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Renal SB > Haematuria and Urological Emergencies > Flashcards

Haematuria and Urological Emergencies Flashcards

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1
Q

definition of haematuria

A

blood in the urine

- either microscopic or macroscopic

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2
Q

what is the diagnosis quota for haematuria

A

presence of 5 or more RBC per high-power field in 3 of 3 consecutive specimens obtained at least one week apart

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3
Q

what are the 2 categories of haematuria

A

visible/macroscopic/gross haematuria

non-visible/microscopic/dip-stick positive haematuria

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4
Q

what are the 2 categories of microscopic haematuria

A

symptomatic; hesitancy, frequency, urgency, dysuria
or
asymptomatic - incidental finding

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5
Q

what else can cause urine to be red that is not blood from urinary tract

A

Menstrual bleeding
Food - beetroot, blackberries, rhubarb
Myoglobin in urine - destruction of muscles, Crush syndrome
Drugs - Nitrofurantoin, Rifampicin, Chloroquine
Toxins - lead, mercury

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6
Q

what can cause brown coloured urine

A

urobilonogen in urine - hemolysis, liver dysfunction

porphyria

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7
Q

what can make people prone to bleeding

A

blood thinners - warfarin, heparin, aspirin

bleeding disorders

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8
Q

what percentage of people with frank haematuria will have cancer

A

20-30%

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9
Q

what percentage of people with microscopic haematuria will have cancer

A

asymptomatic + malignancy

- 2.6%

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10
Q

risk factors for malignancy

A 
smoking history
occupational exposure to chemical or dyes
Hx of gross haematuria
Age > 40
Hx of urological disorder/disease
Hx of irritative voiding symptoms
Hx of UTI
Analgesic abuse
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11
Q

common infections that can cause blood in the urine

A 
urethritis
prostatitis
cystitis
ureteritis
pyelonephritis 
glomerulonephritis
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12
Q

how can stones cause blood in the urine

A

kidney/ureter stones

on the way down can scratch mucous lining and cause bleeding

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13
Q

what Sx does renal tumour presents with

A

Haematuria - 50-60%
Pain - 40%
Kidney mass - 30-40%

Triad

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14
Q

how do tumours of urinary tract present

A

Haematuria - 75-85%
Retention of urine
Urinary irritative symptoms
Loin pain

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15
Q

what are the 2 types of cancers common in urology system

A

Renal Cell Carcinoma

Transition cell carcinoma

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16
Q

what is Sport haematuria

A

renal/bladder trauma from contact sports/running

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17
Q

what is the pathogenesis of sport haematuria

A

vasoconstriction of renal vessel
- hypoxic damage to nephrones

constriction of efferent glomerular arteriole
- increased filtration pressure

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18
Q

what is decompression haematuria

A

patient with retention, drained to quickly then some blood vessels with get broken and you get haematuria

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19
Q

what is pneumaturia

A

passage of gas mixed with urine, and may be as a result of a fistula between the bowel and the bladder
see bubbles in the urine

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20
Q

what is faecaluria

A

presence of fecal matter in the urine

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21
Q

What should be considered in the Hx of haematuria

A 
Trauma
Age
Gender
Nature of haematuria
Smoking
Occupation
Country
Urological Hx
FH of malignancy
Hx of bleeding disorders
Phenacetin abuse
Concomitant treatment e.g. Warfarin
Recent symptoms suggesting UTI
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22
Q

what can the nature of the blood in the urine appear

A

dark red with clots

fresh red blood

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23
Q

dark red with wormlike clots with colic loin pain - ?

