《肾损伤》课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,肾损伤ppt课件,肾损伤ppt课件,Function of the kidney,Produce urine, excrete metabolites,Maintain body fluid and acid-base balance,Endocrine function: Renin, prostaglandin,Regulate blood pressure and balance blood lipids,Endocrine degrading hormone,Background,Function of the kidneyBackgrou,Injuries to urinary system,About 10% of all injuries in the emergency room involve the genitourinary system,Many of them are difficult to define,Early diagnosis is essential to prevent serious complications,Background,Injuries to urinary systemBack,Basic Pathological change,Shock,Urinary extravasation,Urinary obstruction (destruction),Infection ,cost,death,Basic Pathological change,Anatomy,Kidney,Ureter,Bladder,Urethra,Ur,AnatomyKidneyUr,The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly,The kidney is well protected b,Etiology,Blunt trauma directly to the abdomen, flank, or back is the most common mechanism for 8085% renal injuries,Traffic accidents, fights, falling, contact sports, and so on.,Etiology Blunt trauma directly,Blunt trauma: The force transmitted from the center of the impact to the renal parenchyma,Deceleration: The kidney moves upward or downward,cause sudden stretch on the pedicle, acute renal artery injuries and thrombosis may occur,Blunt trauma: The force transm,Direct or indirect violence at upper abdomen or flank area may cause kidney injure,Direct or indirect violence at,Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculature,Gunshot and knife wounds cause penetrating injuries to the kidney,Fracture ribs and transverse v,*,Pathology,Renal contusion,(85% of cases),Superficial cortical lacerations,Subcapsular hematoma,*Pathology Renal contusion,Partial lacerations,Injuries extend to renal capsule,or,collecting system,Perirenal hematoma,Hematuria,Partial lacerations,Deep lacerations,Injuries extend both renal capsule,and,collecting system,Extravasation of urine into perirenal space,Large retroperitoneal hematoma,Hematuria,Deep lacerations,Vascular injury,(less than 1% ),Vascular injury of renal pedicle is rare,Difficult to diagnosis,Emergency operation should be done for saving life,Mortality is still high,Vascular injury,Clinical findings,History of trauma,Symptoms:,Pain may be localized to one flank area or over the abdomen associated to injury,Microscopic or gross hematuria following trauma to the abdomen or flank,Fever : infection,Clinical findingsHistory of tr,Signs,Shock or signs of a large loss of blood from heavy retroperitoneal bleeding may be noted,Palpable mass may represent a large retroperitoneal hematoma or urinary extravasation,Diffuse abdominal tenderness,Lower ribs fracture,Signs,Laboratory findings,Red blood cells in urine: hematuria,Hematocrit may be normal initially,but a drop may be found with time past,HCT dropping represents persistent retroperitoneal bleeding and development of a large retroperitoneal hematoma,Laboratory findings,Ultrasonography,Easy,Fast,Noninvasive,Well descript the parenchyma and hematoma of kidney,Ultrasonography,Radiology,IVU(,i,ntra,v,enous,u,rography, excretory urography),Function of separate sides,Urinary extravasation,Radiology IVU(intravenous urog,Enhanced CT scan,Abdominal CT scan is the most direct and effective means of staging renal injuries,Clearly defines parenchymal lacerations and urinary extravasation,First choice for diagnosis renal injuries,Radiology,Enhanced CT scanRadiology,Plain scanning period,Venous phase,Portal venous phase,Arterial phase,Excretory period,Plain scanning period,Plain scanning period,Plain scanning period,Venous phase,Venous phase,Arterial phase,Arterial phase,Excretory period,Excretory period,Arteriography,Defines major arterial and parenchyma injuries,Arterial thrombosis and avulsion of the renal pedicle are best diagnosis,Invasive, choose carefully,Radiology,ArteriographyRadiology,Others,Retrograde urography : dangerous with infection, should not be chosen,MRI: noninvasive, as an alternate choice,Others,Treatment,Emergency measures,Resuscitation,Treatment of shock and hemorrhage,Evaluation associated injuries,TreatmentEmergency measures,Minor renal injuries from blunt trauma account for 85% of cases do not require operation,Renal contusion,Partial laceration,Minor renal injuries from blun,*,Non-operative treatment,Bed rest for 24 weeks,Watchful waiting : vital signs, blood, urine,Hydration and nutrition,Antibiotics for prevent infection,Symptomatic therapy,：,analgesic, sedative, hemostasis,*Non-operative treatment,Operation indications,Penetrating injuries:,(Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure),Severe blunt injuries:,Deep laceration,Multiple laceration,Renal pedicle injuries, Persistent retroperitoneal bleeding , Severe urinary extravasation ,Operation indications,Operation indications,During non-operation treatment :,Anti-Shock ineffective, or shock occurance again,Hematuria get more severe,Mass of abdominal enlarged,Hemoglobin and hematocrit keep decreasing,Suspicious of Abdominal organ injury,Operation indications,Types of kidney injury?,The simplest and the best checks are?,Non-operative treatment of kidney trauma?,Surgical Indicationgs of kidney trauma?,Long - term complications of renal injury?,Others about Urinary Trauma?,Summary,Types of kidney injury?Summary,Thank You,Thank You,此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢,此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力,