Flashcards in Obstruction Deck (17):
What are causes of haematuria?
Cancers (renal cell carcinoma, upper tract transitional cell carcinoma, bladder cancer, advanced prostate carcinoma), stones, infection, inflammation, benign prostatic hyperplasia, bleeding disorder.
How do you assess haematuria?
If no urological cause is found from the history with no abnormalities detected then look for protein on urine dip, do eGFR and if <60ml/min refer to nephrology.
How do you investigate haematuria?
- Full urological history
- Urological examination (abdomen, genitalia in male, rectal examination, palpable bladder?)
- Flexible cystoscopy (bladder)
- Ultrasound of kidney, bladder, ureters
- Urine microscopy, culture, sensitivity and cytology
How do you manage haematuria?
Urgent admission if significantly visible haematuria, clot retention, loin pain, anaemia, co-morbidities, anticoagulation. Stabilise patient, FBC, 3 way catheter irrigation, CT angiogram if significant bleed, if it doesn't settle then the patient may need intervention (cystoscopy/radiology).
How do you treat acute urinary retention?
Bladder will be permanently damaged if left untreated = urological emergency. Must fit catheter to release pressure of the bladder.
How do you treat acute-on-chronic urinary retention?
Inability to pass urine hence must fit catheter. Monitor for fluid balance, sepsis, trauma etc.
What is supra-pubic catheterisation?
A suprapubic catheter is a type of catheter that is left in place. The catheter is inserted through a hole in the abdomen and then directly into the bladder. May be preferable in LTC e.g. MS
How does ureteric colic present?
Acute onset of severe flank pain radiating to the groin, gross or microscopic hematuria, nausea, and vomiting not associated with an acute abdomen
Describe the relationship between ureteric colic and obstruction
Ureteric colic is an important and frequent emergency in medical practice. It is most commonly caused by the obstruction of the urinary tract by calculi.
How do you treat bladder stones?
Likely to pass within a few weeks. Pain management, may require stent or extracorporeal shock wave lithotripsy (ESWL)
What are the causes of urinary retention in men?
Benign prostatic hyperplasia, prostate cancer, urethral stricture, prostatic infection, clots, drugs, major abdominopelvic surgery.
What are the causes of urinary retention in women?
Prolapses, masses, post botox e.g. for SUI, Fowlers syndrome, clots, drugs, major abdominopelvic surgery.
How do bladder stones present?
Pain, haematuria, infection and if ureteric - obstruction of the renal tract.
How do renal stones form?
Solutes precipitate from urine to form cyrstals.
How do renal stones form?
Solutes precipitate from urine to form crystals.
What is a nephrostomy?
Artificial opening that is performed whenever a blockage keeps urine from passing from the kidneys, through the ureter and into the urinary bladder. Without another way for urine to drain, pressure would rise within the urinary system and the kidneys would be damaged.