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

AUSCULTATION Conducted to assess Normal vs. abnormal chest sounds Breathing equality Depth of breaths Presence or absence of bowel sounds Abnormal 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 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