Imaging of the urinary tract
If there is evidence of upper abdominal injury, and the patient has haematuria, an intravenous urogram is performed to exclude renal injury. This will also show whether there is any ureteric or major bladder damage. In a case of urethral rupture, the base of the bladder may be riding high (dislocated prostate) or there may be a teardrop deformity of the bladder owing to compression by blood and extravasated urine (prostate-in-situ).
When a urethral injury is considered likely, an urethrogram should be undertaken using 25–30ml of water-soluble contrast agent with suitable aseptic technique. A film must be taken during injection of the contrast agent to ensure that the urethra is fully distended. This technique will confirm a urethral tear and will show whether it is complete or incomplete.
In a patient with possible rupture of the bladder (so long as there is no evidence of a urethral injury) a cystogram should be performed.
Types of injury
Injuries of the pelvis fall into four groups: (1) isolated
fractures with an intact pelvic ring; (2) fractures with a broken ring – these may be stable or unstable; (3) fractures of the acetabulum – although these are ring fractures, involvement of the joint raises special problems and therefore they are considered separately; and (4) sacrococcygeal fractures.
---from 《Apley’s System of Orthopaedics and Fractures》
重點詞匯整理:
haematuria /,hi:m?'tju?ri?, ,hem-/n. 血尿;血尿癥
intravenous urogram靜脈尿路造影照片
ureteric adj. 輸尿管的
extravasated /ik'str?v??set/v. (使液體,尤指血液)外滲;(血液、淋巴液等)外滲(extravasate 的過去式及過去分詞)
urethrogram尿道造影照片
water-soluble contrast agent水溶性造影劑
urethra /j??ri?θr?/n. [解剖] 尿道
cystogram膀胱x線照片
acetabulum /??s??t?bj?l?m/n. [解剖] 髖臼;[無脊椎] 吸盤;關(guān)節(jié)窩
sacrococcygeal骶尾的
百度翻譯:
尿路成像
如果有上腹部損傷的證據(jù),并且患者有血尿,則進行靜脈尿路造影以排除腎損傷。這也將顯示是否有輸尿管或主要膀胱結(jié)石。在尿道破裂的情況下,膀胱底部可能高高(前列腺脫臼),或者由于血液壓迫和尿液外滲(原位前列腺),膀胱可能出現(xiàn)淚滴狀畸形。
當認為尿道可能受傷時,應(yīng)使用25-30ml的水溶性造影劑和適當?shù)臒o菌技術(shù)進行尿道造影。注射造影劑時必須拍一張底片,以確保尿道完全擴張。這項技術(shù)將確認尿道撕裂,并顯示它是完整的還是不完整的。
對于膀胱可能破裂的病人(只要沒有尿道損傷的證據(jù)),就應(yīng)該做一次膀胱造影。骨盆損傷分為四類:(1)孤立性損傷骨盆環(huán)完整的骨折;(2)環(huán)斷裂的骨折——可能是穩(wěn)定的,也可能是不穩(wěn)定的;(3)髖臼骨折——雖然是環(huán)狀骨折,但關(guān)節(jié)受累會引起特殊問題,因此應(yīng)單獨考慮;(4)骶尾部骨折。
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