CEDERA_GINJAL

8/17/2019 CEDERA_GINJAL

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RENAL INJURY

(CEDERA GINJAL)

By

Dr. HARDY, SpB


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RELEVANT OF ANATOMY


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ETIOLOGI

- TRAUMA TUMPUL : KECELAKAAN LALULINTAS, OLAHRAGA, JATUH DARIKETINGGIAN, PENGANIAYAAN

- TRAUMA TAJAM : STAB OUND, GUN SHOT

OUND- IATROGENIC : PROSEDUR!

ENDOUROLOGI : ESL, RENAL BIOPSI,PCNL


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GAMBARAN KLINIS

-

RIAYAT TRAUMA- MEKANISME CEDERA

- SISTEM HEMODINAMIK : STABIL " TDKSTABIL

-NYERI DAERAH PINGGANG " ABDOMENBAGIAN ATAS

- GAMBARAN AKUT ABDOMEN : PERITONITIS

- MASSA RETROPERITONEAL : HEMATOM,

URINOMA (E#TRAVASASI URIN)- JEJAS DI DAERAH PINGGANG : MEMAR,

EKIMOSIS

- F# TULANG KOSTA BAGIAN BAAH


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LABORATORIUM

DARAH LENGKAP : H$ MENURUN %"& URINALISA

& HEMATURIA (%): MIKROSKOPISERITROSIT ' LPB, MAKROSKOPIS

HEMATURIA& HEMATURIA (&)

DERAJAT KERUSAKAN GINJAL TDKBERBANDING LURUS DENGAN ADA ATAU

TDKNYA HEMATURIA


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GRADE

TYPE DESCRIPTION

I CONTUSION

HEMATOMA

MICROSCOPIC OR GROSS HEMATURIA, UROLOGICSTUDIES NORMAL

SUBSCAPULAR, NONE#PANDING ITHOUTPARENCHYMAL LACERATION

II HEMATOM

A

LACERATION

NONE#PANDING PERIRENAL HEMATOMA

CONFINED TO RENAL RETROPERITONEUM * CM PARENCHYMAL DEPTH OF RENAL CORTE#ITHOUT URINARY E#TRAVASATION

III LACERATIO

N

' * CM PARENCHYMAL DEPTH OF RENAL CORTE#

ITHOUT COLLECTING SYSTEM RUPTURE ORURINARY E#TRAVASATION

IV LACERATION

VASCULAR

PARENCHYMAL LACERATION E#TENDING TROUGHRENAL CORTE#, MEDULLA AND COLLECTINGSYSTEM

MAIN RENAL ARTERI OR VEIN INJURY ITH

COUNTAIN HEMORRHAGE

RENAL INJURY SCALE


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RENAL INJURY

SCALE


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IMAGING

IVP USG CT SCAN ANGIOGRAFI

PENATALAKSANAAN KONSERVATIF

OPERASI


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KOMPLIKASI

KOMPLIKASI DINI

URINOMA

DELAYED

BLEEDING URINARY FISTULA

ABCES

HIPERTENSI

KOMPLIKASI LANJUT

HIDRONEFROSIS

ARTERIO VENOUSFISTULA

PYELONEFRITIS

CALCULUS

FORMATION DELAYED

HYPERTENSION


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URETERAL INJURY

(CEDERA URETER)

By

Dr. HARDY, SpB


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RELEVANT OF ANATOMY


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ETIOLOGI

E#TERNAL TRAUMA ARE RARE : BLUNT "PENETRATING

IATROGENIK

& PROSEDUR BEDAH : DIGESTIF,

GINEKOLOGI, UROLOGI


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GRADE OF URETERAL INJURY

GRADE

DESCRIPTION

I CONTUSION OR HEMATOMA ITHOUTDEVASCULARI+ATION

II LACERATION : - TRANSECTION

III LACERATION : ' - TRANSECTION

IV LACERATION : COMPLETE TRANSECTION ITH !CM DEVASCULARI+ATION

V LACERATION : AVULSION ITH ' !CM OF

DEVASCULARI+ATION


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GAMBARAN KLINIS

- NYERI ABDOMEN : E#TRAVASASI URIN

(URINOMA)

