kidney trauma
Introduction
Introduction to kidney trauma The kidney is located in the peritoneal space on both sides of the lumbar spine, with a thick fat pad around it and a certain degree of mobility. There are spine, bone, abdominal organs and muscle protection. Under normal circumstances, it is not easy to be injured. Kidney wounds are more common in young men, which is related to factors such as occupational and physical activity. With the development of modern industry and transportation, the incidence rate has been the first in the genitourinary trauma. basic knowledge The proportion of sickness: 0.2% Susceptible people: no specific population Mode of infection: non-infectious Complications: hydronephrosis, pyelonephritis, hypertension, kidney stones, renal arteriovenous fistula
Cause
Cause of kidney trauma
Classification and causes of injury: can be divided into open wounds and closed wounds. The former is more common in wartime firearms penetrating wounds or blade wounds. In normal times, it is puncture wounds, and more combined with chest and abdomen organ damage; the latter is more common in normal times. The causes of injury are divided into direct violence and indirect violence.
Direct violence: The back or upper abdomen may be damaged or injured by impact or squeezing. The violence may come from the rear or the front to make the ribs suddenly move forward or the kidneys suddenly move backwards. It acts on the kidneys and causes damage. It is more common in traffic accidents and the slopes collapse. Or fall from the heights of the waist and abdomen on the hard object, this is the most common reason.
Indirect violence: a fall from a height, a deceleration injury caused by a foot or hip landing and a sharp brake. This indirect violence can cause a tear in the kidney pedicle or a rupture of the pelvic ureter junction.
Strong contraction of the lumbar muscles can also cause kidney contusion and hematuria.
Kidneys that have pathological changes (congenital or acquired organic disease) can also cause kidney rupture by mild external forces, often referred to as spontaneous renal rupture.
The type of injury can be divided according to the degree of kidney damage, the scope and location:
Contusion: intact capsule, does not involve the collection system, limited to renal parenchymal injury or subcapsular hematoma, hematuria, X-ray abdominal plain film and urography without abnormal findings, B-ultrasound or CT examination can be found in renal parenchymal hematoma Its size and location.
A laceration: one or more deep clefts in the renal parenchyma. If the cleft is connected with the renal pelvis, the hematuria is severe. If accompanied by a rupture of the capsule, blood and urine extravasation form a hematoma around the kidney, and the peritoneum is broken at the same time, blood and urine. It can flow into the abdominal cavity, and the X-ray abdominal plain film can be seen with enlarged renal shadow, uneven density, common contrast agent spillover in urography, and B-ultrasound can be seen that the renal parenchyma is divided by hematoma. Such severe injuries often lead to shock.
Smash injury: the renal parenchyma and the capsule are broken into several pieces, the collection system is also ruptured at the same time, the bleeding and urinary extravasation are more serious, the urinary tract angiography is not developed or the development is slow, a large amount of contrast agent overflows, and the renal angiography shows the renal blood vessels. The branches are not developed, and the injuries are heavy. If they are not actively rescued, they often lead to death.
Renal rupture: often accompanied by renal parenchymal laceration, simple renal pelvic rupture is rare, showing signs of urinary extravasation.
Kidney pedicle injury: If the renal pedicle is completely ruptured, a large amount of bleeding is often too late to rescue, and small blood vessel rupture can sometimes be self-embedded, and the renal parenchyma is not developed.
Prevention
Kidney wound prevention
The disease is caused by trauma directly affecting the abdomen, such as kicking or falling injury. Therefore, pay attention to living habits, high-risk workers, such as construction workers, mining workers, car drivers are likely to cause damage due to accidents, should pay attention to protect themselves in the course of work. Pay attention to calmness and avoid emotional conflicts leading to the disease. Secondly, early detection, early diagnosis and early treatment are also important for the prevention of this disease.
Complication
Renal trauma complications Complications, hydronephrosis, pyelonephritis, hypertension, kidney stones, renal arteriovenous fistula
After renal trauma, early complications include secondary bleeding, renal and peri-renal infections and urinary fistula formation, and late complications include hydronephrosis, pyelonephritis, hypertension, kidney stones, urinary cysts, renal arteriovenous fistula and no function. Kidney and so on.
Open or closed injury of the kidney may be combined with chest, abdomen and spinal or distant tissue damage, clinically often cover up their symptoms and signs, should pay attention to the diagnosis, otherwise it may lead to missed diagnosis and misdiagnosis.
Symptom
Renal trauma symptoms Common symptoms Trauma, hematuria, extravasation, abdominal discomfort, high heat shock
It varies depending on the strength of the external force and the degree of damage to the renal parenchyma:
1. Shock: Shock can be caused by trauma and/or hemorrhage, and it is more likely to occur when combined injuries are caused by intra-abdominal organ damage. Therefore, it is important to closely observe vital signs during treatment.
