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RB Y2 Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

destrusor sphincter dysnergia

A

distrubance of coordination of detrusor contraction and external sphincter opening

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2
Q

posterior urethral valve

A
  • obstructing membrane over the posterior urethra as a result of abnormal utero development
  • the most common cause of bladder outlet obstruction in males
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3
Q

what can hypoxia in utero do to the kidneys

A

cause ischemia and scarring, elading to pelvi-ureteric stenosis

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4
Q

what does prolonged bladder obstruction do to the bladder

A
  • causes the detrusor muscle to hypertrophy - trabeculation
  • eventually diverticulum form
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5
Q

other complications of bladder obstruction

A
  • renal failure - hydronephrosis
  • atonic bladder - detrusor muscle hypofunction
  • recurrent UTI
  • overflow incontinence
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6
Q

management of urethral stricture

A
  • optical urethrotomy (incision of urethra)
  • anastomtotic urethroplasty
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7
Q

management of phimosis

A

circumcision or dorsal slit

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8
Q

management of bladder stones

A
  • cystolitholapaxy
  • (fragmentation of stone through US/laser waves)
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9
Q

how much does the bladder normalyl contain

A

around 600ml

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10
Q

what type of medication can precipitate acute urinary retention

A
  • medication with sympathomimetic or anti-cholingeric effects (oxybutynin, tolterodine)
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11
Q

treatment of acute urinary retention

A
  • catheter and start an alpha-blocker (e.g. alfuzosin, tamsulosin) before the catheter is removed for at least 2 days in
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12
Q

TWOC in acute urinary retention

A
  • may be started on the same admission if there is <1l residue and normal serum electrolytes
  • prescribe an alpha blocker with it to increase voiding success
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13
Q

post obstructive diuresis

A

Polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction - osmotic diuresis

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14
Q

management of post obstructive diuresis

A
  • monitor fluid balance and beware of hypovolaemia if urine output is >200ml/hour
  • may require IV fluid and sodium replacement
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15
Q

how long does post obstructive diuresis usually last for

A

usually resolves in 24-48 hours

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16
Q

obstructive uropathy

A
  • The blockage of urinary flow, which may affect one or both of the kidneys. If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal
  • When kidney function is affected, termed obstructive nephropathy
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17
Q

hydronephrosis

A
  • Hydronephrosis refers to the dilation of the renal pelvis and can be present with/out obstruction
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18
Q

what can follow hydronephrosis

A

2y infection often folows stasis, pyonephrosis (pus collects in the renal pelvis)

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19
Q

what is an important DD in acute loin pain

A

AAA

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20
Q

describe renal colic pain

A
  • Renal colic is a severe waxing and waning loin pain radiating to the groin or thigh e.g. with nausea and vomiting.
  • patient is classically rolling about the bed
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21
Q

what is the pain of renal colic due to

A

stretching of the smooth muscle

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22
Q

investigation of renal stone

A
  • KUB X ray first line
    • Lacks specificity (e.g. uterine fibroids, arteriolar calcification may show up), and sensitivity (small/radiolucent calculi are not shown)
  • Spiral non-contrast CT
    • Definitive test to confirm
    • Occasionally struggles to distinguish between small pelvic calculi and phleboliths when there are no 2y signs to help e.g. hydronephrosis
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23
Q

describe how the size of stones determines whether they are likely to pass spontaneously

A
  • <4mm: 80%
  • 4-6mm: 59%
  • >6mm: 21%
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24
Q

indications for urgent treatment of acute loin pain

A
  • Pain unrelieved
  • Pyrexia
  • Presence of infection and obstruction
  • Bilateral obstructing stones
  • Persistent nausea/vomiting
  • High-grade obstruction
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25
Q

name some common sites for ureter blockage due to stones

A
  • pelviureteric junction
  • pelvic brim
  • ureter crossing common iliac artery
  • vesicoureteric junction
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26
Q

where do the ureters run in relation to the spine

A

along transverse processes

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27
Q

investigation of haematuria

A
  • cystosocopy
  • CT urogram
  • if further imaging required can do a ureterorenoscopy
28
Q

which haematuria should be investigated further

A
  • all VH
  • NVH and shock
  • n/vH in children
29
Q
A
30
Q

management of renal colic

A

diclofenac ± opiate

31
Q

how is diclofenac administerd for renal colic

A

rectal or IM (painful)

