Possible bladder injuries. Bladder Injuries First aid for a bladder injury includes
№ 1
* 1 - one correct answer
Sign of complete urethral rupture
1) lack of urine
2) hematuria
3) beer-colored urine
4) urine the color of meat slop
! 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 testing confirming bladder damage
1) general urine test
2) cystography
3) Zemnitsky test
4) excretory urography
! 2
№ 4
* 1 - one correct answer
First aid for bladder injury
1) catheterization
2) ice pack
3) diuretics
4) nitrofuran drugs
! 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 rinse 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) warmth
4) diuretics
! 2
№ 9
* 1 - one correct answer
Urohematoma is a reliable symptom
1) kidney bruise
2) damage to the renal parenchyma and pelvis
3) damage to the spleen
4) adrenal gland injuries
! 2
№ 10
* 1 - one correct answer
Does not apply to methods for examining the urinary system
1) cystoscopy
2) choledochoscopy
3) isotope renography
4) Ultrasound
! 2
№ 11
* 1 - one correct answer
With renal colic, the most typical irradiation of pain is in the
1) periumbilical region
2) groin area 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 to 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) no-shpu
4) dibazole
! 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) retention of stool and gases
! 3
№ 15
* 1 - one correct answer
Renal colic is a complication
1) hemangiomas of the bladder
2) urolithiasis
3) paranephritis
4) cystitis
! 2
№ 16
* 1 - one correct answer
Varicocele
1) increase in testicular size
2) varicose veins of the spermatic cord
3) spermatic cord cyst
4) inflammation of the spermatic cord
! 2
№ 17
* 1 - one correct answer
It allows you to differentiate urolithiasis from acute diseases of the abdominal organs
1) general blood test
2) bladder catheterization
3) Ultrasound of the abdominal cavity and urinary system
4) Kakovsky-Addis test
! 3
№ 18
* 1 - one correct answer
Criteria for diagnosing 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 heat
! 4
№ 20
* 1 - one correct answer
The main diagnostic method for suspected kidney tumor
1) cystoscopy
2) renal angiography
3) survey urography
4) urine analysis according to Nechiporenko
! 2
№ 21
* 1 - one correct answer
Inflammation of the prostate gland 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) pinching 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 morbidity rate in children increases sharply, while in others this is not observed. But, nevertheless, the provoking factors have been known to doctors for a long time.
First of all, this is a hereditary pathology - both genetic diseases and a family history unfavorable for cancer. The incidence of cancer increases in men over 40 years of age, as well as in representatives of the Black race. Smoking doubles the risk of developing kidney cancer, as does working with toxic substances and petroleum products. Systematic use of certain medications, including diuretics and blood pressure-lowering drugs, as well as obesity, hypertension or chronic kidney disease are also risk factors for renal cancer.
Symptoms and treatment
Kidney cancer develops quite slowly, so there are practically no symptoms in the initial stages. A change in the color of urine due to the ingress of blood into it - hematuria - is noticed by patients by chance, just as this cancer is accidentally diagnosed by ultrasound or x-ray examination. Thus, hematuria is the leading symptom of kidney cancer. Later, it is accompanied by pain in the side on the side of the affected kidney; in thin people, changes in the contours of the kidney and its consistency can be palpated. Swelling and signs of hypertension appear. Then symptoms similar to cancer develop: emaciation, anemia, weakness, temperature fluctuations. Sometimes kidney cancer is detected through a random blood test in a urinalysis. Therefore, in case of complaints of pain in the kidney area, urine tests are first performed and, at the same time, ultrasound, renal angiography (x-ray examination with a contrast agent), and computed tomography are performed. The role of biopsy in this case is insignificant - both because of the inaccessibility and 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, through the blood and lymph, spread throughout the body, causing distant and regional metastases, which are much more dangerous in terms of prognosis, than a primary renal tumor. The remaining treatment methods are used as palliative, that is, for advanced, inoperable cases.
Treatment:
For 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.
The 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.
Use fluorobenzotef - 40 mg IV 3 times a week for 2-3 weeks; tamoxifen - 20 mg/day for a long time.
The effectiveness of reaferon (3,000,000 units intramuscularly daily, 10 days, interval 3 weeks) has been established for metastases to the lungs.
Tumor regression or long-term stabilization of the disease occurs in 40% of patients with small pulmonary metastases.
Therefore, after nephrectomy, patients should be closely monitored with chest radiography every 3 months for 2 years.
With early detection of metastases, one can be more confident in the success of treatment.
"NURSING PROCESS IN POOR CIRCULATION SYNDROME."
The death of cells and tissues in a living organism is called necrosis or necrosis.
Gangrene is a form of necrosis in which death is caused by interruption of the blood supply.
