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Urinary > Obstructions + urinary retention > Flashcards

Obstructions + urinary retention Flashcards

(42 cards)

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1
Q

What is obstructive uropathy?

A

blockage preventing urine flow through ureters, bladder + urethra

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2
Q

Anatomy of the kindeys from the outside in

A
  • cortex
  • medulla
  • pyramids + columns
  • major + minor calyx
  • renal pelvis
  • pelviureteric junction
  • ureter
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3
Q

What does a unitary tract obstruction increase your risk of?

A

UTI
Reflux
Stone formation

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4
Q

Presentation of upper urinary tract obstruction (in ureters)

A
  • loin to groin pain
  • oliguria or anuria
  • non-specific symptoms e.g. vomiting
  • impaired renal function on bloods
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5
Q

Presentation of lower urinary tract obstruction (in bladder or urethra)

A
  • difficulty passing urine e.g. poor flow, terminal dribbling
  • urinary retention
  • impaired renal function on blood tests
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6
Q

Diagnosis of urinary obstruction

A
  • USS KUB
  • CT KUB no contrast
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7
Q

Causes of upper urinary tract obstruction

A
  • kidney stones
  • tumours pressing ureter
  • ureter strictures
  • retroperiotneal fibrosis
  • bladder cancer
  • ureterocele
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8
Q

Causes of lower urinary tract obstruction

A
  • BPH
  • prostate cancer
  • bladder cancer blocking the neck
  • urethral strictures
  • neurogenic bladder
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9
Q

what is neurogenic bladder?

A

abnormal function of the nerves innervating the bladder + urethra > overactivity or underactivity in the detrusor muscle + sphincter musclese

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10
Q

Causes of neurogenic bladder

A
  • MS
  • stroke
  • diabetes
  • parkinson’s disease
  • spina bifida
  • brain or spinal cord injury
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11
Q

What can neurogenic bladder cause?

A

urge incontinence
increased bladder pressure
obstructive uropathy

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12
Q

Management of urinary obstruction

A
  • nephrostomy in upper urinary tract
  • urethral or suprapubic catheter in lower urinary tract
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13
Q

complications of obstructive uropathy

A
  • pain
  • post renal AKI
  • CKD
  • infection - Pyonephrosis
  • hydronephrosis
  • urinary retention + bladder distention
  • overflow urinary incontinencey
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14
Q

Causes of urinary retention

A
  • calculi
  • pregnancy
  • benign prostatic hypertrophy
  • recent surgery
  • drugs
  • urethral strictures
  • constipation
  • pelvic masses or tumours
  • inflammation of lower urinary tract
  • issues with spinal cord
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15
Q

How can pregnancy causes urinary retention?

A
  • high levels of progesterone relax muscle fibres in renal pelvis + ureters
  • causes dysfunctional obstruction
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16
Q

Describe acute urinary retention

A

Painful
Inability to void
Residual volume 300-1500ml

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17
Q

Describe chronic urinary retention

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A

Painless
May still be voiding
Residual volume 300-4000ml

18
Q

Acute vs chronic urinary retention

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A
  • Acute: painful + unable to void
  • Chronic: painless + may be able to void
19
Q

Management of acute urinary retention

Study These Flashcards
A
  • USS of bladder
  • catheterise + record residual volume
  • treat any obvious cause
  • BPH - alpha blocker
20
Q

Management of chronic urinary retention

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A
  • catheterise + record residual volume
  • exam
  • urine dipstick + U&Es
  • long term catheterisation

high pressure:
- abnormal U&Es, hydronephrosis
- repeat episodes can cause permanent renal scaring + CKD
low pressure:
- normal renal function
- no hydronephrosis

21
Q

What is acute on chronic urinary retention?

Study These Flashcards
A

Patient has chronic UR but something else happens + causes acute UR so patient has both

22
Q

What is hydronephrosis?

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A
  • Dilation of the renal pelvis + calyces
  • due to obstruction at any point along urinary tract > increased pressure + blockage > urine accumulates in kidneys
  • unilateral or bilateral
23
Q

What is unilateral hydronephrosis caused by?

Study These Flashcards
A

Upper urinary tract obstruction
e.g. in ureter

24
Q

What is bilateral hydronephrosis caused by?

Study These Flashcards
A

Obstruction in lower urinary tract
e.g. enlarged prostate

25
What is idiopathic hydronephrosis due to?
narrowing of pelviureteric junction
26
treatment of idiopathic hydronephrosis
**pyeloplasty** corrects the narrowing + restructures the renal pelvis
27
Treatment of hydronephrosis
- **percutaneous nephrostomy**: insertingtube through skin + kidney into ureter (acute cases) - **antegrade ureteric stent**: inserting stent through kidney into ureter (chronic cases)
28
What is post obstructive diuresis?
Kidneys eliminate excess amounts of water after resolution of urinary retention through catheterisation
29
Management of patients with post obstructed diuresis
- monitor urine output for 24hours post catheterisation - support with IV fluids if losing high urine volumes
30
What type of AKI can hydronephrosis cause?
Post renal AKI
31
Why does GFR decline in hydronephrosis?
- accumulation of urine in kidneys + calyces - back pressure from obstruction transmitted to distal parts of nephron - **increases pressure pushing back against hydrostatic pressure in glomeruli** - GFR declines
32
What does an obstruction at the ureter cause?
Hydroureter Develops into hydronephrosis
33
What does an obstruction in bladder neck cause?
Bladder distension with hypertrophy Then hydroureter Then hydronephrosis
34
What pain does acute ureteric obstruction cause?
Renal colic
35
What can cause an acute ureteric obstruction?
Calculus (mainly) Blood clots Sloughed papilla
36
What is pyonephrosis?
Pus, fluid + inflammation in kidney due to obstruction + infection
37
Presentation of pyonephrosis
- fever + chills - flank pain - N+V - frequency urination - possible sepsis presentation
38
Management of pyonephrosis
- **percutaneous nephrostomy** - **retrograde stenting** - to drain the pus + relieve the obstruction - IV abx
39
What may failure of prompt treatment in pyelonephrosis cause?
Death from sepsis Permanent loss of renal function
39
What can be used to drainage the upper urinary tract?
Nephrostomy JJ stent
40
What drugs can cause urinary retention?
- tricyclic antidepressants *e.g. amitriptyline* - anticholingergics *e.g. anti-muscarinics, antipsychotics, antihistamines* - opioids - NSAIDs
41
Diagnosis of acute urinary retention
USS bladder Volume >300 confirms diagnosis

Urinary (30 decks)

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