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URGENTE Flashcards

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1
Q

Retentie acuta de urina - def

A

imposibilitatea evacuarii VU prin mictiune

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2
Q

Retentie acuta de urina - mecanisme

A

obstructia traiectului de evacuare

disfunctionalitatea contractiei detrusorului

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3
Q

Retentie acuta de urina - cauze

A 
obstructii la nivelul colului VU, prostata, uretra
vezica neurogena (specifica femeilor)
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4
Q

Retentie acuta de urina - clinica

A

imperiozitate mictionala
durere suprapubiana (ac) (cr - nedureroasa)
imposibilitatea evacuarii VU
factori predispozanti
EO - VU dilatata dureroasa/nedureroasa, Pe matitate, poate ajunge pana la ombilic
TR

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5
Q

Retentie acuta de urina - US

A 
VU dilatata +/- identif cauza
ureterohidronefroza bilaterala (Cr)
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6
Q

Retentie acuta de urina - lab

A

ex urina
HLG
BUN, Cr

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7
Q

Retentie acuta de urina - ddx

A 
anurie obstructiva
ruptura VU
sarcina
fibroame uterine
chiste ovariene
peritonita blocata
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8
Q

Retentie acuta de urina - tratament

A

decompresia VU (progresiva - clampare 10 min la fiecare 500 ml -> previne hemoragia ex vacuo) prin cateterizare
cistostomie suprapubiana
! prevenirea sindromului de ridicare al obstacolului - diureza osmotica
rezolvarea cauzei

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9
Q

cistostomie suprapubiana - indicatii

A 
imposibilitatea cateterizarii transureterale
calea falsa urinara
ruptura uretrala, trauma pelvina
stenoza uretrei
protatita ac, abces prostatic
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10
Q

cistostomie suprapubiana - contraindicatii

A

chirurgie pelvina, bypass aorto-bifemural
anticoagulante, discrazii sanguine
tumori VU
hematurie in cantitate mare

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11
Q

hematuria - def

A

prezenta RBC in urina

micro/macroscopica

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12
Q

hematurie - cauze uro inalte

A

tu renale, uroteliale
litiaza reno-ureterala
necroza papilara, HN congenitala, chiste renale, PCKD, anomalii vasculare

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13
Q

hematurie - cauze uro joase

A

tu VU, litiaza vezicala
cistita hemoragica (virala, rad, chimioterapie, bilharioza, supradistensia vu neurologice)
HBP, cancer prostata
hematuria ex vacuo

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14
Q

hematurie - alte cauze uro

A 
infectii urinare nespecifice (PN, cistita, prostatita)
TBC urinar
traumatism
hematurie de efort
supradozare anticoagulante
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15
Q

ddx - pseudohematuria

A

contaminare - hemoragie uretrala (intermictionala), menstruatie, hematospermie
medicamente - ibuprofen, nitrofurantoin, sulfametoxazol, fenitoina, rifampicina, fenolftaleina
alimente - sfecla rosie
bandeleta urinara FP - hemoglobinurie, mioglobinurie, contaminare cu betadina

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16
Q

hematurie - clinc

A

FR tumora uroteliala
semne si simptome de TUI, TUS
sindrom de impregnare maligna

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17
Q

hematurie - localizare

A

initiala - uretra
terminala - trigon vezical
continua - renala, ureterala, VU

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18
Q

hematurie - paraclinic

A

parametrii hemodinamici
gr sg, rh, hlg + plt, coagulograma
bun, cr
ex microscopic urina - > 5 RBC/mm3, urocultura, citologie urinara
imagistic (US, Rx abd, urografie iv, cistoscopie, CT)

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19
Q

hematurie - masuri de urgenta

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A

anemie acuta severa, soc hipovolemic -> reech volemica, transfuzie
retentie urinara acuta cu cheaguri -> cateter Foley cu 3 lumene, evacuare cheaguri, lavaj vezical continuu

20
Q

hematurie - tratament

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A 
cateter Foley cu 3 lumene
lavaj vezical continuu
reech volemica
corectarea coagulopatiei
hemostaza endoscopica/ ligatura iliacei interne/ cistectomia de salvare
rezolvarea cauzei
21
Q

colica renala - def

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A

durere colicativa cauzata de obstructia acuta a tractului urinar superior

22
Q

colica renala - etio

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A

litiaza reno-ureterala
alte cauze - sdr de jonctiune uretero-pelvica, invazie tumorala, compresiune, fibroza retroperitoneala, cheag, pasaj fragment tumoral, corpi straini

23
Q

colica renala - clinic

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A

durere cu debut brusc, caracter paroxistic (exacerbari si remisii), localizare lombara cu iradiere spre OGE
+ simptome digestive (greturi, varsaturi)
+ simptome urinare (polakiurie, imperiozitate, hematuria)

