Bladder injury. Possible bladder injuries
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Ureter injury
Injuries to the ureter are the rarest of the injuries of the genitourinary tract due to external trauma. With blunt trauma, a rupture may occur at the point of origin of the ureter from the pelvis (or slightly below) as a result of hyperextension or separation of the lower end of the ureter, fixed to the triangle of the bladder. With a penetrating wound, a contusion of the ureter is possible, as well as its partial or complete rupture.
Contusion can occur in a gunshot wound if the bullet passes near the ureter, resulting in damage to the vessels of the ureteral wall, including bleeding or thrombosis. Revision of the wound shows that the bullet missed the ureter, while its wall appears intact or slightly damaged. In the event of vascular thrombosis in the wall of the ureter, necrosis is subsequently observed with the formation of a urinary fistula.
Bladder injury
In children, the bladder is an intra-abdominal organ, while in adults it is located much lower and is surrounded by the pelvic bones, which protects it from the most severe injuries in case of trauma to the abdomen and pelvis. Bladder injuries are the second most common injury after kidney injury and are usually associated with pelvic fractures.
Bladder injury
A bruise of the bladder is understood as a violation of the integrity of its wall with hemorrhage. On the cystogram, the contours of the bubble are not changed. With a fracture of the pelvic bones, there is often an extensive hematoma inside the bone pelvis, which leads to a displacement of the bladder either upward or to the side. Treatment in such cases is conservative, since the violation is resolved without deformation of the bladder wall.
Intraperitoneal rupture of the bladder
This injury is the result of an injury to the abdomen or pelvis at the moment when the bladder is filled with urine; in this case, the dome of the bladder ruptures with leakage of urine into the abdominal cavity. The cystogram shows extravasation of contrast along the colon and between intestinal loops. A revision of the abdominal cavity with the elimination of the rupture of the dome of the bladder is necessary.
Extraperitoneal bladder rupture
On the cystogram, the flow of contrast along the side wall of the pelvis and below the bladder is determined. It is most advisable to obtain a radiograph after washing the bladder if extravasation occurs predominantly behind the bladder and the picture is unclear on the cystogram with a filled bladder. Until recently, in such cases, exploration was performed with the elimination of an extraperitoneal rupture. However, with a single extraperitoneal rupture and little extravasation, drainage (only) of the bladder through a catheter has been successfully used. The catheter is left for 14 days; before its extraction, a repeated cystography is performed.
Urethral injury
Distinguish damage to the posterior (prostate-membranous) and anterior (bulbous and spongy) part of the urethra.
Injury to the back of the urethra
Injuries to the posterior urethra are usually associated with a pelvic fracture, while injuries to the anterior urethra are the result of a direct blow (falling on sharp objects with legs wide apart, falling prone). A digital rectal examination and examination of the perineum reveals a perineal hematoma or a highly mixed prostate gland, indicating a complete rupture of the urethra. Examination of the perineum reveals the classic "butterfly mottling" caused by a hematoma that is limited to the attachment of the fascia lata.
In the case of a complete rupture in the posterior part of the urethra, conflicting opinions are expressed regarding the advisability of the primary restoration of the integrity of the urethra with suprapubic cystostomy; some clinicians limit themselves to suprapubic cystostomy. In primary urethral repair, the bladder is left open and the urethra is sutured using the "railroad coupler technique" (two coupled probes are used to pull a Foley catheter into the bladder). When pulling up the catheter, the ends of the ruptured urethra come together.
Healing of the urethra occurs within a few weeks. If only cystostomy is used. then the hematoma of the pelvis resolves, allowing the prostate gland to take its normal position. With both methods, the urethra heals, but with the formation of a stricture; the frequency of impotence and urinary incontinence in both cases is the same.
Urethral contusion
In such cases, there is a release of blood from the external opening of the urethra, while the urethrogram remains normal. Urethral contusion is treated conservatively with or without a catheter.
Partial rupture of the urethra
The urethrogram shows limited extravasation of contrast at the site of injury with passage of the contrast medium into the bladder. In the treatment of partial tears, either only urethral catheterization (performed by a urologist) or catheterization in combination with suprapubic cystostomy is used. Healing occurs within a few weeks.
