Traumatismo
genitourinario
Br. Valentina Lucena
Traumatismos urinarios
traumatismos
renal
ureteral
superior vesical
uretral
inferior
Traumatismo renal
• constituye del 1-5% de todos los traumatismos.
• el riñon es el organo geniturinario lesionado con mas frecuencia
Cerradas (contundentes) Abiertas (penetrantes)
• accidentes de transito • arma blancas
• caidas • armas de fuego
• atropellos
• deportes de contacto
• agresiones
Clasificacion AAST
Traumatismo renal
Clinica Diagnostico
• heridas incisopunzantes de la region lumbar, o • Uroanalisis
porcion superior de abdomen • Hematocrito
• • Creatinina basal
hematuria
• dolor en fosa renal Dx por imagen
• equimosis en la fosa renal tomografia computarizada
• pielografia intravenosa
abrasiones en la fosa renal
E-FAST: Líquido libre (espacio de
• fracturas costales Morrison)
• distension abdominal
• masa abdominal
• dolor a la palpacion abdominal Tratamiento
conservador pacientes estables
(reposo,hidratacion, atb) I II y III
Hemorragia persistente indicacion a recontruccion.
Traumatismo de ureter
Clinica
75% yatrogenicas (73% ginecologico, 14% cirugia general)
18% traumatismos cerrados hematuria 50% de los
casos
7%traumatismo penetrantes
obstruccion de las vias
superiores
sepsis.
dolor en fosa renal ( pos-
sospechar en caso de tx cirugia ginecologica),
penetrantes, tx cerrados por perdida vaginal de orina.
desaceleracion (sobretodo en niños)
Traumatismo de ureter
Clasifi
Diagnostico
TC
cacion
Urografia intravenosa
tratamiento
implatantacion de endoprotesis,
colocacionde un tubo de nefrostomia para
desviar la orina
Traumatismo de vejiga
del 70%-97% de los px con lesiones vesicales causadas por traumatismos cerrados presentan
fracturas pelvicas asociadas
70%
las lesiones suelen apareceren pacientes con la
vejiga llena
las cicatricez pelvicas preexistentes pueden
influir en la vulnerabilidad de la lesion
Traumatismo de vejiga
Clinica Diagnostico
hematuria macroscopica
cistografia retrograda
sensibilidad abdominal tomografia computarizada
hematomas en la region
suprapubica
distencion abdominal
incapacidad de orinar
extravavasacion de orina: hinchazon del
perine, el escroto y los muslos.
Traumatismo de vejiga
Tratamiento rotura intraperitoneal:
rotura extraperitoneal: exploracion quirurgica
drenaje con sonda apertura de la cavidad
entre 15 dias a 3 semanas drenaje
(evitar la obstruccion de la riesgo de peritonitis
sonda)
Traumatismo uretral
el diafragma urogenital divide la uretra masculina en anterior y posterior.
porcion posterior(uretra prostatica y membranosa) porcion anterior (uretra bulbar y
peniana
Clinica etilogia
Dolor hipogastrico y perineal. accidentes de transito
Hematoma local y caida a horcajadas
uretrorragia
hemorragia interna fracturas del pene mordedura de perros
Micción imposible
amputaciones del pene
Traumatismo uretral
Diagnostico Tratamiento
lesiones anteriores cerradas ( pueden tratarse con sonda
suprapubica o sondaje uretral y cistostomia suprapubica)
uretrografia retrograda
lesiones anteriores abiertas
Rayos x (fracturas pelvias
y cuerpos extraños) masculina: exploracion inmediata, reparacion de la lesion.
femenina: lesiones que se producen junto con roturas vesicales
(reparacion con sutura.) lesiones uretrales distales pueden
aborarse por via vaginal
lesiones posteriores : preferrir la derivacion urinaria por
citostomia suprapubica
Traumatismo de intestino
delgado
se observan en un 80% por armas de fuego, 30% por arma blanca.