A

hematuria is coming from upper urinary tract

- blood from kidney, down the ureter

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24
Q

what are the timing stages of bleeding and what can it suggest

A

initial/start of void - suggest bleeding is coming from urethra or prostate gland
terminal/end of void
total/throughout void

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25
what is seen in Egypt land water that can cause urinary problems
schistosoma
26
what flower is seen in china and can cause urinary problems
Aristolochia
27
what drug can cause Transition cell cancer if abused
phenacetin
28
Ix of haematuria
urinalysis culture and sensitivity cytology tenderness in abdo mass in abdo prostate exam
29
``` frank haematuria urinary uregency + frequency smoker female - aged 24 sexually active USS + cytology normal ``` Diagnosis
UTI
30
``` frank haematuria urinary uregency + frequency smoker female - aged 40 paraplegic bladder stones USS + Cytology normal ``` Diagnosis
SCC in the bladder
31
``` frank haematuria urinary uregency + frequency smoker female - aged 60 USS normal cytology suspicious ```
Cancer
32
what is acute urinary retensiont and what causes it commonly
inability to urinate with increasing pain complication of BPH
33
what are precipitated/triggering events of acute urinary retention
- non-prostate related surgery, - catheterization or urethral instrumentation - anaesthesia - medication with sympathomimetic or anticholinergic effects
34
Tx of acute urinary retention
Catheter | Alpha blocker - Tamsulosin
35
who gets post-obstructive diuresis (peeing more)
chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension
36
Mx of post-obstructive diuresis
monitor fluid balance beware urine output > 200ml/hf usually resolves in 24-48hrs if severe IV fluid and sodium replacement
37
DDx of acute loin pain
Ureteric colic secondary to calculus
38
Tx of stones that do not require surgery
NSAID +/- opiate | Alpha-blocker (Tamsulosin) for small stone expected to pass
39
what are the sizes of stones that are likely to pass themselves and what size is not
6mm 21%
40
at what point if a stone hasn't passed then intervention is required
1 month
41
what are indications to treat stones urgently
pain unrelieved pyrexia persistent nausea/vomiting high-grade obstruction
42
Tx for stones that require surgery
ureteric stent or stone fragmentation/removal if no infection percutaneous nephrostomy for infected hydronephrosis
43
what can cause frank haematuria
``` Infection Stones Tumours Benign prostatic hyperplasia (BPH) Polycystic kidneys Trauma Coagulation/platelet deficiencies ```
44
Ix for frank haematuria
CT urogram + cystoscopy
45
what are acute causes of scrotum pain
``` Torsion of spermatic cord Torsion of appendix testis Epididymitis / epididymo-orchitis Inguinal hernia Hydrocoele Trauma / insect bite Dermatological lesions Inflammatory vasculitis Tumour ```
46
what are features of a torsion of spermatic cord
- Most common at puberty - Can occur with trauma or athletic activity but usually spontaneous. Adolescent often woken from sleep Usually sudden onset of pain, sometimes previous episodes of self-limiting pain May be nausea/vomiting May be referral of pain to lower abdomen
47
Ix for torsion of spermatic cord
Doppler USS
48
Tx for torsion of spermatic cord
- Prompt exploration - 2 or 3-point fixation with fine non-absorbable sutures - If testis necrotic then remove - MUST fix contralateral side (bell clapper deformity)
49
how long does it take necrosis to begin in torsion of spermatic cord
4 hours
50
what is the 'blue dot' sign a sign for
torsion of appendage
51
what is Epididymitis
inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm
52
what does a Hx of epididymitis commonly
Dysuria / pyrexia more common | Hx of UTI, urethritis, catheterization/instrumentation
53
Ix for Epididymitis
Doppler USS | send urine for culture + chlamydia PCR
54
Tx for Epididymitis
Analgesia + scrotal support, bed rest | Ofloxacin 400mg/day for 14 days
55
Swelling, with no fever, mild tenderness and some pruritis the scrotal region - diagnosis?
idiopathic scrotal oedema
56
what is paraphimosis and when does it happen
Painful swelling of the foreskin distal to a phimotic ring Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position
57
Tx for paraphimosis
Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin Manual compression of glans with distal traction on oedematous foreskin Dorsal slit
58