Factors causing necrosis:
1. Mechanical (direct crushing or tissue destruction),
2. Thermal (impact tt more than 60 g and less than 10 g),
3. Electrical (exposure to electric current, lightning),
4. Toxic (under the influence of waste products of microorganisms - toxins),
5. Circulatory (cessation of blood supply to a certain area of the body or organ),
6. Neurogenic (damage to nerves, spinal cord - leads to disruption of trophic innervation of tissues),
7. Allergic (death due to incompatibility, hypersensitivity and reaction to foreign tissues and substances).
Types of necrosis:
1. Heart attack- an area 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- skin necrosis.
The role of m\s in the study of patients with vascular diseases:
1. Preparing the patient for examination:
The examination should be carried out in a warm room,
Release symmetrical areas of the limbs for inspection.
2. Clarification of patient complaints:
Pain in the calf muscles when walking, disappearing with rest (“intermittent claudication”),
Muscle weakness that increases with physical activity
Paresthesia (numbness, crawling sensation) or anesthesia (lack of all types of sensitivity),
Swelling is constant 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),
Muscle wasting due to arterial disease,
Dystrophic changes in the skin (thinning, hair loss, dryness, cracks, hyperkeratosis), and nail plates (color, shape, fragility),
4. Palpation:
The researcher measures local t in different areas of the skin with the back of the hand,
Comparison of arterial pulsation in symmetrical areas of the limbs,
The presence of compaction along the superficial veins.
5. Measuring the volume of the limbs in symmetrical areas reveals the severity of edema.
Obliterating endarteritis:
Most often in men 20-30 years old, more often on the lower extremities.
Factors promoting development:
Smoking!
Prolonged hypothermia,
Frostbite,
Injuries of the lower extremities,
Emotional turmoil
Disturbance of autoimmune processes.
First, the arteries of the foot and leg are affected, then more often the large large arteries (popliteal, femoral, iliac). A sharp weakening of blood flow leads to tissue hypoxia, blood thickening, gluing of red blood cells - the formation of blood clots - degenerative changes in tissues - necrosis.
Clinic:
Depending on the degree of insufficiency of arterial blood supply, there are 4 stages of obliterating endarteritis:
Stage 1: stage of functional compensation. Characteristically - chilliness, tingling and burning in the fingertips, increased fatigue, tiredness. When cooling, the limbs become pale in color and become cold to the touch. When walking - “intermittent chroma” when walking 1000 m. PS on the arteries of the foot is weakened or absent.
Stage 2: subcompensation stage.“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, matte. Atrophy of subcutaneous fat tissue. There is no PS on the arteries of the foot.
Stage 3: stage of decompensation. Pain in the affected limb at rest. The patient walks no more than 25-30 m without stopping. The skin is pale when in a horizontal position, and when lowered it becomes purple-cyanotic. Minor injuries lead to the formation of cracks and painful ulcers. Muscle atrophy progresses. Working capacity is reduced.
Stage 4: stage of destructive changes. The pain in the foot and toes becomes constant and unbearable. Sleep - sitting. Trophic ulcers form on the fingers, swelling of the feet and legs. PS is not defined throughout. The ability to work is completely lost. Gangrene of the fingers, feet, and legs develops.
Treatment:
1. Elimination of exposure to adverse factors (quit smoking).
2. Elimination of vascular spasm (antispasmodics - nikoshpan, halidor, etc.).
3. Drugs that improve metabolic processes in tissues (angioprotectors) - Actovegin, B vitamins, etc.
4. Antiplatelet agents to normalize coagulation processes (chimes, trental, aspirin).
5. Analgesics + novocaine blockade of paravertebral ganglia - for pain relief.
6. Surgical treatment - lumbar sympathectomy (removal of sympathetic lumbar nodes), which eliminates spasm.
7. In case of decompensation - amputation.
Varicose veins:
This is a disease of the veins, accompanied by an increase in length, the presence of 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, decreased tone of the vein walls during pregnancy, menopause, and puberty.
2. Producing: causing increased pressure in the veins - professional (salespeople, teachers, surgeons, loaders; compression of veins - constipation, cough, pregnancy.
Clinic: severity of the venous pattern in a standing position (swelling, tension, tortuosity). Patients are concerned about cosmetic defects, a feeling of heaviness in the limbs at the end of the day, and cramps in the calf muscles at night. The disease progresses slowly - trophic disorders develop. Swelling appears on the feet and legs, cyanosis and pigmentation of the skin, and thickening.
Conservative treatment:
Keep your legs elevated during sleep and rest.
If you are forced to stand for a long time, change the position of your legs more often,
Bandaging with an elastic bandage or wearing elastic stockings,
Wearing comfortable shoes,
Limiting physical activity, - water procedures - swimming, foot baths,
Exercise therapy for lower limbs,
Regular blood tests (clotting, prothrombin index),
Angioprotectors (detralex, troxevasin, aescusan),
Locally - ointments (heparin, troxevasin).
Sclerosing therapy: Varicocid, thrombovar, and ethoxysclerol are injected into varicose veins, causing thrombosis and obliteration of the veins.
Surgical treatment:
Phlebectomy - removal of varicose veins,
Correction of valves in case of their incompetence using special spirals.