70% el diagnostico precoz en fundamental.
las lesiones suelen apareceren pacientes con la el 10% de las lesiones del
vejiga llena intestino pueden producirse por
las cicatricez pelvicas preexistentes pueden traumatismos cerrados.
influir en la vulnerabilidad de la lesion por aplastamiento
por explosion
cuerpos extraños
Traumatismo de intestino
delgado
diagnostico Rayos x de columna de torax y
pelvis, ( con el px de pie en busca
traumatismo abierto. de neumoperitoneo)
laparotomia
traumatismo cerrado
tomografia computarizada con
depende del mecanismo
contraste
lesional
realizacion del tacto rectal
( presencia de sangrado lavadoperitoneal diagnostico
endoluminal)
E-FAST
Traumatismo de intestino
delgado
Tratamiento
exploracion de la cavidad:
control de hemorragia
control de contaminacion
identificar lesiones (explorar el
intestino en toda su longitud)
reparar los tejidos
Traumatismo de colon
trauma de colon representa 2-5% de los
traumatismos abdominales
aumento de complicaciones septicas cuando
hay lesiones asociadas
por arma de fuego (penetrantes)
cuerpos extraños (cerrados)
yatrogenicas (perforaciones endoscopicas)
Traumatismo de colon
Diagnostico
clinica imagen Qx
clinica de abdomen Radiografia laparotomia
agudo proctorragia,
evisceracion olor FAST
fecaloide material tomografia
fecaloide libre en
cavidad
Traumatismo de pelvis
● Anillo pelviano: se forma por el sacro y
los dos iliacos( ileon, isquion y pubis).
● la pelvis se relaciona (recto, vejiga,
aparato genital)
segun el grado de estabilidad:
completas
incompletas
Traumatismo de pelvis
clasificacion de TILE
• Fracturas que no afectan la integridad • traumatismo de alta energia:
del anillo: 3 mecanismos de pruccion de la
fractura (anteroposterior, lateral
fracturas de la cresta iliaca y vertical)
rotura de la rama
isquiopubiana
fracturas transversales del
sacro
Saturn is a gas giant. It has
rings and it’s composed of
hydrogen
Traumatismo de pelvis
fracturas a libro abierto fracturas a libro cerrado
producidas por un
traumatismo en se rompe la rama
direccion isquipubiana mas que la
anteroposterior, en el se sinfisis y por detras se
rompen los ligamentos: rompe la art. sacroiliaca
o el ala sacra
<3cm (solo afecta la
sinfisis)
>3cm tuberositario y
sacroiliacos rotos
Traumatismo de pelvis
lesiones asociadas
• Urinaria (ureter, vejiga, uretra)
• Digestivas(recto,sigmoides y ciego)
• Vasculares (arterias y venas iliacas
• Genitales ( utero, ovarios, trompas uterinas, testiculos )
• Osteo-artuclo-musculares (anillo pelviana, psoas, gluteos )
• Partes blandas (piel, escrito, tejido graso subcutaneo de fosas pelvianas)
Traumatismo de pelvis
Clinica diagnostico
Rayos x
● Dolor. espontaneo o provocado
● Palidez cutaneo mucosa Tomografia computarizada
● Taquicardia
Tacto rectal (proctorragia), vaginal (lesion
● Hipotension
en paredes vaginales)
● Ausencia del pulsos femorales
● Hematuria Ecografia (liquido libre en cavidad,
● Anuria tesiones uterinas)
● Proctorragia
● Lesion vaginal Laparoscopia
GRACIAS.
Awesome words
Systems’ review
Mars Mercury Jupiter
Despite being red, Mars Mercury is the smallest Jupiter is the biggest
is a cold place planet planet of them all
Saturn Neptune
Saturn is a gas giant and It’s the farthest planet
has several rings from the Sun
A picture is
worth a
thousand words
A picture is worth a
thousand words
Evolution
Mercury Venus
Mercury is the Venus has a nice
smallest planet name, but it’s hot
Mars Jupiter
To modify this graph, click on it, follow the link, change the data
and paste the new graph here, replacing this one.
Despite being red, Jupiter is the biggest
You can see how to modify the graph here Mars is cold planet
Evolution
Mercury Venus
Mercury is the Venus has a nice
smallest planet name, but it’s hot
2018 2019 2020 2021
To modify this graph, click on it, follow the link, change the
data and paste the new graph here, replacing this one. Learn
how to modify the graph here
Prevalence
10% 30%
Mercury is the Venus has a nice
smallest planet name, but it’s hot
25% 35%
Despite being red, Jupiter is the biggest
Mars is cold planet
To modify this graph, click on it, follow the link, change the
data and paste the new graph here, replacing this one. Learn
how to modify the graph here
Prevalence
45% 55%
Mars Jupiter
Despite being red, Jupiter is the biggest
Mars is cold planet
Follow the link in the graph to modify its data
and then paste the new one here.
