TRAUMA KEPADA SALUR GENITO URINARI

Disediakan Oleh : Nassruto

TRAUMA KEPADA SALUR GENITO URINARI

PENGENALAN

• KECEDERAAN PARAH LEBIH PRIORITI BERBANDING TRAUMA G.U

• PEMERIKSAAN FIZIKAL,URIN DAN X-RAY AMAT BERGUNA

• KENCING BERDARAH KESAKITAN DAN KETENDERAN ADALAH S/S YG UTAMA

ETIOLOGI

1. GUN SHOT WOUND2. STAB WOUND3. CRUSH INJURY4. SEBARANG HENTAMAN YANG KUAT

KEATAS SALUR G.U.

TRAUMA KEPADA G.UJENIS KECEDERAAN1. Kecederaan ginjal2. Kontusi ginjal3. Laserasi ginjal4. Ruptur ginjal5. Kecederaan pedikal renal6. Kecederaan pelvis renal7. Ruptur pelvis renal8. Kecederaan ureter9. Kecederaan pundi kencing10. Kecederaan uretra11. Kecederaan genital – zakar dan buah zakar.

Manifestasi klinikal

1. sejarah punca kecederaan – MVA, jatuh, assault.2. kecederaan luka – “Flank” , suprapubik, genital3. Lebam, kontusi– “Flank” , suprapubik, genital4. Darah dalam urin5. Disuria6. Sakit dan tender bhg. Abdomen7. Tanda & simtom renjatan:- hipovolumik

Investigasi

1. URIN• FEME ~ protenuria, hematuria, red-cell mast

1. Darah

• HB, twdc, BUSE, ABG1. X - RAY

• Abdomen - AP view , KUB• Ivp – intravenous myelogram• Cystogram• Ct Scan

Diagnosis

1. Sejarah dan riwayat pesakit tentang

trauma

2. Ciri-ciri klinikal dan manifestasi

3. Pemeriksaan fizikal

4. Investigasi klinikal

PENGENDALIAN• Bergantung kepada jenis kecederaan• Rawatan kecemasan• Berhentikan pendarahan• Pemerhatian tanda-tanda vital• Pengukuran “abdominal girth”• Pemasangan kateter• I/V line prevent Shock

• Melakukan Ix untuk tujuan pengesahan lanjut organ terlibat.

• Pembedahan kecemasan • Untuk memberhentikan

pendarahan

• Pembedahan pembetulan / reseksi

DIALISIS

DEFINISITeknik/tatacara yang dijalankan untuk

menyingkirkan bahan buangan metabolisma dan plasma berlebihan daripada badan

Dialisis PeritoneumHemodialisis

DIALISIS

Indikasi Dialisis Peritoneum /Hemodialisis

1. Keadaan pesakit merosot ~ koma, sawan, Edema pulmonari

2. Se Urea lebih 50 mmol/L3. Asidosis berterusan4. Hiperkalemia (6 mmol/L)5. Edema Pulmonari Akut

Case presentation

Primary survey: Airway : Maintaining own airway.  Cervical collar & immobilisation in place Breathing : Respiratory rate 20, right sided chest bruising, clinically multiple right sided rib fractures. O2sats 96% Circulation : Pulse 120/min, BP 80/40 Disability : Glasgow Coma Score 14/15.  Bilateral equal pupils.  No gross peripheral motor or sensory deficit. Exposure : No other obvious injuries

32yr old man admitted post Motor Vehicle Crash. On admission :

Demonstrating extravasation of contrast from the right kidney, and a functioning left kidney.

Resuscitation room intravenous urography wasperformed:

Surgery

Patient was taken for laparotomy, where he was found to have a 500mls of free blood in the peritoneum.  There was no injury to intraperitoneal organs, but a large, expanding retroperitoneal haematoma was present, which was leaking into the peritoneal cavity.

The retroperitoneum was opened, revealing an large laceration to the lower pole of the right kidney:

Devitalised tissue was debrided, and the kidney repaired with pledgeted mattress sutures across both ends of the laceration.

A drain was placed to the retroperitoneum and the abdomen closed. The patient had an uneventful postoperative course and was discharged home on day 8.

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