Features of nursing care for a patient after phlebectomy:
Ensuring that the patient maintains strict bed rest,
Elevated position for the operated limb on the Beler splint,
Observation of the patient's dressing and appearance, blood pressure, PS?
Application of an elastic bandage from the 2nd day and walking on crutches,
Ensuring asepsis during dressings,
Providing daily bowel movements,
Assist the doctor in removing sutures on the 7-8th day,
Ensure that the patient wears an elastic bandage for 8-12 weeks after surgery.
Bedsore (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 bony protrusion during prolonged forced stay of seriously ill patients in a supine position. Places where bedsores occur: sacrum, shoulder blades, back of the head, heels, back of the elbow joints, greater trochanter of the femur.
In their development, bedsores pass 3 stages :
1. Stage of ischemia(pallor of the skin, loss of 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, appearance of purulent discharge, penetration of the process deep into the muscles and bones).
Bedsores can occur not only on the body, but also in internal organs. Prolonged stay of drainage in the abdominal cavity can cause necrosis of the intestinal wall; with a long stay of the naso-gastric tube in the esophagus, necrosis can form in the mucous membrane of the esophagus and stomach; necrosis of the tracheal wall is possible during prolonged intubation.
Bedsores can form from tissue compression by bandages or splints.
Treatment of bedsores:
In stage 1: the skin is treated with camphor alcohol, it dilates blood vessels and 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 and promote the formation of a scab that protects the bedsore from necrosis.
In 3 stages: treatment is carried out according to the principle of a purulent wound in accordance with the phase of the wound process.
The role of nurses 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, wrinkle-free laundry.
3. Anti-decubitus mattress, in the sections of which the pressure is constantly changing.
4. Use of rubber circles, “donuts” (placed under the most common locations of bedsores).
5. Carrying out a massage.
6. Skin hygiene.
7. Treating the skin 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 (demarcation) line.
Conditions for the development of dry gangrene:
1. Impaired blood circulation in a small limited area of tissue.
2. Gradual start of the process.
3. Absence of fluid-rich tissues (muscles, adipose tissue) in the affected areas.
4. Absence of pathogenic microbes in the area of circulatory disorders.
5. The patient has no concomitant diseases. Dry necrosis develops more often in patients with low nutrition and stable immunity.
Local treatment:
1. Treatment of the skin around necrosis with antiseptics,
2. Applying a bandage with ethyl alcohol, boric acid, chlorhexidine.
3. Drying the necrosis zone with 5% KMrO4 or brilliant green.
4. Excision of non-viable tissue - necrectomy (amputation of a finger, foot).
General treatment:
1. Treatment of the underlying disease.
Wet (coliquation) gangrene:
This is the sudden development of edema, inflammation, an increase in organ volume, the presence of pronounced hyperemia around the focus of necrosis, the appearance of blisters filled with serous and hemorrhagic contents. The process extends over considerable distances. A purulent and putrefactive infection is attached, and symptoms of general intoxication are expressed.
Conditions for the development of wet gangrene:
1. Occurrence of OAN over a large area of tissue (thrombosis).
2. Acute onset of the process (embolism, thrombosis).
3. The presence of fluid-rich tissues (fat, muscles) in the affected area.
4. Attachment of infection.
5. The patient has concomitant diseases (immunodeficiency states, diabetes, foci of infection in the body).
Local treatment:
1. washing the wound with a 3% solution of hydrogen peroxide.
2. Opening of leaks, pockets, drainage.
3. Applying bandages with antiseptics (chlorhexidine, furatsilin, boric acid).
4. Mandatory therapeutic immobilization (plaster splints).
General treatment:
1. AB (v\v, v\a).
2. Detoxification therapy.
3. Angioprotectors.
Trophic ulcers is a long-term non-healing superficial defect of the skin or mucous membrane with possible damage to deeper tissues.
Bladder rupture is classified as a group of diagnoses based on organ trauma. Injuries may result from blunt, penetrating, or iatrogenic (treatment-induced) trauma. The likelihood of injury varies according to the degree of stretching of the organ walls—a full bladder is more susceptible to injury than an empty one. Treatment ranges from conservative approaches that focus on maximizing artificial urinary diversion to major surgical procedures aimed at long-term recovery.
Reasons why a bladder rupture may occur
There are only a few reasons why the walls of the bladder can rupture.
- Blunt trauma is characterized by rupture of the bladder wall without damage to external tissues
Often the cause of blunt trauma is pelvic fractures, when bone fragments or sharp parts damage the integrity of the bladder wall. Approximately 10% of patients with a pelvic fracture suffer significant damage to the bladder area. The susceptibility of this organ to injury is associated with its degree of stretching at the time of injury. A blunt blow to the stomach with a fist or a kick can cause the bladder to rupture when its capacity is significantly full. Bladder rupture has been reported in children who suffered a blow to the lower abdomen while playing with a soccer ball.
- Penetrating trauma
This group includes gunshot wounds and stab wounds. Patients often suffer concomitant injuries to the abdominal cavity and pelvic organs.