Complete rupture of the urethra
The urethrogram shows significant extravasation of contrast at the site of injury in the absence of passage of a contrast agent into the bladder. This injury is repaired surgically at the anterior urethra: suprapubic drainage is performed through a catheter, an epicystostomy is placed to divert urine, and a small urethral dilator is used to immobilize the anastomotic site.
Genital injury
testicles
Testicular mobility, contraction of the levator testicle muscle, and the presence of a strong testicular capsule contribute to the infrequent injury to the testicles in car accidents. A direct blow with pressing the testicle to the pubic joint leads to damage - a bruise or rupture. In both cases, the sac of the vaginal membrane fills with blood (hematocele), which leads to the appearance of an extensive and intense bluish swelling of the scrotum. Early revision with evacuation of blood clots and suturing of testicular rupture contributes to faster normalization of testicular function than is observed with conservative treatment; while complications such as infection of the hematoma and testicular atrophy are less common.
The uncovered testis should be covered with the remaining skin, even if the reconstruction creates tension in the area of suturing. It usually takes a few months for the scrotum to return to its near-normal size.
Penis
Self-harm injuries include vacuuming and blade cuts. With the help of a vacuum cleaner, extensive damage is inflicted in the region of the glans penis, as well as the urethra, in which excision of dead tissues and reconstruction are necessary. Blade cuts range from superficial wounds of the preputial sac to complete amputation of the glans penis. When the penis is amputated, replantation or local reconstruction of the external opening of the urethra is performed. In the presence of the distal part of the penis, good tissue condition and duration of ischemia less than 18 hours, replantation is preferable.
A traumatic rupture of the cavernous body or a fracture of the penis occurs when a member in an erection is hit hard against a hard object (pubic joint or pelvic floor of a sexual partner), as well as when a direct blow is applied to a member or when it is excessively flexed. At this moment, a crepitating sound is heard, then pain in the penis appears; edema rapidly increases, the color of the skin changes, and the curvature of the penis occurs. With such injuries, an immediate operation is necessary to remove blood clots and restore the integrity of the damaged albuginea of the cavernous body.
Restoration of the skin lost due to detachment or as a result of a burn is carried out by transplanting split flaps onto a cleaned and uninfected wound of the penis. Torn off skin should not be sutured back to its original place, as it inevitably becomes infected and necrotic; subsequently it has to be removed.
Damage to the penis also occurs when the skin of the preputial sac gets into the zipper of the trousers. Manipulations on the snake to remove the skin are usually long and painful. In this case, it is better to use wire cutters to separate the middle link (or lock) of the snake, which will free the pinched skin. Turnstile syndrome of the penis due to compression or squeezing, for example, by a hair, ring, steel washer or metal nut, is manifested by the early onset of pain and swelling of the head. The squeezing object must be removed or dissected.
Summary
Injury to the organs of the genitourinary system significantly complicates the treatment of patients with multiple injuries. The ED physician should have a thorough knowledge of the radiological techniques that help in determining damage, as well as possible treatment options. The use of CT scanning in the assessment of retroperitoneal injury is gaining ground, supplanting HSV. However, in cases where a rapid assessment of kidney function is required, intravenous pyelography is still indispensable.
A. S. Kess, K. S. Smith
№ 1
* 1 - one correct answer
Sign of complete rupture of the urethra
1) lack of urine
2) hematuria
3) urine the color of beer
4) urine the color of meat slops
! 1
№ 2
* 1 - one correct answer
Sign of kidney injury
1) false urge to urinate
2) pain when urinating
3) positive Shchetkin-Blumberg symptom
4) micro or macrohematuria
! 4
№ 3
* 1 - one correct answer
Additional study confirming bladder damage
1) general urinalysis
2) cystography
3) sample according to Zemnitsky
4) excretory urography
! 2
№ 4
* 1 - one correct answer
First aid for bladder injury
1) catheterization
2) ice pack
3) diuretics
4) nitrofuran preparations
! 2
№ 5
* 1 - one correct answer
First aid for acute urinary retention due to prostate adenoma
1) ice pack
2) diuretics
3) painkillers
4) catheterization
! 4
№ 6
* 1 - one correct answer
Symptom confirming intraperitoneal rupture of the bladder
1) soft belly
2) Shchetkin-Blumberg symptom
3) Sitkovsky's symptom
4) bleeding from the urethra
! 2
№ 7
* 1 - one correct answer
A solution is used to flush the bladder.
