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Phase 2 - General Surgery Placement > Urinary Post-Op Complications > Flashcards

Urinary Post-Op Complications Flashcards

1
Q

what is acute kidney injury (AKI)?

A

an abrupt decrease in kidney function

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2
Q

what is the criteria in identifying AKI?

A
  • ≥50% rise in serum creatinine from baseline
  • increase in serum creatinine
  • urine output <0.5mls/kg/hour
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3
Q

what are the stages of AKI?

A

measured by raise in creatinine level relative to baseline:
stage 1: 1.5-2x the baseline
stage 2: 2-3x the baseline
stage 3: >3x the baseline

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4
Q

what are the three different kinds of causes of AKI?

A
  • pre renal - reduction in blood flow and GFR
  • intra renal - damage to kidney structures
  • post renal - obstruction in urinary output
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5
Q

what are the pre renal causes of AKI?

A
  • sepsis
  • dehydration
  • haemorrhage
  • renal artery stenosis
  • cardiac or liver failure
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6
Q

what are the intra renal causes of AKI?

A
  • nephrotoxins such as NSAIDs, ACE-i, chemotherapy drugs

- parenchymal disease such as glomerulonephritis, rhabdomyolysis

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7
Q

what are the post renal causes of AKI?

A
  • renal stones
  • tumour
  • urinary retention
  • catheter blockage
  • prostatic enlargement
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8
Q

what investigations should be done for a patient with AKI?

A 
assess their fluid status
scan bladder for signs of retention
review drugs for signs of nephrotoxins
urine dip can help identify underlying cause
bloods and blood gas
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9
Q

what imaging should be done for a patient with AKI?

A

USS of the kidneys, ureters and bladder to check for obstructive causes as indicated by hydronephrosis

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10
Q

how would you manage an AKI patient’s fluid status?

A

look for signs of dehydration and give resuscitation fluids

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11
Q

what is the standard fluid resus. regime?

A

500mls 0.9% saline IV over 15 minutes

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12
Q

what would you continually monitor in an AKI patient?

A

monitor urine output using a catheter

regular blood tests to assess U&Es to monitor creatinine

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13
Q

true or false: a patient that does not improve with fluid resus. in AKI most likely has a intra or post renal cause

A

true.

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14
Q

what drugs would you stop in a patient with AKI?

A
  • ACE-i or ARBs
  • NSAIDs
  • Aminoglycoside antibiotic e.g. gentamycin
  • potassium sparing diuretics
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15
Q

what drugs would you alter in a patient with AKI?

A
  • metformin (risk of lactic acidosis)
  • diuretics (in case of intra vascular fluid depletion)
  • low molecular weight heparin
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16
Q

what is acute urinary retention?

A

the inability to completely empty the bladder

17
Q

what are the clinical features of acute urinary retention??

A
  • little or no urine passed in the post-operative period
  • feeling the need to void
  • suprapubic mass that has a dull percussion note
18
Q

what are the common underlying causes for post-operative urinary retention?

A
  • uncontrolled pain
  • constipation
  • infection
  • anaesthetic agents (e.g. spinal or epidural)
19
Q

what are the risk factors for urinary retention?

A
  • age >50
  • male
  • previous retention
  • pelvic or urological surgery
  • spinal or epidural anaesthesia
  • medication e.g. antimuscarinics, alpha agonists, opiates
20
Q

what investigations should be conducted in a patient with suspected urinary retention?

A

an ultrasonic bladder scan to assess post-void residual volume

21
Q

how would you manage a patient with post-operative urinary retention?

A

tends to respond spontaneously, but if not then catheterise the patient
TWOC them and check if they re-enter retention

22
Q

what if the patient re-enters urinary retention post-TWOC?

A

they need to be re-catheterised and TWOC should be attempted again in 1-2 weeks

23
Q

what is the most common organism for causing a UTI?

A

e. coli

24
Q

what are the risk factors for a post-operative UTI?

A
  • age
  • female
  • comorbidities (DM, renal failure)
  • catheterisation
  • retention
  • renal stones
25
Q

what are the clinical features of a UTI?

A

urinary frequency, urinary urgency, dysuria

patients can also present with delirium, septic, or in urinary retention

26
Q

what are the clinical signs of a UTI?

A

patient will be pyrexial and have suprapubic pain

27
Q

what investigations should be taken in a patient with a suspected UTI?

A
  • urine dip which is later sent for microscopy if nitrates/leukocytes/blood are positive
  • routine bloods
  • bladder scan to check if the patient has entered retention
  • renal USS if pyelonephritis is suspected
28
Q

how would you manage a patient with a post-op UTI?

A
  • maintain patient hydration
  • treat with antibiotics
  • change catheter before starting antibiotics
29
Q

what is the recommended antibiotic for UTI treatment?

A

nitrafurantoin

Phase 2 - General Surgery Placement (14 decks)

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