- Obstetric traumatism
During prolonged labor or difficult labor, when there is constant pressure from the fetal head on the mother's bladder, her bladder may rupture. This happens due to the thinning of the organ wall at the point of constant contact. Direct wall rupture occurs in 0.3% of women who have had a cesarean section. Previous operations complicated by adhesions are a serious risk factor, since excessive scarring can disrupt the normal density and stability of tissues.
- Gynecological traumatism
Bladder injuries can occur during a vaginal or abdominal hysterectomy. Blind dissection of tissue in the wrong plane, between the base of the bladder and the neck of the fascia, usually damages the bladder wall.
- Urological trauma
Possible during bladder biopsy, cystolitholapaxy, transurethral resection of the prostate or transurethral resection of a bladder tumor. Perforation of the bladder walls during biopsy reaches an incidence of 36%.
- Orthopedic traumatism
Orthopedic equipment can easily perforate the bladder, especially during internal fixation of pelvic fractures. In addition, thermal injury may occur during the placement of cementitious substances used for arthroplasty.
- Idiopathic bladder injury
Patients diagnosed with chronic alcoholism and individuals who chronically drink large amounts of fluid are susceptible to hypertensive bladder injury. Previous bladder surgery is a risk factor for scarring.
This type of injury can result from a combination of an overfilled bladder and minor external trauma occurring during a fall.
Classification and emergency care for suspected bladder injury
The classification of bladder injuries is based on several characteristics that describe the injury.
- Extraperitoneal bladder rupture— the contents of the organ do not penetrate into the abdominal cavity.
- Intraperitoneal bladder rupture- the contents penetrate into the abdominal cavity. A common occurrence of ruptures at the moment of maximum filling of the bladder.
- Combined bladder rupture— the contents penetrate into the abdominal cavity and pelvic cavity.
Types of damage
- Open Bladder injury is a common occurrence with penetrating wounds in the bladder area or with other violations of the integrity of the outer layers.
- Closed Bladder injury is blunt trauma.
Severity of injury
- Injury(the integrity of the bladder is not compromised).
- Incomplete break bladder walls.
- Complete break bladder walls.
Presence of damage to other organs
- Isolated bladder injury - only the bladder is damaged.
- Combined bladder injury - other organs are also damaged.
If a bladder rupture is suspected, all measures should be taken to ensure the survival of the victim until the ambulance arrives.
- Needs to be applied a tight bandage in the pubic area if there is a penetrating wound.
- The patient is positioned on his side with his knees bent, if possible.
- On place cold on the lower abdomen.
- Provide patient immobility.
Diagnosis of bladder injury
Laboratory tests can be a key tool in diagnosing minor bladder injuries.
Serum creatinine levels can help diagnose organ wall rupture. In the absence of acute kidney injury and urinary tract obstruction, elevated serum creatinine may be a sign of urinary leakage.
Visual Research
Computed tomography
Often, a computed tomography (CT) scan is the first test performed in patients with blunt abdominal trauma. Transverse images of the pelvic organs provide information about their condition and possible damage to bone structures. This procedure has the potential to largely replace conventional fluoroscopy as the most sensitive means of detecting bladder perforation.
A CT scan of the bladder is performed by filling the bladder with a urethral catheter and performing a non-contrast study to assess damage. The finished result is able to reflect even minor perforations, helping to more clearly determine how often urine leakage occurs and in what area.
- Cystography
Is the historical standard for imaging suspected bladder trauma. Although the examination should ideally be performed under fluoroscopic guidance, clinical circumstances often do not allow this. In such cases, simple cystography is performed. Tests can be easily performed in bed using portable imaging equipment.
Specialists perform a number of procedures if urethral trauma is excluded and the use of a catheter is possible.
- The results of the initial x-ray examination are obtained.
- Placed in the bladder.
- Slowly fill the bladder under the influence of gravity to a volume of 300-400 ml with contrast liquid.
- An x-ray of the anterior wall of the bladder is obtained.
- If no leakage is observed, continue filling the bladder.
- Oblique and lateral images are obtained.
- Drain the contrast liquid.
The importance of properly performed filling and subsequent drainage is of paramount importance in diagnosis. Injuries may be missed if radiographs of the bladder are not performed correctly. A well-executed procedure can detect leaks with 85-100% accuracy.
If the patient is quickly taken to the operating room, an immediate bladder examination is performed. In this case, if damage to the urethra is excluded, a urethral catheter is used. Otherwise, a suprapubic cystostomy can be performed, draining urine into the external environment through the stoma. After this, the bladder is carefully examined for perforation, for which it is filled with fluid. In some cases, intravenous indigo carmine or methylene blue is used to color the urine, which is very helpful in visualizing possible perforations.
If surgery is delayed or not indicated, access to the bladder is achieved using urethral or suprapubic catheterization. A CT scan or a regular x-ray of the bladder is used for control purposes.
Histological examination of tissue is usually not performed in conditions of damage and subsequent repair of the bladder. However, if bladder perforation occurs secondary to a pathological process or foreign masses are noticed, samples may be sent for analysis. The results will reflect the underlying disease.