1) furatsilina
2) hydrogen peroxide
3) physiological
4) pervomura
! 1
№ 8
* 1 - one correct answer
First aid for kidney injury
1) narcotic drugs
2) cold, urgent hospitalization
3) warm
4) diuretics
! 2
№ 9
* 1 - one correct answer
Urohematoma - a reliable symptom
1) kidney injury
2) damage to the renal parenchyma and pelvis
3) damage to the spleen
4) adrenal injury
! 2
№ 10
* 1 - one correct answer
Does not apply to methods of studying the urinary system
1) cystoscopy
2) choledochoscopy
3) isotope renography
4) ultrasound
! 2
№ 11
* 1 - one correct answer
In renal colic, the most characteristic irradiation of pain in
1) umbilical region
2) groin and thigh
3) shoulder
4) epigastrium
! 2
№ 12
* 1 - one correct answer
Cause of pain in renal colic
1) urge to urinate
2) difficulty urinating
3) spasm of the ureter and injury of the ureteral mucosa
4) ascending infection
! 3
№ 13
* 1 - one correct answer
To relieve an attack of renal colic, it is necessary to enter
1) lasix
2) diphenhydramine
3) but-shpu
4) dibazol
! 3
№ 14
* 1 - one correct answer
Symptom of renal colic
1) urinary incontinence
2) polyuria
3) acute pain in the lumbar region with irradiation along the ureter
4) stool and gas retention
! 3
№ 15
* 1 - one correct answer
Renal colic is a complication
1) bladder hemangiomas
2) urolithiasis
3) paranephritis
4) cystitis
! 2
№ 16
* 1 - one correct answer
Varicocele
1) an increase in the size of the testicle
2) varicose veins of the spermatic cord
3) spermatic cord cyst
4) inflammation of the spermatic cord
! 2
№ 17
* 1 - one correct answer
Differentiation of urolithiasis with acute diseases of the abdominal cavity allows
1) complete blood count
2) bladder catheterization
3) Ultrasound of the abdominal cavity and urinary system
4) Kakovsky-Addis test
! 3
№ 18
* 1 - one correct answer
Criteria for the diagnosis of acute renal failure
1) increasing swelling
2) change in blood pressure
3) hourly diuresis
4) hematuria
! 3
№ 19
* 1 - one correct answer
Emergency care for renal colic
1) antibiotics and bladder catheterization
2) diuretics and heat
3) cold on the stomach and furagin
4) antispasmodics and warmth
! 4
№ 20
* 1 - one correct answer
The main diagnostic method for suspected kidney tumor
1) cystoscopy
2) renal angiography
3) survey urography
4) urinalysis according to Nechiporenko
! 2
№ 21
* 1 - one correct answer
Inflammation of the prostate is called
1) dropsy
2) prostatitis
3) epididymitis
4) varicocele
! 2
№ 22
* 1 - one correct answer
Phimosis is
1) inflammation of the foreskin
2) narrowing of the foreskin
3) infringement of the glans penis
4) damage to the foreskin
! 2
kidney cancer
In the structure of oncological pathologies, renal cancer is a relatively rare disease, but its danger cannot be underestimated, since in addition to its own malignant nature, this type of tumor gives rapid metastasis.
Until now, doctors do not know the causes of this type of cancer. It is not clear why in some years the incidence in children increases sharply, while in others this is not observed. But, nevertheless, provoking factors have been known to doctors for a long time.
First of all, it is a hereditary pathology - both genetic diseases and a family history unfavorable for cancer. The frequency of cancer increases in men over 40 years of age, as well as in representatives of the black race. Smoking doubles the risk of kidney cancer, as does working with toxic substances and refined petroleum products. The systematic use of certain drugs, including diuretics and lowering blood pressure, as well as obesity, hypertension, or chronic kidney disease, are also risk factors for kidney cancer.
