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Urological Causes of an Acute Abdomen

Urological Causes of an Acute Abdomen. Dr Charles Chabert. Renal Trauma. 1-5% of all Trauma 50% all GU Trauma Both kidneys equally affected Majority blunt trauma. Renal Trauma. Haematuria Absent in 40% pedicle injuries Does not differentiate minor from major. Renal Imaging.

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Urological Causes of an Acute Abdomen

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  1. Urological Causes of an Acute Abdomen Dr Charles Chabert

  2. Renal Trauma 1-5% of all Trauma 50% all GU Trauma Both kidneys equally affected Majority blunt trauma

  3. Renal Trauma Haematuria Absent in 40% pedicle injuries Does not differentiate minor from major

  4. Renal Imaging Who and How? Contrast CT Unstable patients - One shot IVP

  5. Injury Scaling • Subcapsular haematoma • Cortical laceration <1cm • Cortical laceration >1cm • A. Cortical laceration into collecting system B. Vascular injury with contained haematoma • A. Shattered kidney B. Avulsion Organ injury Scaling AAST

  6. Renal Trauma

  7. Renal Trauma – grade 5

  8. Renal Trauma

  9. Renal Trauma

  10. Grade 5

  11. Grade 5

  12. Gunshot injury

  13. Gunshot injury

  14. Gunshot injury

  15. Indications For Exploration Persistent , life threatening haemorrhage Pulsatile, expanding haematoma Grade 5 injuries

  16. Ureteric Colic Pain Haematuria Sepsis

  17. Ureteric Colic Urinalysis FBC, EUC Imaging: CT scan & KUB Xray

  18. Ureteric Colic

  19. Ureteric Colic

  20. Ureteric Colic

  21. Management Analgesia Hydration Drainage renal unit: Pain Sepsis Deteriorating renal function Single system

  22. Ureteric Trauma < 1% renal trauma Iatrogenic more common Paediatric trauma - PUJ

  23. Bladder Trauma Extraperitoneal or intraperitoneal Extra- associated with pelvic fracture Intra- associated with deceleration

  24. Bladder Trauma Suprapubic pain Haematuria Retention Peritoneal irritation

  25. Bladder trauma Cystogram CT Cystogram Pevic X Ray

  26. Extraperitoneal Rupture

  27. Bladder Trauma Principles of Treatment Urethral drainage Exploration and formal repair

  28. Summary Urological trauma is rare Treatment conservative Stones – unilateral Drainage for: Pain Sepsis Deterioration renal function

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