Treatment methods for bladder rupture
Majority extraperitoneal injuries bladder can be effectively drained through a urethral or suprapubic catheter and treated conservatively. Depending on the expected size of the defect, there is a need for artificial drainage of urine for 10 to 14 days. Then a control x-ray is taken to determine the quality of healing. Approximately 85% of these injuries show signs of healing within 7-10 days. After this, the catheter can be removed and the first voiding test can be performed. In general, almost all extraperitoneal bladder injuries heal within 3 weeks.
Essentially, every intraperitoneal injury bladder requires surgical treatment. Such lesions will not heal on their own with prolonged bladder drainage alone, because urine will continue to flow into the abdominal cavity despite the presence of a functional catheter. This leads to metabolic disorders and culminates in urinary ascites, bloating and intestinal obstruction. All gunshot wounds must be surgically explored because the likelihood of injury to other abdominal organs and vascular structures is quite high.
- Pain in the lower abdomen, above the pubis, or throughout the entire abdomen.
- Blood in urine.
- Urinary retention - the patient cannot urinate on his own.
- Frequent, unsuccessful urge to urinate, during which a few drops of blood are released.
- Urine leakage from the wound - with open injuries to the bladder (with violation of the integrity of the skin).
- Signs of bleeding (pale skin, low blood pressure, rapid pulse).
- Symptoms of peritonitis (inflammation of the walls of the abdominal cavity) - occur with intraperitoneal rupture of the bladder (the cavity of the bladder communicates with the abdominal cavity - the space in which the intestines, stomach, liver, pancreas, spleen are located):
- abdominal pain;
- forced position of the patient: half-sitting (abdominal pain intensifies when the patient is lying down and weakens when sitting);
- increased body temperature;
- bloating;
- abdominal muscle tension;
- stool retention;
- nausea, vomiting.
- In case of extraperitoneal rupture of the bladder (there is no communication between the bladder cavity and the abdominal cavity), the following may be observed:
- swelling above the pubis, in the groin areas;
- cyanosis of the skin (due to the accumulation of blood under the skin) above the pubis.
Forms
In relation to the abdominal cavity (the space in which the intestines, stomach, liver, pancreas, spleen are located) are distinguished:
- extraperitoneal rupture bladder (occurs most often with fractures of the pelvic bones, the bladder cavity does not communicate with the abdominal cavity);
- intraperitoneal bladder rupture (occurs most often when the bladder was full at the time of injury, in this case the bladder cavity communicates with the abdominal cavity);
- combined bladder rupture (the injury led to a fracture of the pelvic bones, and at this moment the bladder was full; the bladder is damaged in several places, while there is communication with the abdominal cavity and the pelvic cavity (the space in which the rectum, prostate gland is located)).
- open bladder injury (with a violation of the integrity of the skin, while communication of internal organs with the external environment occurs);
- closed bladder injury (without compromising the integrity of the skin).
- injury (the integrity of the bladder is not compromised);
- incomplete rupture of the bladder wall;
- complete rupture of the bladder wall.
- isolated bladder injury (only the bladder is damaged);
- combined bladder injury (in addition to the bladder, the abdominal organs are damaged).
Reasons
- Falling from a height onto a hard object.
- A sharp shaking of the body when jumping (against the background of a full bladder).
- A blow to the abdomen (usually due to a traffic accident).
- Gunshot or knife wound.
- Medical procedures:
- Bladder catheterization (insertion of a thin plastic or metal tube into the bladder to drain urine);
- bougienage of the urethra (expansion of the urethra using metal rods);
- surgical operations on the pelvic organs for fractures of its bones.
- Alcohol intoxication contributes to bladder injury, as the feeling of the urge to urinate is dulled.
- Diseases that lead to disruption of the outflow of urine from the bladder contribute to the occurrence of bladder injury:
- prostate adenoma (benign prostate tumor);
- prostate cancer (malignant tumor of the prostate);
- narrowing of the urethra (urethral stricture).
Diagnostics
- Analysis of the medical history and complaints - when the injury occurred, when blood appeared in the urine, difficulty urinating, whether treatment was carried out for this reason, examination, whether there were previous injuries to the bladder.
- Analysis of life history - what diseases the person suffers from, what operations he has undergone. Particular attention is paid to prostate diseases.
- General blood test - allows you to determine signs of bleeding (decrease in the level of red blood cells (red blood cells that carry oxygen), hemoglobin (iron-containing protein found in red blood cells, which is involved in the transport of oxygen and carbon dioxide)).
- Urinalysis - allows you to determine the presence of erythrocytes (red blood cells) and determine the degree of bleeding.
- Ultrasound examination (ultrasound) of the kidneys and bladder - allows one to evaluate the size and structure, the presence of blood accumulation near the bladder, the presence of blood clots inside the bladder, and identify a violation of the outflow of urine from the kidneys.
- Ultrasound examination (ultrasound) of the abdominal organs. Allows you to detect the presence of blood in the abdomen, which should not be normal.
