Causes of HTN
H- hyperthyroidism
Y - why? unknown/idiopathic
P- pheo
E- eats too much - obesity
R- renal
T- thrombosis
E- Endo: CAH, hyperpara, aldosteronism
N- ICP, GBS, NF
S- Stenosis. (renal artery, coarct, supravalv AS)
I- Ingestion (cocaine, steroids, OCP, decongestants)
O- Obs (eclampsia)
N- neuroblastoma
What renal injuries are possible without hematuria?
Renal Artery injury (laceration or avulsion)
Scrotal TRAUMA: Indications for surgery
- Testicular rupture
- Large hematoceles
3.Testicular laceration ( if tunica albuginea NOT intact)
SCROTAL TRAUMA: complications
- Testicular rupture
- Injury to the spermatic cord
- Large Hematocele ( Blood within the tunica vaginalis – may suggest severe injury)
- Intratesticular hematoma or laceration of the tunica albuginea
- Traumatic epidydimitis
- Scrotal avulsion
SCROTAL TRAUMA: complications of not surgically correcting
- Unsalvageable (ruptured) testis
- Missed testicular torsion ( Spurious history of trauma)
- Infection/poor healing of testicular hematocele or if penetrating trauma
- Compression of testis by hematoma or large hematocele
Urinary retention: possible causes
– Infection (UTI): Urethritis and urethral edema, leading to acute urinary retention
– Constipation: fecal impaction
– Obstruction: Flow of urine is impeded by outflow obstruction from mechanical, structural or dynamic factors
– Neurologic impairment: Secondary to the interruption of sensory/motor nerve innervation to the detrusor muscle, incomplete relaxation of the urinary sphincter mechanism or inefficient detrusor muscle contraction
– Medications lead to acute urinary retention through a variety of mechanisms (e.g., anticholinergic medications decrease bladder sensation and reduce detrusor contractility)
Signs of urethral injury (trauma)
Blood at meatus
Retention
hematuria
Test for urethral injury
Retrograde urethrogram
Balanitis : management
- Urinalysis
- Sitz baths (warm soaks) 3-4 times per days, void in bath if too painful to void
- PO Cephalexin and or cover for STIs in teen
- Needs FU: Exam post acute infection to ensure that there isn’t a true phimosis if unable to retract foreskin and consider circumcision if true phimosis (or recurrent infections)
Most important sign of renal injury.
Who to image?
Hematuria.
Image if:
- gross hematuria
- microscopic hematuria: >50 RBCs/hpf (blunt) or >5 if penetrating
- microscopic hematuria with shock
- clinical findings indicative of renal injury: bruising/FF on POCUS
Renal injuries classification/grading:
I: Contusion or non expanding subcapsular hematoma
II: Hematoma confined to retroperitoneum or Laceration <1cm depth , no urinary extravasation
III: Laceration into perinephric fat >1cm , no extravasation
IV: Deep lac into collecting system/vascular, contained hematoma
V: Fractured/completely shattered kidney, or avulsed from renal pedicle , avascular
Diagnostic test of choice for renal injuries:
- stable pt
- Unstable pt
CT with contrast
