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Case discussion Renal trauma

Case discussion Renal trauma . 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.

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Case discussion Renal trauma

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  1. Case discussion Renal trauma

  2. 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.

  3. 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?

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

  5. 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

  6. 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.

  7. RTA + FLANK PAIN + HEMATURIA = ?

  8. Investigations • Abdominal and Pelvic CT.

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

  10. 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

  11. Renal Trauma • Renal Lacerations • Renal Contusions • Renal Vascular Injury

  12. 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

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