistent retroperitoneal bleeding,Severe urinary extravasation lOperation indicationsDuring non-operation treatment:Anti-Shock ineffective,or shock occurance againHematuria g

15、et more severeMass of abdominal enlarged Hemoglobin and hematocrit keep decreasingSuspicious of Abdominal organ injurylTypes of kidney injury?lThe simplest and the best checks are?lNon-operative treatment of kidney trauma?lSurgical Indicationgs of kidney trauma?lLong-term complications of renal injury?lOthers about Urinary Trauma?SummaryThank You此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