Symptoms and treatment
Kidney cancer develops rather slowly, so there are practically no symptoms of the initial stages. A change in the color of urine due to the ingress of blood into it - hematuria - patients notice by chance, just as this cancer is accidentally diagnosed by ultrasound or x-ray. Thus, hematuria is the leading symptom of kidney cancer. Later, pain in the side on the side of the affected kidney joins it; in thin people, a change in the contours of the kidney and its consistency can be palpated. Edema and signs of hypertension appear. Then symptoms similar to oncological diseases develop: emaciation, anemia, weakness, temperature fluctuations. Sometimes kidney cancer is detected by random detection of blood in a general urine test. Therefore, with complaints of pain in the kidney area, urine tests are first performed and, at the same time, ultrasound, renal angiography (X-ray with a contrast agent), and computed tomography. The role of a biopsy in this case is insignificant - both because of the inaccessibility and because of the complexity of the operation. Most often, the diagnosis is clarified during treatment, which in this case is practically the same - surgical. This is due to the fact that cancer cells from the kidneys with the blood and lymph flow spread throughout the body, causing distant and regional metastases, which are much more dangerous in terms of prognosis, than a primary kidney tumor. The remaining methods of treatment are used as palliative, that is, in advanced, inoperable cases.
Treatment:
In localized renal cell carcinoma, the kidneys undergo nephrectomy, after which the 5-year survival rate is 40-70%.
Nephrectomy is also performed in the presence of metastases in the lungs, and sometimes in the bones.
An indication for surgery in such a situation may be the possibility of removing a large tumor, relieving the patient of painful symptoms (hematuria, pain).
Drug therapy is sometimes effective.
Fluorobenzotef is used - 40 mg IV 3 times a week for 2-3 weeks; tamoxifen - 20 mg / day for a long time.
Efficacy of reaferon (3,000,000 IU IM daily, 10 days, interval - 3 weeks) was established for lung metastases.
Tumor regression or long-term stabilization of the disease occurs in 40% of patients with small lung metastases.
Therefore, after nephrectomy, careful follow-up of patients with lung radiography should be carried out every 3 months for 2 years.
With early detection of metastases, one can rely more on the success of treatment.
"NURSING PROCESS IN THE SYNDROME OF IMPAIRED CIRCULATION".
The death of cells and tissues in a living organism is called necrosis or deadness.
Gangrene is a form of necrosis in which necrosis is caused by the interruption of the blood supply.
Factors causing necrosis:
1. Mechanical (direct crushing or tissue destruction),
2. Thermal (exposure tt more than 60 gr and less than 10 gr.),
3. Electrical (exposure to electric current, lightning),
4. Toxic (under the influence of waste products of microorganisms - toxins),
5. Circulatory (cessation of blood supply in a certain part of the body or organ),
6. Neurogenic (damage to nerves, spinal cord - leads to disruption of trophic innervation of tissues),
7. Allergic (necrosis due to incompatibility, hypersensitivity and reaction to foreign tissues and substances).
Dead types:
1. Heart attack- a section of an organ or tissue that has undergone necrosis due to a sudden cessation of its blood supply.
2. Gangrene: dry - mummified necrosis.
wet- necrosis with putrefactive decay.
3. Bedsores- necrosis of the skin.
The role of m/s in the study of patients with vascular diseases:
1. Preparing the patient for examination:
Examination is carried out in a warm room,
Free for inspection symmetrical parts of the limbs.
2. Clarification of patient complaints:
Pain in the calf muscles when walking, disappearing at rest (“intermittent claudication”),
Muscle weakness that worsens with exercise
Paresthesia (numbness, crawling sensation) or anesthesia (absence of all kinds of sensitivity),
Edema is permanent or appears at the end of the day.
3. Visual inspection:
The severity of the venous pattern in varicose veins,
Skin color (pallor, cyanosis, marbling),
Muscular wasting in arterial disease,
Dystrophic changes in the skin (thinning, hair loss, dryness, cracks, hyperkeratosis), and nail plates (color, shape, brittleness),
4. Palpation:
Measurement of local t of various parts of the skin is carried out by the examiner with the back of the hand,
Comparison of arterial pulsation in symmetrical parts of the limbs,
The presence of compaction along the superficial veins.
5. Measurement of the volume of the limbs in symmetrical areas reveals the severity of edema.
Obliterating endarteritis:
More often in men 20-30 years old, more often on the lower extremities.