- URINOMA

- MASSA PD ABDOMEN " PINGGANG

-NYERI PD CVA

- GAMBARAN PERITONITIS

- KELUAR CAIRAN DR LUKA ATAU VAGINA


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IMAGING

URETEROSCOPY

KUB " IVP

CT SCAN

PENATALAKSANAAN& PEMBEDAHAN


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BLADDER INJURY(CEDERA KANDUNG

KEMIH)By

Dr. HARDY, SpB


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RELEVANT OF ANATOMY


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ETIOLOGI

- BLUNT INJURY (CEDERA TUMPUL) :

♦ CEDERA DAERAH PELVIK

♦ SERING DIIKUTI CEDERA ABDOMEN

- PENETRETING INJURY (CEDERA TAJAM)

♦

LUKA TUSUK ♦ LUKA TEMBAK

- IATROGENIK

♦ PROSEDUR GYNECOLOGI : SC, HITEREKTOMY

♦ PROSEDUR UROLOGI : TUR P " TUR BT ♦ PROSEDUR ORTHOPEDI : PEMBEDAHANPADA TULANG PELVIK


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KLASIFIKASI

& BLADDER CONTUSION : INCOMPLETE "

PARTIAL THICKNESS TEAR OF THEBLADDER, HEMATOME

- E#TRAPERITONEAL BLADDER RUPTURE

-INTRAPERITONEAL BLADDER RUPTURE

- KOMBINASI : INTRA " E#TRA PERITONEALBLADDER RUPTURE


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GRADE OF BLADDER INJURY

GRADE

DESCRIPTION

I HEMATOME " INTRAMURAL HEMATOMEPARTIAL THICKNESS LACERATION

II LACERATION : E#TRAPERITONEAL BLADDER ALL

LACERATION !CMIII LACERATION : E#TRAPERITONEAL ('!CM) OR

INTRA&PERITONEAL (!CM) BLADDER ALLLACERATIONS

IV LACERATION : INTRAPERITONEAL BLADDER ALL

LACERATION '!CM

V LACERATION E#TENDING INTO BLADDER NECK ORURETERAL ORIFICE (TRIGONE)


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PATOFISIOLOGI INCOMPLETE " PARTIAL THICKNESS TEAR OF THE

BLADDERHEMATOME

KLINIS LOER ABDOMINAL PAIN " SUPRA PUBIC PAINGROSS HEMATURIA

LABORATORIUM

IMAGING CYSTOGRAFI

PENATALAKSANAAN SELF LIMITINGNO SPECIFIC THERAPYPEMASANGAN KATETER

BLADDER CONTUSSION


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PATOFISIOLOGI ASSOCIATED ITH ANTERIOR PUBIC ARC PELVIC

FRACTUREDIRECT PERFORATION BY BONY FRAGMENT ORDISRUPTION OF THE PELVIC GIRDL /PUBOPROSTATIC LIGAMENTBURST INJURY

DERAJATKERUSAKAN

DIRECTLY RELATED TO THE SEVERITY OF THEFRACTURE.

KLINIS LOER ABDOMINAL PAIN " SUPRA PUBIC PAIN GROSS HEMATURIA INABILITY OF VOIDING

KLINIS TAMBAHAN HEMATOME " SELLING : PERINEUM,

SKROTUM,ABDOMINAL ALL

LABORATORIUM

IMAGING CYSTOGRAFI : E#TRAVASATION CONTRAST CT SCAN : E#TRAVASATION CONTRAST

E#TRAVASASI KE DINDING ABDOMEN,PERINEUM, SKROTUM

E#TRA PERITONEAL BLADDER RUPTURE


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PATOFISIOLOGI TEARS IN THE BLADDER DOME

FULL BLADDER COMMON IN SEAT BELT / STEERING HEELINJURY AND

IN CHRONIC ALCHOOL

KLINIS LOER ABDOMINAL PAIN " SUPRA PUBIC PAIN GROSS HEMATURIA INABILITY OF VOIDING GAMBARAN PERITONITIS, URINARY ASCITES KADANG! : SILENT " LATE PRESENTATIONS :UREMIA,