- Retrograde cystography. A substance visible on x-ray is injected into the bladder cavity through the urethra. The method allows you to determine the type of damage to the bladder and the condition of the pelvic bones.
- Intravenous urography. An X-ray drug is injected into the patient’s vein, which is excreted by the kidneys after 3-5 minutes, during which time several images are taken. The method allows you to assess the degree of injury to the bladder and identify the place where there is a defect in the bladder.
- Magnetic resonance imaging (MRI) is a highly accurate method for diagnosing bladder injury, based on the possibility of layer-by-layer study of the organ. The method allows you to determine the degree of damage to the bladder. This method can also help identify damage to neighboring organs.
- Computed tomography (CT) is an x-ray examination that allows you to obtain a spatial (3D) image of an organ. The method allows you to accurately determine the degree of damage to the bladder, as well as the volume of blood and urine located next to the bladder. This method can also help identify damage to neighboring organs.
- Laparoscopy is a diagnostic method based on the introduction of a video camera and instruments into the abdominal cavity through small incisions in the skin. The method allows you to determine the type of damage to the bladder, the degree of bleeding, and assess damage to internal organs.
- Consultation is also possible.
Treatment of bladder injury
Conservative (non-surgical) treatment is possible for minor injuries to the bladder (bruise, small rupture of the wall with an extraperitoneal type of injury).
- Installation of a urethral catheter (thin rubber tube) into the bladder through the urethra for several days.
- Strict bed rest.
- Reception:
- hemostatic drugs;
- antibiotics;
- anti-inflammatory drugs;
- painkillers.
- suturing a bladder rupture;
- drainage of the pelvis or abdominal cavity (installation of tubes next to the bladder through which blood and urine flow);
- in men, cystostomy is the installation of a rubber tube into the cavity of the bladder for the outflow of urine.
Complications and consequences
- Heavy bleeding with shock (lack of consciousness, low blood pressure, rapid pulse, frequent shallow breathing). The condition can lead to death.
- Urosepsis is the penetration of microorganisms into the blood and the development of inflammation throughout the body.
- Suppuration of blood and urine around the bladder.
- Formation of urinary fistulas. Suppuration of blood and urine near the bladder leads to disruption of tissue integrity, which in turn leads to the abscess breaking out through the skin. As a result, a channel is formed through which the external environment communicates with the internal organs.
- Peritonitis is inflammation of the walls and organs in the abdominal cavity.
- Osteomyelitis is inflammation of the pelvic bones.
Preventing bladder injury
- Timely treatment of prostate diseases, such as: prostate adenoma (benign tumor), prostate cancer (malignant prostate tumor).
- Elimination of injuries.
- Avoiding excessive alcohol consumption.
- After injury, regular follow-up for at least 3 years.
- PSA control (prostate-specific antigen - a specific protein detected in the blood, which increases in diseases of the prostate gland, including cancer).
It is not uncommon for a person to experience bladder injuries. The internal organ may rupture or partially damage the integrity of its walls and muscles. The problem arises for various reasons, sometimes even due to a minor bruise the bladder can burst. Injury to an internal organ varies in types and forms.
Main types
Combined injury to the bladder and urethra occurs in accidents or other serious situations. In this case, a hematoma often occurs in the abdominal organs.
Forms of defeat
Extraperitoneal and intraperitoneal injuries
Bladder contusion is divided into several forms, each of which differs in location relative to the abdominal cavity. There are 3 forms:
The second type of organ rupture occurs when the peritoneum is damaged.
- Extraperitoneal rupture of the bladder. In this case, the organ ruptures in the front or side of the peritoneum due to injury to the pelvic bones. When the bladder ruptures, it completely empties. All urine flows into the soft tissues that are located near the organ.
- Intraperitoneal. In the event of an intra-abdominal injury, the organ will rupture in the upper or posterior part of the abdomen. With such a lesion, the integrity of the abdominal cavity is also damaged, resulting in an intraperitoneal breakthrough.
- Combined. This form of urinary organ injury is observed in patients with pelvic fractures. The wound leads to multiple ruptures in different places. In this case, urine is poured into the peritoneum and pelvis.
Partial and complete rupture
It is customary to categorize bladder injuries based on their severity. Some patients experience a minor bruise or stretching of the bladder, which soon goes away on their own. In others, the injury leads to partial or complete rupture of the organ. With a partial rupture, incomplete damage to the integrity of the walls is noted. A complete lesion indicates that the bladder has ruptured completely and its walls are largely destroyed.
Main reasons
The integrity of the walls of the bladder is damaged by various injuries caused to the peritoneal area. If the organ is not affected by external factors, then it is reliably protected by the pelvic bones. Injuries often occur when the bladder is full, because if the organ is emptied, it takes a very strong blow to damage the integrity of the bladder. The following are the causes of bladder damage:
If you jump incorrectly without first emptying the bubble, it may burst. - Wrong jump. Injury occurs only if the bladder is heavily filled with urine.