Factors contributing to development:
Smoking!
prolonged hypothermia,
frostbite,
lower extremity injuries,
emotional turmoil,
Violation of autoimmune processes.
First, the arteries of the foot and lower leg are affected, then more often large large arteries (popliteal, femoral, iliac). A sharp weakening of the blood flow leads to tissue hypoxia, thickening of the blood, agglutination of red blood cells - the formation of blood clots - dystrophic changes in tissues - necrosis.
Clinic:
Depending on the degree of insufficiency of arterial blood supply, there are 4 stages of obliterating endarteritis:
1 stage: functional compensation stage. Characteristic - chilliness, tingling and burning in the fingertips, fatigue, fatigue. When cooled, the limbs become pale in color, become cold to the touch. When walking - "intermittent chromate" when passing 1000 m. PS on the arteries of the foot is weakened or absent.
2 stage: stage of subcompensation.“Intermittent claudication” occurs after walking 200 m. The skin of the feet and legs is dry, flaky, hyperkeratosis (heels, soles), nail growth slows down, they are thickened, brittle, dull, dull. Atrophy of the subcutaneous adipose tissue. PS on the arteries of the foot is absent.
3 stage: stage of decompensation. Pain in the affected limb at rest. The patient walks without stopping no more than 25-30 m. The skin is pale when lying down, when lowered it is purple-cyanotic. Minor injuries lead to the formation of cracks, painful ulcers. Progressive muscle atrophy. Employability is reduced.
4 stage: stage of destructive changes. Pain in the foot and fingers becomes constant and unbearable. Sleep - sitting. Trophic ulcers are formed on the fingers, swelling of the foot and lower leg. PS is not defined throughout. The ability to work is completely lost. Gangrene of the fingers, feet, legs develops.
Treatment:
1. Eliminate the impact of adverse factors (quit smoking).
2. Elimination of vasospasm (antispasmodics - nikospan, halidor, etc.).
3. Drugs that improve metabolic processes in tissues (angioprotectors) - actovegin, vitamins of group B, etc.
4. Antiplatelet agents to normalize coagulation processes (chimes, trental, aspirin).
5. Analgesics + novocaine blockade of paravertebral ganglia - to relieve pain.
6. Surgical treatment - lumbar sympathectomy (removal of sympathetic lumbar nodes), which eliminates spasm.
7. With decompensation - amputation.
Varicose disease:
This is a disease of the veins, accompanied by an increase in length, the presence of a serpentine tortuosity of the saphenous veins and a saccular expansion of their lumen. Women get sick 3 times more often than men. Age from 40 to 60 years.
Factors:
1. Predisposing: failure of the valvular apparatus of the veins, a decrease in the tone of the walls of the veins during pregnancy, menopause, puberty.
2. Producing: causing an increase in pressure in the veins - professional (sellers, teachers, surgeons, loaders; compression of the veins - constipation, cough, pregnancy.
Clinic: the severity of the venous pattern, in a standing position (swelling, tension, tortuosity). Patients are concerned about a cosmetic defect, a feeling of heaviness in the limbs by the end of the day, cramps in the calf muscles at night. The disease progresses slowly - trophic disorders develop. Edema appears on the feet and legs, cyanosis and pigmentation of the skin, its thickening.
Conservative treatment:
During sleep and rest, keep your legs in an elevated position,
When forced to stand for a long time, change the position of the legs more often,
Bandaging with an elastic bandage or wearing elastic stockings,
Wearing comfortable shoes
Limitation of physical activity, - water procedures - swimming, foot baths,
Exercise therapy for n / limbs,
Regular blood tests (clotting, prothrombin index),
Angioprotectors (detralex, troxevasin, aescusan),
Locally - ointments (heparin, troxevasin).
Sclerotherapy: Varicocide, thrombovar, ethoxysclerol, which causes thrombosis and obliteration of veins, are injected into varicose veins.
Surgery:
Phlebectomy - removal of varicose veins,
Correction of valves in case of their failure, using special spirals.
Features of nursing care for a patient after phlebectomy:
Making sure the patient is on strict bed rest
Elevated position for the operated limb on the Beler splint,
Observation of the dressing and appearance of the patient, BP, PS?
