Kidney Lacerations & Contusions

1. Kidney Lacerations & Contusions Rina Parrish & Michelle Jones 1 October 2003 AH 322 Eval. Of athletic injuries I

2. 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

3. Kidneycontusions& lacerations

4. KidneyContusions & Lacerations • Usually caused by external force causing abnormal extension • Degree of injury depends on extent of distension, angle, and force of blow

5. KidneyContusions & Lacerations

6. 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

7. Kidneycontusions& lacerations • Signs & symptoms of Kidney injury Cont… • Rigidity of back muscles • High pain in the posterior costoverterbral angle

8. Kidneycontusions& lacerations • Physical Examination • Following vital signs progresses to • INSPECTION • AUSCULTATION • PERCUSSION • PALPATION & SPECIAL TESTS

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. Kidneycontusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • Hyperresonance

17. Kidneycontusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • hyperresonance

18. 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

19. Kidneycontusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • hyperresonance

20. Kidneycontusions& lacerations • PALPATION & SPECIAL TESTS • Palpation is process of determining various abdominal pathologies by pressing with your hands in various quadrants

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Kidneycontusions& lacerations Any questions