Kidney Lacerations Contusions Rina Parrish Michelle Jones 1

Kidney Lacerations & Contusions Rina Parrish & Michelle Jones 1 October 2003 AH 322 Eval. Of athletic injuries I

Kidney contusions& lacerations • Kidneys • Paired solid, bean-shaped organs located in both RUQ & LUQ near spine(the right kidney is slightly lower than the left ) • Function to help control blood volume • Also remove waste from blood in form of urine

Kidney contusions& lacerations

Kidney Contusions & Lacerations • Usually caused by external force causing abnormal extension • Degree of injury depends on extent of distension, angle, and force of blow

Kidney Contusions & Lacerations •

Kidney contusions& lacerations • Kidneys • Signs & symptoms of Kidney injury • • • Hematuria Bloody discharge or inability to void Flank pain + Grey-Turner sign - Ecchymosis in flank No acute abdominal signs Possible bony crepitus due to rib fx

Kidney contusions& lacerations • Signs & symptoms of Kidney injury Cont… • Rigidity of back muscles • High pain in the posterior costoverterbral angle

Kidney contusions& lacerations • Physical Examination • Following vital signs progresses to • INSPECTION • AUSCULTATION • PERCUSSION • PALPATION & SPECIAL TESTS

Kidney contusions& lacerations • Palpation determines • Signs of acute abdomen such as • • • Rebound tenderness Rigidity Guarding General & specific areas of tenderness Location of deformities Location & extent of swelling

Kidney contusions& lacerations • INSPECTION • Observe the following • Level of consciousness • Skin color • Patient's positions, movements & signs of guarding or apprehension • Respiratory rate & rhythm for dyspnea or (shortness of breath)

Kidney contusions& lacerations • INSPECTION • Observe the following • Signs of trauma • • • Hemoptysis or (coughing up blood) Hematemesis or (vomiting up blood) Ecchymosis Evidence of mass Evidence of penetrating trauma Vomiting

Kidney contusions& lacerations • Auscultation, Percussion & Palpation • each quadrant of the abdominal cavity is affected & should be included in your physical exam • When examining the abdomen, each quadrant should be auscultated, percussed & palpated

Kidney contusions& lacerations • AUSCULTATION • Conducted to assess • Normal vs. abnormal chest sounds • Breathing equality • Depth of breaths • Presence or absence of bowel sounds • Abnormal vascular noises

Kidney contusions& lacerations • AUSCULTATION • Process of listening for sounds produced in thoracic & abdominal cavity • Stethoscope is used & auscultation is normally conducted by medical professionals with extensive training & experience in this complex skill

Kidney contusions& lacerations • AUSCULTATION • Conducted to assess • Normal vs. abnormal chest sounds • Breathing equality • Depth of breaths • Presence or absence of bowel sounds • Abnormal vascular noises

Kidney contusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • Hyperresonance

Kidney contusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • hyperresonance

Kidney contusions& lacerations • PERCUSSION • Usually performed by trained medical professionals • Involves tapping on various parts of the body to elicit certain sound • Sound produced assists in determining the presence or absence of certain conditions • To yield informative results, extensive training & practice are required

Kidney contusions& lacerations • PERCUSSION • Listen for normal/abnormal sounds such as • tympany • dullness • hyperresonance

Kidney contusions& lacerations • PALPATION & SPECIAL TESTS • Palpation is process of determining various abdominal pathologies by pressing with your hands in various quadrants

Kidney contusions& lacerations • Palpation determines • Signs of acute abdomen such as • Bony crepitus (produced by rough edges of fractured bones rubbing together) • Asymmetry • Air crepitus (produced by air caught in subcutaneous tissue) • Muscle rigidity

Kidney contusions& lacerations • IMMEDIATE REFERRAL • Necessary with following S & S • Diminished chest movement on the affected side • Shifting or moving of trachea with each breath • Suspected rib fracture or costochondral separation • Severe abdominal pain

Kidney contusions& lacerations • IMMEDIATE REFERRAL • Necessary with following S & S • Difficulty in breathing • Shortness of breath--inability to catch breath • Severe pain increasing in chest • Vomiting or coughing up blood

Kidney contusions& lacerations • IMMEDIATE REFERRAL • Necessary with following S & S • Prolonged discomfort, sensation of weakness, or pulling in groin • Superficial protrusion or palpable mass • Increasing nausea • Vomiting

Kidney contusions& lacerations • IMMEDIATE REFERRAL • Necessary with following S & S • Signs of acute abdomen • Rebound tenderness • Rigidity • Guarding • Signs of shock • Blood in the urine or stool

Kidney contusions& lacerations • IMMEDIATE REFERRAL • Necessary with following S & S • Presence of fever • Presence of radiating or referred pain • Any doubt regarding the nature and severity of the abdominal injury

Kidney contusions& lacerations • Management • Twenty-four hours in the hospital • Gradual increase of fluid intake • Two weeks bed rest • Refrain from any physical activity • Some cases surgery

Kidney contusions& lacerations • Return to Play • When all signs & symptoms are cleared • No pain associated with the contusion • Sometimes wont return to sports at all • When return surveillance of athlete • Protected padding

Kidney contusions& lacerations Any questions