Applying an elastic bandage from the 2nd day and walking on crutches,
Ensuring asepsis during dressings,
Providing daily stool,
Assistance to the doctor when removing stitches for 7-8 days,
Ensure that the patient wears an elastic bandage for 8-12 weeks after surgery.
Decubitus (decubitus) - aseptic necrosis of soft tissues due to impaired microcirculation caused by prolonged compression.
Soft tissues are compressed between the surface of the bed and the underlying bone protrusion during prolonged forced stay of seriously ill patients in the supine position. Places of occurrence of bedsores: sacrum, shoulder blades, back of the head, heels, back surface of the elbow joints, greater trochanter of the thigh.
In their development, bedsores pass 3 stages :
1. Stage of ischemia(pallor of the skin, impaired sensitivity).
2. Stage of superficial necrosis(swelling, hyperemia with areas of black or brown necrosis in the center).
3. Stage of purulent inflammation(attachment of infection, development of inflammation, the appearance of purulent discharge, the penetration of the process deep down to the defeat of muscles and bones).
Bedsores can occur not only on the body, but also in the internal organs. Prolonged stay of drainage in the abdominal cavity can cause necrosis of the intestinal wall, with a long stay of the nasogastric tube in the esophagus, necrosis can form in the mucosa of the esophagus and stomach, necrosis of the tracheal wall is possible with prolonged intubation.
Bedsores can be formed from tissue compression with bandages or splints.
Treatment of bedsores:
In stage 1: the skin is treated with camphor alcohol, it dilates blood vessels, improves blood circulation.
In stage 2: the affected area is treated with a 5% solution of permanganate K or an alcohol solution of brilliant green, which have a tanning effect, contribute to the formation of a scab that protects the bedsore from necrosis.
In 3 stages: carry out treatment according to the principle of a purulent wound in accordance with the phase of the wound process.
The role of m / s in the prevention of bedsores:
1. Early activation of the patient (if possible, get up, or consistently turn the patient over in bed).
2. Use clean, dry linen without wrinkles.
3. Anti-decubitus mattress, in the sections of which the pressure is constantly changing.
4. The use of rubber circles, "donuts" (placed under the places of the most frequent localizations of bedsores).
5. Massage.
6. Hygiene of the skin.
7. Skin treatment with antiseptics.
Bedsores are easier to prevent than to treat!
Dry (coagulative) gangrene:
This is the gradual drying of dead tissues with a decrease in their volume (mummification), the formation of a demarcation (delimiting) line.
Conditions for the development of dry gangrene:
1. Violation of blood circulation in a small limited area of tissue.
2. Gradual start of the process.
3. The absence of fluid-rich tissues (muscles, adipose tissue) in the affected areas.
4. The absence of pathogenic microbes in the area of circulatory disorders.
5. The absence of concomitant diseases in the patient. Dry necrosis develops more often in patients with reduced nutrition, stable immunity.
Local treatment:
1. Treatment of the skin around the necrosis with antiseptics,
2. Dressing with ethyl alcohol, boric acid, chlorhexidine.
3. Drying of the necrosis zone with 5% KMrO4 or brilliant green.
4. Excision of non-viable tissues - necrectomy (amputation of the finger, foot).
General treatment:
1. Treatment of the underlying disease.
Wet (colic) gangrene:
This is a sudden development of edema, inflammation, an increase in the volume of the organ, the presence of severe hyperemia around the focus of necrosis, the appearance of blisters filled with serous and hemorrhagic contents. The process spreads over considerable distances. A purulent and putrefactive infection joins, symptoms of general intoxication are expressed.
Conditions for the development of wet gangrene:
1. The occurrence of OAN on a large area of tissue (thrombosis).
2. Acute onset of the process (embolism, thrombosis).
3. The presence in the affected area of tissues rich in fluid (fat, muscles).
4. Accession of an infection.
5. The presence of concomitant diseases in the patient (immunodeficiency states, diabetes, foci of infection in the body).
Local treatment:
1. washing the wound with a 3% hydrogen peroxide solution.
2. Opening of streaks, pockets, drainage.
3. Bandaging with antiseptics (chlorhexidine, furatsilin, boric acid).
4. Mandatory therapeutic immobilization (gypsum splints).
General treatment:
1. AB (in / in, in / a).
2. Detoxification therapy.
3. Angioprotectors.
Trophic ulcers- this is a long-term non-healing superficial defect of the skin or mucous membrane with a possible lesion of deeper lying tissues.
