Shared Flashcard Set

Details

Dr. Elisco
urology
29
Medical
Graduate
12/16/2007

Additional Medical Flashcards

 


 

Cards

Term
(Genitourinary trauma)

Q. ___ acounts of 80 -90% of all trauma to the upper urinary tract
Definition
blunt
Term
Pt was in a MVA and experienced blunt trauma. You do a CT scan of the upper urinary tract and found blood at the meatus. What is the next test you call for and who do you consult?
Definition
Test = retrograte urethrogram
Consult: urology
Term
Adult blunt trauma with no blood in meatus and find microhematuria and patient is not in shock. on x-ray you find a pelvic fracture. what is the next exam you choose to get for this patient?
Definition
cystogram. if abnormal consult urology

If no pelvic fracture -- just observe

iF no shock --> consider CT or IVP in major deceleration injury
Term
Patient experienced a stab wound to the penis and is hemodynamically stable. what should you do next?
Definition
urology consult and retrograde urethrogram if positive microscopic or gross hematuria
Term
What grade is the following renal injury?
Pt has a renal contusion, intact renal capsule and collecting system
Definition
Grade I
Term
what grade is the following renal injury: major laceration greater than 1 cm in depth. collecting system intact
Definition
grade III
Term
Minor laceration, superificial cortical disruption less than 1 cm. collecting system intact is what grade in terms of renal injury?
Definition
II
Term
Describe a Grade IV renal injury
Definition
parenchymal laceration extending through the renal cortex, medulla and collecting system; pr main renal artery or vein injury with contained hemorrhage
Term
describe a Grade V renal injury
Definition
completely shattered kidney or avulsion of main renal artery or vein that devascularizes the kidney. AKA pedical injury
Term
How do manage Grade 1, 2 and most of grade 3 renal traumas
Definition
bed rest, serial H/H, repeat X-rays i.e. CT scan; once pt is hemodynamically stable can be managed as an outpatient
Term
you have a patient with a parenchymal lacertion extending through the renal cortex, medulla, and collecting system -- how would you manage this patient?
Definition
Patient has a grade IV renal trauma: manage with
stent
renal exploration
nephrectomy ??
autotransplant

also applies to Grave V
Term
How do you diagnose a ureteral injury and what is the most common cause?
Definition
diagnosed by contrast study: CT scan, IVP, and or retrograde pylogram.
almost always from a sharp trauma.
most common causes are iatrogenic: ureteroscopy, pelvic surgery and cancer.
Term
What are the signs and symptoms of ureteral injury?
Definition
flank pain: 1-21 days
flever >100F
anuria bilateral only
ureterovaginal fistula: 1-30 days
ureterocutaneous fistula: 1-30 days
Term
what is your primary goal in treating a ureteral injury and what are some ways you can establish this goal?
Definition
#1: reestablish the flow of urine!!!

ureteric stent
nephrostomy tube
ureteroureterostomy
nephrectomy??
Term
The bladder is most vulnerable to injury during MVAs, falls, crush injuries, blows to the abdomen when??
Definition
then bladder is full
Term
What symptom is unavoidable and always present when diagnosing someone with a bladder injury?
Definition
gross hematuria (disrupt bladder lining you are going to get hematuria!)
Term
What is a pathopneumonic finding for bladder injury when using CT scan or cystogram as a imaging modality?
Definition
urinary extravasation (80% of the time is extraperitoneal and 20% of the time is intraperitoneal)
Term
where is the intraperitoneal extravasation located?
Definition
at the dome of the bladder. usually requires surgical repair
Term
posterior urethra includes what parts?
Definition
prostate and membranous

anterior = bulbous and pendulous
Term
Patient fell from a hieght and experienced a shearing force of pelvic bone diruption with the prostate and membranous urethra being pulled in opposite directions. If you were to diagnose the following patient with a posterior urethral injury, what would y
Definition
1. the patients history!
2. blood per meatus
3. classicly: "high riding prostate"
4. pelvic hematoma
5. retrograde urethrogram would be done prior to catherization!!
Term
How do you treat a posterior urethral injury?
Definition
establish urinary drainage! very useful and safe= suprapubic tube (pt.s will later need realignment)

for partial tears - cystoscopy with realignment using foley catheter
Term
What are long term complications following a posterior urethral injury?
Definition
incontinence
stricture formation
impotence
Term
Follow up of the long term complications of posterior urethral injuries =
Definition
cystoscopy
dilation of strictures
ED therapy if necessary
Term
Most anterior urethral injuries are caused by external violence and blunt trauma to the perineum. how would be work up this patient
Definition
diagnose with H/p
retention
blood per meatus
echhymosis of the penis scrotum and/or perineum
retrograde urethragram and cystoscopy important in diagnosis
Term
what are some complications of penile injuries?
Definition
impotency and urethral strictures as well as psychological effects
Term
what test is the most helpful for diagnosing scrotal injuries?
Definition
ULtrasound!!
Term
how do you treat scrotal hematomas?
Definition
conservatively, most will resolve with time.
Term
t?F most testicular fractures most be removed
Definition
true
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