GENITOURINARY
TRAUMA
INDAH D. PRATIWI
Additional Injury
Spillage of hollow organ contents
Peritonitis
Abdominal Boundaries
Diaphragm
Anterior abdominal wall
Pelvic skeletal structures
Vertebral column
Muscles of the abdomen and flanks
Abdominal & Pelvic Cavities
Retroperitoneal
Kidneys, ureters, bladder, reproductive organs, inferior vena cava, abdominal
aorta, pancreas
Peritoneal
Bowel, spleen, liver, stomach, gall bladder
Pelvic
Rectum, ureters, pelvic vascular plexus, femoral arteries, femoral veins,
pelvic skeletal structures, reproductive organs
Pathophysiology
Hemorrhage
Limited external signs
Rapid blood loss possible
Hypovolemic shock
Blood does not result in peritonitis
Solid Organ Injuries
Death usually because of hemorrhage
May due to blunt or penetrating mechanism
Solid Organ Injuries
Spleen
Frequently injured solid organ
Usually due to blunt trauma
Often trauma to ribs 9-11 on left side
Bleeds easily
Capsule around spleen tends to promote slow development of shock
Rapid shock onset when capsule ruptures
May present with left shoulder pain
diaphragm irritation
Solid Organ Injuries
Liver
Largest organ in abdomen
Frequently injured organ
May be due to blunt or penetrating trauma
Often trauma to ribs 8-12 on right side
Bleeding
Slow and contained under capsule
Enters peritoneal cavity
Solid Organ Injuries
Pancreas
Lies across lumbar spine
Usually due to penetrating trauma
also due to compression against vertebral column by steering wheel, handle bars, or other
object
Sudden deceleration produces straddle injury
Very little hemorrhage
Irritation to peritoneum
fluid loss from leakage of pancreatic enzymes
auto-digestion of tissue
Hollow Organ Injuries
Death may result from hemorrhage and/or content spillage
May result from penetrating or blunt trauma
Hollow Organ Injuries
Stomach
Usually injured due to blunt trauma
Full stomach prior to incident risk of injury
Spillage of contents into peritoneal cavity
Immediate pain, tenderness, guarding, and rigidity
Small Bowel
Spillage of contents into peritoneal cavity
Immediate pain, tenderness, guarding, and rigidity
Less bacteria
May take 24-48 hours for S/S to manifest
Abdominal Vascular Injuries
High mortality due to rapid
blood loss
Survival dependent upon extent of injury and
time to surgery
Penetrating
Rare, usually associated
GSW or Stab wound
Kidney Trauma S/S
Gross Hematuria
80% of cases
absence does not exclude renal injury
Scrotal/Testicular
Penetrating injury
Blunt injury
Management
Control bleeding / Indirect ice / Analgesia
Psychological and Modesty Concerns
Female External Genitalia
Usually intentional due to assault
Primarily soft tissue injury
Hemorrhage likely
Look for other injuries
Sexual Assault
Emotional state provides additional challenge
NPO
Caution with
Sedatives
Narcotic Analgesics
Question???