- Falling down. Damage often occurs when falling from a height onto a hard surface. In this case, not only the bladder is noted to burst, but also other internal organs.
- Gunshot or stab wound.
- A strong blow to the lower peritoneum.
- Surgery or medical procedures:
- installation of a catheter for diseases of the urinary system;
- dilatation of the urethra;
- Surgical intervention on organs localized in the pelvis.
- Not emptying the bladder on time due to alcohol intoxication.
- Pathologies in the body:
- tumors in the pelvis or nearby localized organs;
- compression of the urethra.
In men, damage to the bladder wall can occur against the background of pathological proliferation of prostate tissue.
Characteristic symptoms
With closed injuries, a person feels pathological symptoms only after a few hours, or even days. This is due to the fact that the patient is in a state of shock, in which painful feelings are dulled. If the bladder ruptures, a person will experience the following symptoms:
A rapid pulse may be a symptom of organ injury.
- improper excretion of urine, in which it will be problematic for a person to go to the toilet on his own;
- blood in urine;
- frequent trips to the toilet if the urethra is damaged along with the bladder;
- decreased blood pressure due to heavy bleeding;
- rapid pulse;
- paleness of the skin.
If the patient's bladder ruptures inside the peritoneum, then symptoms resembling peritonitis are noted:
- painful sensations of a sharp nature, which intensify when taking a lying position;
- increase in temperature;
- bloating and nausea;
- tension of the abdominal muscles.
Extraperitoneal trauma is not characterized by signs of peritonitis; it is manifested by other symptoms:
- swelling in the groin and pubic area;
- hematoma in the lower part of the peritoneum.
Consequences
If a woman or man's bladder bursts, they will need to immediately seek help from a doctor, since such an injury is fraught with serious consequences:
If the patient is not immediately helped, he will develop shock.
- Heavy bleeding and shock. With this complication, the patient’s pulse quickens and blood pressure levels rapidly drop. If treatment is delayed, the patient may die.
- Attachment of infection. An open wound occurs in the peritoneum, in which pathogenic microorganisms easily enter the blood fluid.
- Inflammation in the affected area.
- Formation of a pathological channel. This complication occurs if the bladder bursts and a purulent-inflammatory process develops. In this case, the skin is injured and a channel is formed through which microorganisms penetrate into neighboring organs.
- Bone tissue disorder. When the bladder is injured and subsequently ruptures, an inflammatory and infectious process develops in the bone tissue of the pelvic organs.
Bladder injuries can be open or closed. In peacetime, closed injuries of the bladder are much more common, which are divided into extra- and intraperitoneal (Fig. 12.4).
The degree of such damage can be different: bruise, incomplete (non-penetrating) or complete (penetrating) damage to the bladder wall, separation of the bladder from the urethra. Among closed injuries (ruptures) of the bladder, there are simple (extra- or intraperitoneal), mixed (a combination of intra- and extraperitoneal ruptures), combined (combined with fractures of the pelvic bones or with damage to other organs) and complicated (shock, peritonitis, etc.) damage.
Closed bladder injury is most often observed with a direct blow to the suprapubic area. A predisposing condition is bladder overflow with urine. Extraperitoneal rupture of the bladder most often occurs when the pelvic bones are fractured as a result of tension of the vesicopelvic ligaments or damage from bone fragments. Intraperitoneal rupture of the bladder occurs when the bladder is full due to bruise or pressure on the anterior abdominal wall.
Rice. 12.4. Bladder damage:
A -extraperitoneal rupture;b -intraperitoneal rupture
Damage to the bladder can also be iatrogenic, associated with instrumental manipulations (cystoscopy, cystolithotripsy, catheterization of the bladder with a metal catheter), with surgical intervention (laparotomy, hernia repair, etc.).
Symptoms and clinical course. Symptoms of closed bladder injury are pain above the pubis, urinary disturbances, hematuria and signs of urine leakage into the peri-vesical and pelvic tissue (urinary leakage) or the abdominal cavity (peritonitis). When a patient presents late with an extraperitoneal rupture of the bladder, which happens when urination is preserved, redness and swelling may appear on the anterior abdominal wall in the symphysis area, in the groin areas, and on the inner surface of the thighs as a result of the development of urinary leaks and the inflammatory process.
Extraperitoneal ruptures of the bladder are usually accompanied by pain in the suprapubic region, urinary retention, and frequent urge to urinate. The pain is diffuse in nature, it is constant, intensifies with the urge to urinate, especially when straining. Sometimes the pain radiates to the perineum, rectum, or penis.
With extraperitoneal closed damage to the bladder, a false urge to urinate is characteristic, accompanied by painful tenesmus and the release of a small amount of blood-stained urine or blood. Palpation reveals tension in the abdominal wall above the pubis and dullness of percussion sound in the lower abdomen.
The urination disorder is explained by the emptying of the bladder into the paravesical space through a defect in its wall. As the paravesical hematoma increases, pain in the lower abdomen appears and intensifies over time, radiating to the perineum and external genitalia, tension in the abdominal wall above the pubis appears, and a dull sound without clear boundaries is detected by percussion, spreading to the groin area. With the addition of infection, urinary phlegmon and urosepsis develop.
