cedera_ginjal
TRANSCRIPT
-
8/17/2019 CEDERA_GINJAL
1/35
RENAL INJURY
(CEDERA GINJAL)
By
Dr. HARDY, SpB
-
8/17/2019 CEDERA_GINJAL
2/35
RELEVANT OF ANATOMY
-
8/17/2019 CEDERA_GINJAL
3/35
ETIOLOGI
- TRAUMA TUMPUL : KECELAKAAN LALULINTAS, OLAHRAGA, JATUH DARIKETINGGIAN, PENGANIAYAAN
- TRAUMA TAJAM : STAB OUND, GUN SHOT
OUND- IATROGENIC : PROSEDUR!
ENDOUROLOGI : ESL, RENAL BIOPSI,PCNL
-
8/17/2019 CEDERA_GINJAL
4/35
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
-
8/17/2019 CEDERA_GINJAL
5/35
LABORATORIUM
DARAH LENGKAP : H$ MENURUN %"& URINALISA
& HEMATURIA (%): MIKROSKOPISERITROSIT ' LPB, MAKROSKOPIS
HEMATURIA& HEMATURIA (&)
DERAJAT KERUSAKAN GINJAL TDKBERBANDING LURUS DENGAN ADA ATAU
TDKNYA HEMATURIA
-
8/17/2019 CEDERA_GINJAL
6/35
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
-
8/17/2019 CEDERA_GINJAL
7/35
RENAL INJURY
SCALE
-
8/17/2019 CEDERA_GINJAL
8/35
IMAGING
IVP USG CT SCAN ANGIOGRAFI
PENATALAKSANAAN KONSERVATIF
OPERASI
-
8/17/2019 CEDERA_GINJAL
9/35
-
8/17/2019 CEDERA_GINJAL
10/35
-
8/17/2019 CEDERA_GINJAL
11/35
KOMPLIKASI
KOMPLIKASI DINI
URINOMA
DELAYED
BLEEDING URINARY FISTULA
ABCES
HIPERTENSI
KOMPLIKASI LANJUT
HIDRONEFROSIS
ARTERIO VENOUSFISTULA
PYELONEFRITIS
CALCULUS
FORMATION DELAYED
HYPERTENSION
-
8/17/2019 CEDERA_GINJAL
12/35
URETERAL INJURY
(CEDERA URETER)
By
Dr. HARDY, SpB
-
8/17/2019 CEDERA_GINJAL
13/35
RELEVANT OF ANATOMY
-
8/17/2019 CEDERA_GINJAL
14/35
ETIOLOGI
E#TERNAL TRAUMA ARE RARE : BLUNT "PENETRATING
IATROGENIK
& PROSEDUR BEDAH : DIGESTIF,
GINEKOLOGI, UROLOGI
-
8/17/2019 CEDERA_GINJAL
15/35
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
-
8/17/2019 CEDERA_GINJAL
16/35
GAMBARAN KLINIS
- NYERI ABDOMEN : E#TRAVASASI URIN
(URINOMA)
- URINOMA
- MASSA PD ABDOMEN " PINGGANG
-NYERI PD CVA
- GAMBARAN PERITONITIS
- KELUAR CAIRAN DR LUKA ATAU VAGINA
-
8/17/2019 CEDERA_GINJAL
17/35
IMAGING
URETEROSCOPY
KUB " IVP
CT SCAN
PENATALAKSANAAN& PEMBEDAHAN
-
8/17/2019 CEDERA_GINJAL
18/35
BLADDER INJURY(CEDERA KANDUNG
KEMIH)By
Dr. HARDY, SpB
-
8/17/2019 CEDERA_GINJAL
19/35
RELEVANT OF ANATOMY
-
8/17/2019 CEDERA_GINJAL
20/35
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
-
8/17/2019 CEDERA_GINJAL
21/35
KLASIFIKASI
& BLADDER CONTUSION : INCOMPLETE "
PARTIAL THICKNESS TEAR OF THEBLADDER, HEMATOME
- E#TRAPERITONEAL BLADDER RUPTURE
-INTRAPERITONEAL BLADDER RUPTURE
- KOMBINASI : INTRA " E#TRA PERITONEALBLADDER RUPTURE
-
8/17/2019 CEDERA_GINJAL
22/35
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)
-
8/17/2019 CEDERA_GINJAL
23/35
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
-
8/17/2019 CEDERA_GINJAL
24/35
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
-
8/17/2019 CEDERA_GINJAL
25/35
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
-
8/17/2019 CEDERA_GINJAL
26/35
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
-
8/17/2019 CEDERA_GINJAL
27/35
CEDERA URETRA
By
Dr. HARDY, SpB
-
8/17/2019 CEDERA_GINJAL
28/35
RELEVANT OF ANATOMY
-
8/17/2019 CEDERA_GINJAL
29/35
ETIOLOGI
- BLUNT INJURY
-PENETRATING INJURY
- IATROGENIK
KLASIFIKASI- CEDERA URETRA ANTERIOR
- CEDERA URETRA POSTERIOR
-
8/17/2019 CEDERA_GINJAL
30/35
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
-
8/17/2019 CEDERA_GINJAL
31/35
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
-
8/17/2019 CEDERA_GINJAL
32/35
CEDERA TAJAM " PENETRATING
- MUTILASI : DIRI SENDIRI, PASANGAN →
PENILE AMPUTATION- GIGITAN
- LUKA TUSUK
-
LUKA TEMBAK - BENDA ASING
IATROGENIK
- TERPOTONG SAAT SIRKUMSISI
- PEMASANGAN KATETER
- PROSEDUR! UROLOGI
-
8/17/2019 CEDERA_GINJAL
33/35
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
-
8/17/2019 CEDERA_GINJAL
34/35
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
-
8/17/2019 CEDERA_GINJAL
35/35
IMAGING
- RETROGRADE URETROGRAPHY
- CT SCAN " MRI
PENATALAKSANAAN
-KONSERVATIF
- OPERATIF