Case discussion Renal trauma

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Case discussion Renal trauma
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Flank Area Pain

• The flanks are the sides of the abdomen, located
  between the ribs and the pelvis, or hipbone.
• Flank pain refers to any pain or discomfort in
  this area.
• Flank pain usually only occurs on one side, but
  may be mild or severe. There are many possible
  causes, ranging from unimportant to serious.

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When someone complains of flank pain, the
healthcare provider may ask questions, such as

• exactly Where the pain is located?
• When the pain started?
• the Type of pain, such as sharp, dull, or crampy?
• whether the person has ever had this type of pain
  Before?
• whether the pain is Constant or only occurs
  sometimes?
• whether there has been any Injury to the painful
  area?
• whether anything makes the pain Better or Worse?
• whether or not there has been any other Symptoms,
  such as swelling, rash, or fever?
• what Other medical conditions a person has, if
  any?
• what Medications, drugs, or herbs a person takes,
  if any?

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Flank Pain

• Differential Diagnosis
• Abdominal Aortic Aneurysm
• Renal Infarction
• Urolithiasis
• Pyelonephritis
• Renal Abscess
• Renal Vein Thrombosis
• Herpes Zoster
• Radicular/ Muscular

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Hematuria

• Differential Diagnosis?
• Benign prostatic hyperplasia (BPH) in men over 40
  
• Kidney and bladder stones
• Kidney disease
• Medications (e.g., quinine, rifampin, phenytoin)
• Trauma (e.g., a blow to the kidneys)
• Tumors and/or cancer in the urinary system
• Urinary tract blockages
• Viral infections of the urinary tract and
  sexually transmitted diseases, particularly in
  women

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• 30 years old male patient involved in road
  traffic accident sustains injury in the right
• flank area.
• The patient is presented in the emergency room
  with history of right flank pain and hematuria.
• He is heamodynamically stable.
• Discuss Management.

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• RTA
• FLANK PAIN
• HEMATURIA
• ?

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Investigations

• Abdominal and Pelvic CT.

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Investigations

• Lab studies
• Urinalysis
• Imaging Studies
• Intravenous Pyelogram (IVP)
• Computed Tomography (CT)
• Angiography
• Ultrasonography (USS)

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Renal Trauma

• The most common urologic trauma and occurs in
  8-10 of patients with significant blunt or
  penetrating abdominal trauma.
• Most renal injuries are associated with hematuria
  (95), however, hematuria may not be present.
• The most common cause of renal trauma is motor
  vehicle accidents with significant blunt
  abdominal trauma

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Renal Trauma

• Renal Lacerations
• Renal Contusions
• Renal Vascular Injury

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Management

• Nonoperative Treatment
• Surgical Therapy
• Surgical techniques
• Nephrectomy - Shattered kidney, multiple
  concurrent injuries, and uncontrolled hemorrhage
• Partial nephrectomy - Avulsed fragments, polar
  penetrating mechanism, and collecting system
  repair
• Adjuncts - Absorbable mesh wrap, topical
  thrombostatic agents, and omentum