32
Q

mangement of stones <5mm

A

give plenty of fluids ,they may pass spontaneously

33
Q

management of stones >5mm/unresolving

A
  • diclofenac and an alpha blocker to promote expulsion and reduce analgesia requirements
  • this is used for small stones that are expected to pass
34
Q

what procedure can be performed for larger stones that arent infected

A
  • ureteric stent
    • bypasses stone and allows urine to drain around it
    • can cause discomfort
  • stone fragmentation
35
Q

what can be given to relieve the discomfort of a ureteric stent

A

alpha blocker

36
Q

what procedure can be performed for infected hydronephrosis

A

Percutaneous nephrostomy

37
Q

outline CT urography procedure (non contrast used for stones)

A
  • initial pre-contrast stone search
  • inject contrast and second scan
  • cortical enhancement phase 25-70 seconds after injection
  • nephrographic: renal cortex and medulla
  • excretory: opacification of renal collecting system and ureters 5-15 minutes after injection
38
Q

what can reduce the damage caused by contast imaging to kidneys

A

IV hydration before and after procedure

39
Q

contra indications to contrast

A
  • Risk factors are DM, hypovolemia and high doses of dye
  • Not recommended in eGFR <60
40
Q

why is Metformin a contra indication to contrast

A
  • Metformin: if the contrast medium causes renal failure, and the patient continues to take Metformin, the Metformin will accumulate and there will be subsequent lactic acidosis
41
Q
A
42
Q
A

corticomedullary phase

43
Q
A

nephrogenic phase

44
Q
A

pre phase stone search

45
Q
A

excretory phase

46
Q
A
47
Q

what imaging is used for renal artery stenosis

A

MR angiography

48
Q

suspected vesico-ureteric reflux imaging

A

micturating cystogram

49
Q
A

vesico ureteric reflux - micturating cystogram

50
Q

investigation of haematuria >50

A
  • Always requires endoscopic inspection of bladder – cystoscopy
    • Option for ureteroscopy
  • CT urogram for upper urinary tract imaging
51
Q

investigation of haematuria <50

A

Incidence of urothelial tumours of kidney/ureter is low, so routine CTU which imparts double radiation dose is unjustified.

  • US of kidneys
  • Cystoscopy
  • Only CT urogram if previous 2 are normal and haematuria persists
52
Q

indications for CT urography

A
  • further haematuria investigation
  • assess collecting system, ureters and bladder
  • good for finding tumours
53
Q

for bladder injury, see acute scrotum lol

A
54
Q

what is a posterior urethral injury often associated with, and which is the most vulnerable bit

A
  • fracture of pubic rami
  • bulbomembranous junction most vulnerable
55
Q

on examination of urethral injury

A
  • blood at meatus
  • inability to urinate and palpably full bladder
  • HIGH RIDING PROSTATE is characteristic
  • butterfly perineal haematoma
56
Q
A

urethral injury - butterfly perineal haematoma

57
Q

investigation of urethral injury

A
  • retrograde urethrogram - investigation of choice for uretehral strictures, trauma etc
58
Q

management of urethral injury

A
  • suprapubic catheter
  • delayed reconstruction after at least 3 months
59
Q

complications of urethral injury

A

long term complications of stricture formation

60
Q

how does penile fracture tend to occur

A

buckling injury as penis slips out vagina during intercourse and strikes pubic

61
Q

what is heard on fracture of penis

A

cracking or popping sound

62
Q

what happens to penis when it is fractured

A

pain, rapid detumescence, discolouration and sweling

63
Q

what is often injured with penile fracture

A

urethra (20%) - frank haematuria and blood at meatus

64
Q

management of penile fracture

A
  • prompt exploration and repair
  • circumcision incision with degloving of penis to expose all 3 compartments
65
Q

presentation of testicular injury

A

exquisite pain and nausea, swelling and bruising is variable

66
Q

investigation of testicular injury

A

USS to assess integrity/vascularity

67
Q
A

RB Y2 Renal (26 decks)

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