24
Q

colica renala - EO

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A

dificil
contractura abd -> ddx cu peritonita
orificii herniare -> ddx cu herniile strangulate
TA crescuta -> infarct visceral

25
colica renala - paraclinic
sumar urina, sediment - hematurie, leucocite, cristalurie | hlg, ionograma, bun, cr
26
colica renala - ddx cu durere de origine extrarenala
afectare musculo-vertebrala colica biliara, colecistita acuta pancreatita acuta apendicita acuta, ulcer peptic, diverticulita colonica, ocluzie intest torsiune testiculara/ovarian, chist ovarian rupt, sarcina ectopica, epididimita acuta afectiuni CV
27
colica renala - ddx cu durerea de origine renala
``` reflux V-U, tumora renala cu hrg intratu chist renal simptomatic/infectat PCKD cu hrg intrachistica PNA abces perirenal embolie de a renala tromboza de v renala ```
28
colica renala - dg
US - HN Rx abd - calculi CT nativ - de prima intentie
29
grade HN
1 - dilatatia pelvisului renal 2 - pelvis moderat dilatat, cateva calice vizibile 3 - aproape toate calicele viz, pelvis largit 4 - aproape toate calicele viz, parenchim subtiat/atrofiat
30
colica renala - complicatii
``` colica renala rebela febrila -> PNA obstructiva IRA obstructiva (bilat/ unilat pe rinichi unic) intoleranta digestiva marcata => INTERNARE! ```
31
colica renala - tratament
masuri gen - restrictie fluide, Q locala medicatie - AINS (diclofenac, indometacin), antispastice, analgezice, alfa-bloc +/- ATB indepartarea obstructiei - !urgenta (hiperalgie, febra, anurie obstructiva) -> stent ureteral, nefrostomie - ureteroscopie cu litotripsie, eswl (litotripsie extracorporeala cu unde de soc), nefrolitomie percutana (nlp), interventie chirurgicala scopica/clasica ! calculii <5mm se elimina spontan (80%)
32
anuria obstructiva - def
absenta urinarii datorita obstructiei urinare bilaterale/ unilaterale pe rinichi unic => ureterohidronefroza bilaterala + VU goala
33
anurie obstructiva - etio
comun - litiaza, cancere pelviene invazive, fibroza retroperitoneala, post radioterapie altele - fibroza retroperitoneala idiopatica, sdr de jonct pielo-ureter, tu retroperitoneale bilat
34
anurie obstructiva - clinic
absenta mictiunilor >12h, VU goala colica lombara uni/bilaterala febra, frisoane greturi, varsaturi, stare gen alt, dispnee, HTA, aritmii
35
anurie obstructiva - investigatii
lab - bun, cr, ionograma, hlg, astrup US - HN/ UHN bilat Rx abd - calculi opaci CT
36
anurie obstructiva - ddx
retentie acuta de urina anurie prerenala anurie renala
37
anurie obstructie - complicatii
urosepsis EPA aritmii cardiace
38
anurie obstructiva - trat ob
corectarea dezechilibrelor metabolice drenaj urinar tratament etiologic
39
hemodializa de urgenta - indicatii
K+ > 7,5 mmol/l acidoza metabolica <7,15 hiperhidratare cu semne de EPA
40
anurie obstructiva - tratament
dezobstructie de urgenta - stent, nefrostomie percutana, ureteroscopie tratament etio - al doilea timp
41
torsiune de testicul - def
rotatia testiculului in jurul cordonului spermatic cu ischemie reversibil -> 6h
42
torsiune de testicul - etio
absenta/ laxitatea elementelor de fixare testiculara
43
torsiune de testicul - clinic
durere scrotala cu debut brutal, iradiere inghinala si lombara, greata, varsaturi debut in repaus, app de durere similare (torsiuni intermitente) fara febra, simptome de TUi
44
torsiune de testicul - eo
12-16 ani cresterea in volum a scrotului, semne celsiene palpare foarte dureroasa, epididim anterior, cordon spermatic ingrosat, sensibil testicul ascensionat, retractat inspre inelul inghinal, orizontal
45
torsiune de testicul - us
doppler - absenta vascularizatie | crestere dimensiuni
46
torsiune de testicul - ddx
``` epididimita, orhiepididimita acuta varicocel simptomatic traumatism testicular hernie strangulata inghino-scrotal colica renala ```
47
torsiune de testicul - tratament
chir - descalcirea cordonului spermatic, testarea viabilitatii - sutura testiculului la scrot/orhiectomie - orhidopexie contralat profilactica

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