what is priapism
Prolonged erection (> 4hrs), often painful and not associated with sexual arousal
59
what can cause priapism
``` Intracorporeal injection for ED, e.g. papaverine Trauma (penile / perineal) Haematologic dyscrasias e.g. sickle cell Neurological conditions Idiopathic ```
60
what are the classifications of priapism
Ischaemic | Non-ischaemic
61
what happens in ischaemic priapism
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome. corpus cavernosum is rigid and tender, penis often painful
62
what happens in non-ischaemic priapism
Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora. Fistula formation between cavernous artery and lacunar spaces allows blood to by-pass the normal helicine arteriolar bed
63
Ix of priapism and what results would indicate what type of priapism
Aspirate blood from corpus cavernosum – dark blood, low O2 , high CO2 in low-flow - normal arterial blood in high-flow Colour duplex USS - minimal or absent flow in cavernosal arteries in low-flow - normal to high flow in non-ischaemic priapism
64
Tx of ischaemic priapism
Aspiration +/- irrigation with saline Injection of alpha-agonist Surgical shunt
65
Tx of non-schaemic priapism
Observe, may resolve spontaneously | Selective arterial embolization with non-permanent materials
66
what is Fournier's gangrene
form of necrotizing fasciitis occurring about the male genitalia Most commonly arises from skin, urethra or rectal region
67
what are predisposing factors for Fournier's gangrene
diabetes local trauma periurethral extravasation perianal infection
68
how does Fournier's gangrene first start
as cellulitis - swollen, erythematous, tender - marked pain, fever, systemic toxicity
69
how does Fournier's gangrene progressive
Swelling + crepitus of scrotum, dark purple areas
70
Ix of Fournier's gangrene
Plain X-ray or USS may confirm gas in tissues
71
Tx of Fournier's gangrene
Antibiotics and surgical debridement
72
what is Emphysematous pyelonephritis
severe, necrotizing infection of the renal parenchyma | caused by gas-forming uropathogens, usually E coli
73
how does Emphysematous pyelonephritis present and what is it associated with
fever, vomiting, flank pain associated with diabetes and ureteric obstruction
74
Ix of Emphysematous pyelonephritis
KUB - see gas | CT
75
Tx of Emphysematous pyelonephritis
nephrectomy
76
what causes a perinephric abscess
results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
77
features of perinephric abscess
high WCC high serum creatinine pyuria
78
IX of perinephric abscess
CT
79
Tx of perinephric abscess
Antibiotics + percutaneous or surgical drainage
80
what are the 5 levels of renal trauma
I Haematoma, subcapsular, non-expanding, no parenchymal laceration II Laceration 1cm depth, no collecting system rupture or extravasation IV Laceration through cortex, medulla and collecting system Main arterial/venous injury with contained haemorrhage V Shattered kidney Avulsion of hilum, devascularizing kidney
81
what are indications for imaging in trauma
Frank haematuria in adult Frank or occult haematuria in child Occult haematuria + shock (systolic
82
what is the gold standard Ix for kidney trauma
CT with contrast
83
what is features of bladder injury and what is it associated with
Suprapubic/abdominal pain + inability to void Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds Associated with pelvic fracture and catheterisation
84
Ix for bladder injury
CT cystography
85
how does an extraperitoneal injury appear in a contrast of the pelvis
as a flame-shaped collection
86
Tx for bladder injury
Large-bore catheter Antibiotics Repeat cystogram in 14 days
87
how can the urethra be injured
fracture of pubic rami
88
what is seen O/E to urethral injury
``` Blood at meatus Inability to urinate Palpably full bladder “High-riding” prostate Butterfly perineal haematoma ```
89
what is Ix for urethral injury
retrograde urethrogram
90
Tx of urethral injury
Suprapubic catheter
91
MOI of penile fracture
happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
92
Tx for penile fracture
Prompt exploration and repair Circumcision incision with degloving of penis to expose all 3 compartments
93
presentation of testicular injury
presents with extremely pain and nausea | swelling/bruising variable
94
Ix of testicular injury
USS
95
when is early exploration/repair important in testicular injury
improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

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