For more info, click here
Discussion
Dr. Jenna Doe Dr. John James
“Despite being red, Mars is a cold place, “Jupiter is a gas giant and the biggest in
not hot. It’s full of iron oxide dust, which the Solar System. It’s the fourth-brightest
give its reddish cast” object in the sky”
Discussion
Mercury Mars Venus
Mercury is the smallest Despite being red, Mars Venus has a nice name,
planet is cold but it’s hot
150,000
Big numbers catch your audience’s attention
754,000
Big numbers catch your audience’s attention
Discussion summary
Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a
bit larger than the Moon. The planet’s name
has nothing to do with the liquid metal
02
Diagnosis
You can enter a subtitle here if you need it
Comparison
Jupiter Mercury Venus Mars
No No Yes Yes
Yes Yes Yes Yes
Yes No Yes Yes
No Yes Yes No
No Yes Yes No
Comparison
John S Frank M Mike M Danny F
Mercury
Mars
Saturn
Diagnosis
Mercury Venus Mars
Mercury is the smallest Venus has a nice name, but Despite being red, Mars is
planet of them all it’s hot a cold place
Jupiter Saturn Neptune
Jupiter is a gas giant and Saturn is composed mostly Neptune is the farthest
the biggest planet of hydrogen planet from the Sun
Diagnosis
#1 #2
Mercury Venus
It’s the closest planet to Venus is the second
the Sun and the smallest planet from the Sun. It’s
one hot there
Higher incidence
35% 10%
Jupiter is the biggest Saturn is composed
planet mostly of hydrogen
40% 15%
Mercury is the Venus has a nice
smallest planet name, but it’s hot
Most affected areas
New Delhi New York
Jupiter is the biggest Saturn is the ringed
planet planet
N’Djamena Santiago
Mercury is the Venus has a nice
smallest planet name, but it’s hot
Treatment
Jupiter Venus
Jupiter is the biggest Venus has a nice name,
planet of them all but it’s hot
Saturn Mars
Saturn is a gas giant Despite being red, Mars
with rings is very cold
Patient monitoring
Week 1 Week 2 Week 3 Week 4
Mercury is the Venus has a nice Saturn is mostly Despite being red,
smallest planet of name, but it’s terribly composed of Mars is actually cold
them all hot hydrogen place
Stages of hepatitis
01 02 03
First stage Second stage Third stage
Jupiter is the biggest Venus has a nice Saturn is the ringed
planet name, but it’s hot planet
Contraindications & indications
● You can describe the treatment ● You can describe the treatment
contraindication here indication here
● You can describe the treatment ● You can describe the treatment
contraindication here indication here
● You can describe the treatment ● You can describe the treatment
contraindication here indication here
Indications
● You can describe the treatment indication
here
● You can describe the treatment indication
here
● You can describe the treatment indication
here
Post-prevention
Mars
Despite being red, Mars
is a cold place
Jupiter Saturn
Jupiter is the biggest Saturn is composed
planet of them all mostly of hydrogen
Mercury Venus
Mercury is the smallest Venus has a nice name,
planet but it’s hot
Post-prevention
Jupiter Mercury Mars
Jupiter is the It’s a small Despite being
biggest planet of planet close to red, Mars is a
them all the Sun cold place
9h 55m 23s
Jupiter's rotation period
333,000
The Sun’s mass compared to Earth’s
386,000 km
Distance between Earth and the Moon
35% 30%
Venus Earth
Venus has a very beautiful Earth is the planet where
name we all live on
15% 20%
Mercury Mars
Mercury is the smallest Despite being red, Mars is
planet of them all very cold
Case timeline
Day 2 Day 4
Venus has a very Jupiter is the biggest
beautiful name planet
Day 1 Day 3 Day 5
Mercury is the Earth is where we all Despite being red,
smallest planet live on Mars is very cold
Case timeline
Earth is where we all Venus has a very
live on beautiful name
01 02 03 04
Mercury is the Despite being red,
smallest planet Mars is very cold
Conclusions
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than the Moon. The planet’s
name has nothing to do with the liquid metal
Conclusions
Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a
bit larger than the Moon. The planet’s name
has nothing to do with the liquid metal
References
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● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
References
● AUTHOR (YEAR). Title of the ● AUTHOR (YEAR). Title of the
publication. Publisher publication. Publisher
● AUTHOR (YEAR). Title of the ● AUTHOR (YEAR). Title of the
publication. Publisher publication. Publisher
● AUTHOR (YEAR). Title of the ● AUTHOR (YEAR). Title of the
publication. Publisher publication. Publisher
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