2. Hematuria: The most common and most important symptom of renal trauma is gross hematuria. It is worth noting that the degree of hematuria is not necessarily consistent with the severity of trauma. Therefore, it is not clinically possible to judge the injury by the amount of blood in the urine. Light and heavy, when the hematuria is not heavy, it will disappear within a few days. If the activity is too early or complicated by infection, it may appear to be followed by blood.
3. Local lumps: extravasation of blood and urine to the surrounding tissues of the kidney, which can be seen in the upper abdomen and lumps. It should be observed whether or not it continues to expand. If local pain is accompanied by high fever, white blood cells are increased, which is a manifestation of infection around the kidney.
4. Pain and muscle tension: soft tissue injury of the wound, renal parenchymal injury, renal capsule irritability can cause pain in the waist or upper abdomen, clot obstruction of the ureter can also cause colic, extravasation of blood and urine into the abdominal cavity can cause typical peritoneum Stimulating symptoms, muscle tension and tenderness in the pain area.
5. Symptoms of combined injury: open or closed injury of the kidney may be combined with chest, visceral and spinal or distant tissue damage, clinically often cover up their symptoms and signs, should pay attention to the diagnosis, otherwise it may lead to missed diagnosis Misdiagnosed.
6. Kidney open injury: According to the injury site and direction and the leakage of urine, it is estimated that there is no kidney injury, but the wound does not necessarily have a large amount of bleeding or leakage of urine. Because such wounds have combined injuries, early surgical exploration should be performed.
Examine
Kidney wound examination
(1) Urine: Hematuria is an important basis, so urine examination is extremely important. If you cannot urinate on your own, you should have a catheterization test.
(2) X-ray inspection:
Abdominal plain film: There is no abnormality in renal contusion. Kidney laceration can be seen as enlarged or blurred kidney shadow, waist muscle shadow disappears, the spine is convex to the healthy side, or there is a fracture, etc. If there is a gunshot wound, metal foreign matter can be seen.
Excretory urography: should be carried out under the circumstances of the injury, generally need to use double or large doses of contrast agent to obtain the desired results, this method can not only understand the condition of the kidney or the presence and function of the contralateral kidney, kidney contusion At the time, the renal pelvis and renal pelvis showed normal, the renal pelvis may be slightly displaced due to the subcapsular hematoma, and some renal pelvis development may be slow in the case of renal laceration, the contrast agent spillover is the renal parenchymal laceration, and the pelvis is the renal pelvis Do not develop or have multiple contrast agents spilling out.
Renal angiography: not as a routine examination, only when the failure of pyelography can not be diagnosed, especially for the diagnosis of vascular injury.
Retrograde pyelography: This method has diagnostic value for the collection system trauma. As a supplementary examination, it is rarely used clinically due to its vulnerability to infection and certain pain.
(3) Radionuclide kidney scan: The scan shows normal on the scan, the kidney shape is not smooth, and the hematoma is radioactive cold zone, which can be used as a supplementary examination.
(4) B-mode ultrasound and CT examination: can detect the renal parenchymal condition and the extent of the hematoma.
Diagnosis
Diagnostic diagnosis of renal trauma
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Contusion: intact capsule, does not involve the collection system, limited to renal parenchymal injury or subcapsular hematoma, hematuria, X-ray abdominal plain film and urography without abnormal findings, B-ultrasound or CT examination can be found in renal parenchymal hematoma Its size and location.
A laceration: one or more deep clefts in the renal parenchyma. If the cleft is connected with the renal pelvis, the hematuria is severe. If accompanied by a rupture of the capsule, blood and urine extravasation form a hematoma around the kidney, and the peritoneum is broken at the same time, blood and urine. It can flow into the abdominal cavity, and the X-ray abdominal plain film can be seen with enlarged renal shadow, uneven density, common contrast agent spillover in urography, and B-ultrasound can be seen that the renal parenchyma is divided by hematoma. Such severe injuries often lead to shock.
Smash injury: the renal parenchyma and the capsule are broken into several pieces, the collection system is also ruptured at the same time, the bleeding and urinary extravasation are more serious, the urinary tract angiography is not developed or the development is slow, a large amount of contrast agent overflows, and the renal angiography shows the renal blood vessels. The branches are not developed, and the injuries are heavy. If they are not actively rescued, they often lead to death.
Renal rupture: often accompanied by renal parenchymal laceration, simple renal pelvic rupture is rare, showing signs of urinary extravasation.
Kidney pedicle injury: If the renal pedicle is completely ruptured, a large amount of bleeding is often too late to rescue, and small blood vessel rupture can sometimes be self-embedded, and the renal parenchyma is not developed.