The leading clinical symptoms of extraperitoneal rupture are severe cramps in the lower abdomen. Frequent false urge to urinate is accompanied by the release of a few drops of blood or complete urinary retention. Sometimes urination persists, but hematuria is noted. Urinary streaks appear in the perivesical tissue, edema spreads to the perineum, scrotum and labia, inner thighs, buttocks. Extraperitoneal ruptures of the bladder in pelvic fractures are accompanied by severe traumatic shock.
With an intraperitoneal rupture, urine, blood, and feces enter the abdominal cavity, which leads to the development of the classic picture of an "acute abdomen".
First aid for bladder injuries
First aid for bladder injuries is provided according to the following algorithm.
- Apply an aseptic bandage if there is a wound.
- Ensure peace in the "frog" position (rollers under the knees) lying on your back with a raised head end. Note. With signs of traumatic shock, the patient should be placed in the Trandelburg position.
- Place cold on the lower abdomen.
- Warm the victim.
- Introduce coagulants as prescribed by the doctor.
- Transport the victim to the hospital.
Note. For closed injuries, do not administer painkillers.
V.Dmitrieva, A.Koshelev, A.Teplova
"Symptoms and first aid for bladder injuries" and other articles from the section
Bladder injury- this is one of the manifestations of a closed injury to a hollow organ. Traumatic injury to the bladder can occur as a result of a localized blow or a general concussion of the body. The likelihood of injury is higher if the bladder is full of urine.
Bladder contusion carries a high level of danger, since even a not very powerful mechanical effect can lead to rupture of the organ wall. Violation of the integrity of the bladder, in turn, leads to the release of its contents and the formation of urinary streaks. Such a chain of pathological phenomena can lead to the development of severe septic conditions and the formation of a threat to the patient's life.
Causes of bladder injury
Damage to the bladder is always the result of mechanical action. Bladder injury may result from:
- blunt injury from impact with an object
- trauma penetrating into the abdominal cavity
- falling from a height
- mechanical compression during collapses and destruction.
With any of the options for influencing the bladder, patients present almost the same complaints:
- frequent urge to urinate
- increased pain when trying to empty the bladder
- acute urinary retention with traumatic edema of the bladder neck
- gross hematuria - droplets of blood
- painful tension of the abdomen in the lower sections.
Bladder Contusion Diagnosis
The initial stage of the diagnostic search is an assessment of the complaints made by the patient during a conversation with a doctor. Examination of the patient makes it possible to determine the general condition of the patient, the probable degree of blood loss.
To assess the condition of the walls of the bladder, ureters and adjacent organs, ultrasound of the kidneys and bladder is performed. Ultrasound may be supplemented by an examination of the abdominal cavity to exclude the presence of blood and urine in it.
Most studies are aimed at eliminating the occurrence of wall ruptures as a result of its bruising. These include the introduction of a contrast agent into the organs of the urinary system and the assessment of the quality of its distribution.
Radiopaque methods are divided into 2 groups:
- retrograde cystography - the introduction of a substance through the urethra
- intravenous urography
Computed tomography and magnetic resonance imaging are the gold standard in the diagnosis of bladder injuries. These techniques make it possible to give an accurate assessment of all layers that form the bladder wall and assess the nature of their damage.
Bladder injury treatment
Bladder contusion, which is not complicated by ruptures, does not require surgical treatment. After an injury on the first day, conservative treatment is mandatory, which consists in observing strict bed rest and fulfilling prescriptions.
To relieve symptoms of bladder damage, drugs of the following groups are prescribed:
- hemostatic - in the presence of blood in the urine or other signs of bleeding
- antibacterial drugs
- non-steroidal anti-inflammatory drugs
- painkillers.
Treatment of a urinary bruise can be carried out in almost any multidisciplinary private medical center where a urologist or surgeon is receiving. In addition, a private clinic has the ability to do it immediately on the day of seeking help.
An appointment can be made by phone call to the help desk for private clinics "Your Doctor". The help desk staff will select a clinic for you that you can contact immediately after the injury, so as not to delay the start of treatment.
This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.