METABOLIC ACIDOSIS

LABORATORIUMIMAGING CYSTOGRAFI : E#TRAVASASI URIN KE RONGGA

PERITONEAL CT SCAN : E#TRAVASASI URIN KE RONGGAPERITONEAL

PENATALAKSANAAN

PEMASANGAN KATETER REPAIR

INTRA PERITONEAL BLADDER RUPTURE


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KOMPLIKASI

- SEPSIS

-PELVIC INFECTION

- INCONTINENCE URINE

- SMALL CAPACITY BLADDER

-HEMAORRAGE

- URINE ASCITES

PEMASANGAN KATETER DI

KONTRAINDIKASIKAN PD CEDERA " FRAKTURPELVIK JIKA DI JUMPAI 0BLOOD DISCHARGE1PADA MEATUS URETRA E#TERNA


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CEDERA URETRA

By

Dr. HARDY, SpB


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RELEVANT OF ANATOMY


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ETIOLOGI

- BLUNT INJURY

-PENETRATING INJURY

- IATROGENIK

KLASIFIKASI- CEDERA URETRA ANTERIOR

- CEDERA URETRA POSTERIOR


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GRADE OF URETHRAL INJURY

GRADE INJURYTYPE DESCRIPTION

I CONTUSION

BLOOD AT URETHRAL MEATUS2 RETROGRAPHYNORMAL

II STRETCHINJURY

ELONGATION OF URETHRA ITHOUTE#TRAVASATION ON URETHROGRAPHY

III PARTIALDISRUPTION

E#TRAVASATION OF URETHROGRAPHY CONTRASTAT INJURY SITE ITH VISUALI+ATION IN THEBLADDER

IV COMPLETEDISRUPTIO

N

E#TRAVASATION OF URETHROGRAPHY CONTRASTAT INJURY SITE ITHOUT VISUALI+ATION IN THE

BLADDER2 !CM OF URETHRA SEPERATION

V COMPLETEDISRUPTION

COMPLETE TRANSACTION ITH '! CMURETHRAL SEPARATION, OR E#TENSION INTO THEPROSTATE OR VAGINA


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CEDERA URETRA ANTERIOR

BLUNT INJURY

SERING MENGENAI PARS BULBOSA STRADDLE TYPE INJURY

& KECELAKAAN PADA SAAT MENGENDERAISEPEDA " SEPEDA MOTOR

& TENDANGAN DAERAH PERINEUM

TERDAPAT TEKANAN BERLAANANANTARA RAMI PUBIK INFERIOR DENGAN

URETRA PARS BULBOSA → KONTUSIO ATAULACERASI URETRA

FRAKTUR PENIS : SAAT EREKSI


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CEDERA TAJAM " PENETRATING

- MUTILASI : DIRI SENDIRI, PASANGAN →

PENILE AMPUTATION- GIGITAN

- LUKA TUSUK

-

LUKA TEMBAK - BENDA ASING

IATROGENIK

- TERPOTONG SAAT SIRKUMSISI

- PEMASANGAN KATETER

- PROSEDUR! UROLOGI


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GAMBARAN KLINIS

- JARANG DISERTAI CEDERA PD ORGAN LAIN

-KDG TAMPAK RINGAN : TTP BBRP BLN KMDNPENDEITA DATANG TLH MENGALAMI STRIKTURURETRA

- KDG DISERTAI F# PENIS (PEROBEKAN PD TUNIKA

ALBUGINEA, CORPUS SPONGIOSUM): PD SAATEREKSI

- SAKIT BAK, SULIT BAK DAN TDK BISA BAK

- DARAH PD MEATUS URETRA EKSTERNA

& HEMATOM PD PENIS, PERINEUM : JK CEDERAMEROBEK FASCIA BUCK1S / FASCIA COLLESMEMBERIKAN GAMBARAN 0BUTTERFLY HEMATOME


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CEDERA URETRA POSTERIOR

- SERING DISERTAI TRAUMA % F# PD PELVIK

- STRADDLE INJURY

- PD PARS MEMBRANOUS / PARSPROSTATIKA

GAMBARAN KLINIS

- DARAH PD MEATUS URETRA EKSTERNA

-

HEMATOM PD PERINEUM- KETDK MAMPUAN BERKEMIH

- RT : FLOATING PROSTAT


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IMAGING

- RETROGRADE URETROGRAPHY

- CT SCAN " MRI

PENATALAKSANAAN

-KONSERVATIF

- OPERATIF

CEDERA_GINJAL

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