Hematuria with damage to the bladder is often observed, but is not a constant sign. More intense bleeding is observed when the wound is localized in the neck and bottom of the bladder. Injury to the anterior wall or apex of the bladder is usually not accompanied by severe hematuria. The absence of hematuria does not exclude the possibility of bladder rupture.
With intraperitoneal ruptures of the bladder, victims are often in a state of shock or collapse in the first hours after the injury. The most common and early symptom is pain, which is first localized in the suprapubic region, and then spreads throughout the abdomen and is diffuse (rarely cramping) in nature.
One of the common symptoms of intraperitoneal ruptures of the bladder is difficulty urinating with frequent and false urges to urinate. In such patients, urine enters the abdominal cavity through a defect in the wall of the bladder.
Retention of urination against the background of increasing peritonitis is a more reliable symptom of intraperitoneal rupture of the bladder. Already in the first hours after the injury, the abdomen becomes tense, later it becomes swollen and sharply painful due to the development of peritonitis. Over time, as a result of increasing urinary intoxication, the victim becomes lethargic and adynamic. Due to the accumulation of fluid in the abdominal cavity, the abdomen swells, the percussion sound above the pubis and in its sloping parts becomes dull, and a positive Shchetkin sign is noted. Dullness of percussion sound above the pubis is also observed with the formation of a hematoma. During digital examination through the rectum, overhang of the rectovesical muscle can be detected.
Diagnostics. Damage to the bladder is diagnosed based on medical history, instrumental and X-ray examinations. When collecting anamnesis, it is necessary to identify the mechanism of injury (blow to the stomach, car injury, fall from a height, etc.). An objective examination can determine dullness of percussion sound over the pubis, pain on palpation, and symptoms of peritoneal irritation.
Sometimes bladder damage is only suspected during diagnostic catheterization. With extraperitoneal ruptures, urine either does not flow through the catheter, or a small amount is released in a weak stream mixed with blood. With intraperitoneal ruptures, when the catheter passes through a defect in the wall of the bladder into the abdominal cavity, a large amount of fluid containing up to 10% protein or more can be released.
One of the main methods for diagnosing bladder rupture is ascending cystography, which allows one to determine the location and shape of the rupture and the location of bone fragments (Fig. 12.5, a).
With the help of cystography, it is possible to distinguish non-penetrating bladder ruptures from penetrating ones and avoid unnecessary surgical interventions, differentiate extraperitoneal injuries from intraperitoneal ones (the accumulation of a liquid radiopaque substance in the peri-vesical tissue is a sign of an extraperitoneal rupture, and in the abdominal cavity - an intraperitoneal rupture); identify the location of urinary leaks and, approximately, the localization of ruptures (Fig. 12.5, b).
If it is not possible to pass a catheter through the urethra, then it is necessary to perform excretory or infusion urography. In case of shock, when the excretory function of the kidneys decreases, excretory urography is contraindicated.
Treatment. For closed bladder injuries, treatment should be early and comprehensive.
For non-penetrating closed bladder injuries, treatment is conservative. If there is a danger of a complete rupture, strict bed rest is prescribed for 5-8 days, cold compresses on the abdomen, hemostatic and anti-inflammatory therapy, and, if necessary, painkillers.
If there is difficulty urinating or urinary retention, it is necessary to install a bladder irrigation system with an antiseptic solution for 5-8 days.
Rice. 12.5. Ascending cystograms:
A -extraperitoneal rupture of the bladder;b -intraperitoneal bladder rupture
Patients with complete closed bladder injuries are treated only with surgical methods. If a ruptured bladder is suspected, the victim is urgently hospitalized and, after short preparation, is operated on. The extent of surgical intervention depends on the severity of the injury, the nature of the damage to the bladder, the individual characteristics and general condition of the patient.
In case of intraperitoneal ruptures, a laparotomy is performed, a revision of the abdominal cavity is performed, the location of the damage is determined, the bladder is sutured with a double-row catgut suture and the urinary leaks are drained. After laparotomy, the abdominal cavity is thoroughly drained and the abdominal and pelvic organs are examined. The operation is completed with drainage of the bladder (installation of a bladder irrigation system for 6-8 days, less often - epicystostomy).
In case of extraperitoneal rupture of the bladder, its anterior wall is isolated extraperitoneally through a median incision between the pubis and the navel, the bladder is inspected, and the defect is sutured. The operation is completed by draining the bladder (epicystostomy). In case of urinary leakage, the pelvic tissue is also drained according to Buyalsky-McWhorter through the obturator foramina.
When the neck of the bladder is separated from the urethra, after a thorough inspection of the walls of the bladder and the internal opening of the urethra, the neck of the bladder is pulled to the urethra using a Foley catheter (with an inflatable balloon) and the urethra is sutured to the neck of the bladder with a double-row catgut suture. The operation is completed with epicystostomy, drainage of the prevesical and pelvic tissue.
