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JMS Management > Renal/uro > Flashcards

Flashcards in Renal/uro Deck (24)
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1

Urinary tract obstruction - imaging

- Ultrasound is first line (sensitivity 45%)
- If this fails to pick it up but you still think it’s there, do non-contrast CT (99% sensitive) – note
that using contrast is bad because it obscures the view of the radio-opaque stone
- INITIAL = USS
- BEST = non-contrast CT KUB

2

stones - <5mm

Medical management
- IM/oral diclofenac
- Alpha adrenergic blockers to aid passage of stone out the bladder neck (tamsulosin)
- Nifedipine can help in small stone as it relaxes the ureters.
- This solves most stones <5mm and they pass within 4 weeks. More treatment is required is
there is they are bigger, if there is obstruction, or if there is a horseshoe kidney or previous
transplant

3

stones - 5mm to 2cm

ECSL

4

stones >2cm/complex e.g. staghorn

percutaneous nephrolithotomy

5

Complicated stone (with hydronephrosis or pyrexia)

decompression with percutaneous
nephrostomy. Worry about stone later.

6

stone recurrence prevention -

calcium - thiazides
urate - allopurinol/ bicarb for urine alkalisation
oxalate - cholestyramine/pyridoxine

7

lower uti

Trimethoprim/nitrofurantoin

8

lower uti and preg

Trimethoprim/nitrofurantoin/cefalexin

9

upper uti

Ciprofloxacin/co-amoxiclav

10

upper uti and preg

Cefalexin

11

BPH

Conservative – Avoid caffeine + alcohol, void x2, bladder training

Medical

1st line = α blockers (tamsulosin)

2nd line = 5-α reductase inhibitor (finasteride)

3rd line = BOTH 🡪 LUTS + >30g prostates or PSA >1.4ng/ml

Surgical – TURP, TUIP, TULIP, open prostatectomy

12

PSA cut off values

40-49

≥ 2

50-59

≥ 3

60-69

≥ 4

≥70

≥ 5

13

Prostate cancer

Confined to the prostate:
Watchful waiting
Radical prostatectomy
Radical radiotherapy – External beam or brachytherapy

Hormone therapy
LHRH agonists (Goserelin) – Result in a flare
LHRH antagonists (Degarelix) – Effective for advanced cancer
Anti-androgens (Cyproterone acetate)
Orchidectomy

If metastatic - Hormone therap

14

bladder cancer

Mx

Tis/Ta/T1 – Diathermy via TURBT + chemo

T2-3 – Radical cystectomy

T4 – Palliative chemo/radiotherapy

15

varicocele

Surgical ligation, embolisation

16

hydrocele

Mx

Ligation of PPV

Aspiration +/- sclerosing agent

Jaboulay – Inversion of sac

Lord’s – Plication of sac

17

epidydimal cyst

Often not indicated, surgical excision if symptomatic

18

epidydimo orchitis

<35y/o Doxycycline (chlamydia) or ceftriaxone (gonorrhoea)

>35y/o Ciprofloxacin (UTI)

19

testicular tumours

Radical inguinal orchiectomy

Radiotherapy (seminomas)

Chemotherapy (NSGCT)

20

aki definition

Rise in creatinine >26μmol/L in 48hrs

Rise in creatinine >1.5 x baseline

Urine output <0.5ml/kg/h for >6h

21

aki

Treat fatal consequences of AKI (↑K+ and pulmonary
oedema-morphine, o2, cpap, nitrates, diuretics)

Treat underlying cause!!

Stop nephrotoxic drugs e.g. metformin/nsaids/vanc/gent/acei

Supportive care

Fluid balance

Electrolyte balance

Acid-base balance

Nutritional support

>> Dialysis

22

ckd def

GFR <60 mL/min/1.73 m2
for >3months

23

obstruction

Treat underlying cause!

Upper – Nephrostomy or ureteric stent

Lower – Urethral or suprapubic catheter

24

retention

Mx

Voiding tricks – Running water, analgesia, privacy

Catheterise!

Tamsulosin

Treat underlying cause