ASSOCIATE PROFFESSOR Gross Hematuria Following Abdominal Wall Trauma URINARY TRACT INJURY: HISTORY: 1)Type of injury Time of injury 2)Detailed history about pain: Site, Character of pain, Radiation 3)Any other Symptoms General Examination • Degree of Shock • Pulse • Blood Pressure • Respiration • Temperature • Exclude other injury:RTA,14Yyr Boy Bladder Injury/pelvic fracture/Managed Emergency laparotomy Local Examination Of Abdomen INSPECTION:Distension, Loin swelling PALPATION:Guarding, Rigidity, Tenderness, Mass in the loin. PERCUSSION: Shifting Dullness, Obliteration of liver Dullness AUSCULTATION:Absent Bowel Sounds HEMOPERITONEUS PERITONITIS • Four quadrant aspiration • P/R:Any Fluid Collection, Pelvic Tenderness Grades Of Renal Injury GRADE 1: Subcapsular Non Expanding Hematoma GRADE 2:Cortical Laceration <1cm of Depth, No urinary extravasation GRADE 3: Cortical Laceration >1cm of Depth GRADE 4: Parenchymal Laceration Extenting Through Cortex,Medulla and Collecting System, Extravasation of Urine GRADE 5:Shattered Kidney, Avulsion of Renal Pedicle NEPHRECTOMY done in GRADE 4 & GRADE 5 CONSERVATIVE TREATMENT • Bed rest • Blood transfusion • Intravenous Fluids • Antibiotics • Analgesics • Monitor:Pulse rate, Blood pressure,Urine examination INVESTIGATIONS 1.Urine Examination: Gross, Microscopic 2.CT Scan Contrast: Extent Of Injury Vascular Injury 3. Intravenous Urography 4.USG Abdomen: perinephric Hematoma Hematuria Due To URETHRAL RUPTURE 1.Bleeding through Meatus 2.Inability to Urinate 3.Perineal Hematoma TYPES OF URETHRAL RUPTURE: 1.Partial 2.Complete Hematuria Due To URETHRAL RUPTURE… INVESTIGATION: Retrograde Cystourethrography Injury due to fracture plevis, 16Fr Foley's Catheter TREATMENT: PARTIAL: Repair-Urologist COMPLETE: Suprapubic Catheterization Definitive Repair after 3months POLYCYSTIC KIDNEY DISEASE AUTOSOMAL DOMINANT TRAIT: *Congenital Defect in the development of kidney *Faulty development of Secretory and Collecting tubules Failure in fusion of Glomeruli with convoluted tubules with the Collecting Tubules, leading to formation of CYSTS POLYCYSTIC KIDNEY DISEASE… PATHOLOGY: 1. Bilateral more advanced, one kidney 2. 3-4 times Enlarged 3.Cyst contain thick yellow or dark hemorrhagic fluid 4.Atrophic Cortical Tissue 5.Hematuria CLINICAL FEATURES: *Asymptomatic/Renal lumps/Infection/Hypertension/Chronic Renal Failure/Anuria TREATMENT: Deroofing Operation/USG guided Aspriation/Rovsin's Operation HYDRONEPHROSIS ASEPTIC DILATATION OF PELVICALCYEAL SYSTEM: Due to partial or intermittent obstruction of Urine CAUSES: congenital /acquired PRESENTATION: Renal lump/pain/bladder obstruction/hematuria GRADES OF HYDRONEPHROSIS: GRADE 1:most minimal dilatation with slight bulging of calyceal fornices GRADE 2: Enlargement and obvious blunting of calyses GRADE 3:Rounding of calyces with obliteration of papilla shadow GRADE 4:Extreme Calyceal balooning HYDRONEPHROSIS… INVESTIGATION: RADIONUCLIDE 99mTc DTPA SCANNING- Offer better functional information. HEATURIA IN GENITOURINARY TUBERCULOSIS (GUTB) PATHOGENESIS: 1) Endogenous 2) Exogenous * In the form of Granuloma and Caeation * Mycobacterium enter blood via thoracic duct, then to various organs mainly to Kidneys(GUT) *Communication of Caseating Granuloma with Collecting system spread to various parts of Urinary Tract:Calyx,Pelvis,Ureter,Bladder, Accessory Genital Organs HEATURIA IN GENITOURINARY TUBERCULOSIS (GUTB)… CHEMOTHERAPY: Healing by fibrosis, formation of Contractures And Strictures SYOMTOMS: Dysuria, Back or Flank pain Hematuria Nocturia Fever/weight loss/night sweats/anorexia ANTITUBERCULOSIS CHEMOTHERAPY STANDARD PROGRAMMES:UTTB INH,PAS,EMB- 2-3Months , for 18-24 months Supplemened with STREPTOMYCIN for 2-3months 18 - 24months
GUTB SHORT COURSE CHEMOTHERAPY:
1) INH, RIFAMPICIN , PYRAZINAMIDE : Daily for 2months ANTI TB CHEMOTHERAPY… FOLLOWED BY INH , RIFAMPICIN - Double dose 3times a week for next 2months ALTERNATIVLY INH/RIFAMPICIN/PYRAZINAMIDE AND STREPTOMYCIN Daily for 2 months Follwed by: INH/RIFAMPICIN on DOUBLE DOSE 3 timess a week for next 2 months WITH THORACIC MEDICINE / ICMR COUNCIL Surgery in GUTB 1)Excisional 2)Ablative 3)Reconstructive -Partial NEPHRECTOMY/EPIDIDYMECTOMY -Non Functional Kidney -Grossly Destroyed Kidney amd Coexistence Malignancy -Endoscopic Dilatation In Stricture THANK YOU