Penetrating Injuries To The Kidneys, Ureters, Or Bladder

WHAT YOU SHOULD KNOW:

  • Penetrating injuries are also called piercing injuries. These may be caused by anything that goes through the skin and into the body. Piercing injuries to the abdomen (stomach) and lower back area may injure the kidneys, ureters, or bladder. Injuries may include a tear, bruise, or, in severe cases, a ruptured kidney or bladder. The organ's blood vessels may also be affected. A piercing injury may also cut or put a hole in the ureter. The kidneys are located on each side of the spine (backbone) in the back of your abdomen. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder is a hollow, round organ that holds urine. Gunshot, stab wounds, or objects going into the abdomen may also cause organ injuries. These objects may include shrapnel, spikes, broken bones, and other pointed objects.

  • Signs and symptoms may include blood in the urine, bleeding from open wounds, and abdominal pain. Bruising, swelling, or scratches over the injured area may also be seen. A complete check-up of your body to look for open wounds may help diagnose piercing injuries. Imaging tests that take pictures of your abdomen, such as x-rays, ultrasound, and computerized tomography (CT) scan, may be done. Treatment will depend on your symptoms, condition, and how severe your injuries are. Sometimes, watchful waiting may be all that is needed for mild injuries. You may have surgery or other procedures to treat bleeding or more severe organ injuries. With treatment, such as surgery, your kidneys, ureters, or bladder may heal over time, and serious problems may be prevented.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Treatment for piercing injuries of the kidneys, ureters, or bladder carries certain risks. Surgery may cause you to bleed too much or other parts of your abdomen to be damaged. You may get an infection. After surgery, you may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

  • If an injury is left untreated, medical problems could develop or worsen. Piercing injuries may cause internal bleeding and be life-threatening. Ask your caregiver if you are worried or have questions about your condition, care, or treatment.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Drains:

These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

A Foley catheter

is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus. The Td booster may be given to adolescents and adults every 10 years or for certain wounds and injuries.

Tests:

Certain tests use a special dye to help organs and structures show up better. Tell caregivers if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. One or more of the following tests may be done:

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Imaging tests:

    • Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.

    • Angiography: This test looks for problems with blood flow in your abdomen. A catheter (long, thin, bendable tube) is placed in a blood vessel in your groin. The groin is the area where your abdomen meets your upper leg. A dye is put into the catheter. Pictures are taken using an x-ray or a CT scan after the dye goes to your abdominal organs.

    • Computerized tomography scan: This is also called CT scan. A special X-ray machine uses a computer to take pictures of different areas of your abdomen and pelvis. It may be used to look at your bones, organs, and blood vessels. Before taking the pictures, you may be given dye through an IV in your vein.

    • Cystogram: This is an x-ray test during which a catheter is put into your bladder. Dye is put through the catheter into your bladder while x-rays are being taken. The size and shape of your bladder can be seen on the x-rays. The x-rays also show how much urine your bladder can hold. Caregivers will also look to see if urinary reflux is happening. Urinary reflux is when urine backs up from the bladder into your ureters and kidneys. This reflux may cause a kidney infection.

    • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.

    • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your abdomen. During an MRI, pictures are taken of your bones, abdominal or pelvic organs, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.

  • Urine test: A sample of your urine is collected and tested for blood in your urine.

  • X-rays:

    • IVP: This is also called an intravenous pyelogram. An IVP is an x-ray of the kidneys, bladder, and ureters (tubes that carry urine). Dye is put into your IV, which makes these organs show up better in x-ray pictures. You may need to have more than one x-ray over short periods of time during your IVP. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or other medicines.

    • KUB x-ray: An x-ray machine takes pictures of your kidneys (K), ureters (U), and bladder (B). The ureters are tiny tubes that carry urine from your kidneys to your bladder. The bladder is where the urine is stored before leaving your body. Caregivers use these pictures to check for problems with your intestines , kidneys, or abdomen.

Treatment options:

  • Watchful waiting: If your condition is stable and your injury is mild, watchful waiting may be all that is needed. Your caregiver will watch you closely for a period of time until your injury heals on its own. You may need to rest in bed and limit your activity.

  • Embolization: This is done to stop bleeding from an injured blood vessel. After doing an angiography, caregivers block off the bleeding by injecting a liquid, coil, or gel into the vessel.

  • Surgery: Open or laparoscopic surgery may be done to clean and repair an injured organ. Caregivers may use sutures (threads) to close a cut. Bleeding from blood vessels may be stopped by applying heat or closing them with sutures. A ureter, that is cut into two, may have its ends reattached. Surgery to take out all or part of the injured kidney, ureter, or bladder may be done. Sometimes, surgery to correct other problems or treat other injuries may be done first. You may need to have more than one surgery.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Penetrating Injuries To The Kidneys, Ureters, Or Bladder (Inpatient Care)

Hide
(web5)