TRAUMA KEPADA SALUR GENITO URINARI
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TRAUMA KEPADA SALUR GENITO URINARI
Disediakan Oleh : Nassruto
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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
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ETIOLOGI
1. GUN SHOT WOUND2. STAB WOUND3. CRUSH INJURY4. SEBARANG HENTAMAN YANG KUAT
KEATAS SALUR G.U.
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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.
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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
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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
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Diagnosis
1. Sejarah dan riwayat pesakit tentang
trauma
2. Ciri-ciri klinikal dan manifestasi
3. Pemeriksaan fizikal
4. Investigasi klinikal
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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.
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• Pembedahan kecemasan • Untuk memberhentikan
pendarahan
• Pembedahan pembetulan / reseksi
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DIALISIS
DEFINISITeknik/tatacara yang dijalankan untuk
menyingkirkan bahan buangan metabolisma dan plasma berlebihan daripada badan
Dialisis PeritoneumHemodialisis
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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
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Case presentation
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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 :
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Demonstrating extravasation of contrast from the right kidney, and a functioning left kidney.
Resuscitation room intravenous urography wasperformed:
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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.
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The retroperitoneum was opened, revealing an large laceration to the lower pole of the right kidney:
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Devitalised tissue was debrided, and the kidney repaired with pledgeted mattress sutures across both ends of the laceration.
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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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Terima kasih