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AY Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

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1
Q

Presentation of acute urinary retention

A

Inability to urinate with increasing pain

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2
Q

What is acute urinary retention a complication of?

A

BPH

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3
Q

Treatment of acute urinary retention?

A

Catheterisation

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4
Q

If painful retention with

A

Trial without catheter (TWOC)

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5
Q

What should be prescribed before TWOC for best chance of success?

A

Uroselective alphablocker (Alfuzosin, Tamsulosin)

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6
Q

Why do patients get postobstructive diuresis?

A

Solute diuresis (retained irea, sodium & water) + defect in concentrating ability of kidney

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7
Q

How long does post-obstructive diuresis take to resolve?

A

Approx. 24 hrs

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8
Q

Potential diagnosis of loin pain outwith urinary tract

A

AAA

Muscular pain

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9
Q

What causes pain in ureteric colic secondary t calculus?

A

Pain mediated by prostaglandins released by ureter in response to obstruction

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10
Q

Treatment of ureteric colic

A

NSAID +/- opiate

Alphablocker (tamsulosin) for small stones that are expected to pass

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11
Q

What are the indications to treat ureteric colic urgently

A

Pain unrelieved
Pyrexia
Persistant nausea/vomiting
High-grade obstruction

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12
Q

Treatment of urgent stones in the abscence of infection

A

Ureteric stent or stone fragmentation/removal

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13
Q

Treatment for infected hydronephrosis

A

Percutaneous nephrostomy

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14
Q

Causes of frank haematuria

A 
Infection 
Stones 
Tumours 
BPH 
Polycystic kidneys 
Trauma 
Coagulation/platelet deficiencies
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15
Q

Investigation of frank haematuria?

A

CT urogram + cystoscopy

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16
Q

Causes of acute scrotal pain

A 
Torsion of spermatic cord 
Torsion of appendix testis 
Epidymitis/epididymo-orchitis 
Inguinal hernia 
Hydrocoele 
Trauma/insect bite 
Dermatological lesions 
Inflammatory vasculitis 
Tumour
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17
Q

When is torsion of the spermatic most common?

A

Puberty

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18
Q

Presentation of torsion fo spermatic cord

A

Sudden onset pain
(sometimes previous episodes of self-limiting pain)
Referra of pain to lower abdomen
May be nausea/vomtiting

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19
Q

Examination findings of testicular torsion

A

Testis high in scrotum
Transverse lie
Abscence of cremasteric reflex
(Acute hydrocoele + oedema may obliterate landmarks)

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20
Q

Investigation of testicular torsion

A

Doppler USS

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21
Q

Treatment of testicular torsion

A

Prompt exploration (

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22
Q

Why must the contralateral side be fixed in testicular torsion

A

Bell clapper deformity

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23
Q

What is the blue dot sign indicative of?

A

Torsion of appendage of testis

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24
Q

If there is a torsion of the appendage of testis is the cremasteric reflex present?

A

Yes

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25
What features of a history would suggest epididymitis rather than testicular torsion?
Hx of UTI, uretheritis, catherterization/instrumentation
26
Examination findings of epidiymitis
Cremasteric refle present | Pyuria
27
Doppkler findings od epididymitis
Swollen epididymis | Increased blood flow
28
Investigations for epididymitis
urine for culture + Chlamydia PCR
29
Treatment of epididymitis
Analgesia + scrotal support | Ofloxacin for 14 days
30
s idiopathic scrotal oedema associated with erythema?
Not usually
31
What is paraphimosis?
Painful swelling of the foreskin distal to a phimotic ring
32
What does paraphimosis usually occur after?
Foreskin retracted for surgery or ytoscopy and staff member forgets to replace it in its natural replacement
33
Treatment of paraphimosis
Iced glove Granulated sugar for 1-2 hrs Multiple punctures in oedematous skin
34
What is priapism?
Prolonged erection (>4hrs) often painful and not asociated with sexual arousal
35
Causes of paraphimosis
Intracorporeal injection for ED Trauma Haematologic dyscrasias Neurological conditions
36
Pathogenesis of ischaemic (low flow) paraphimosis
Vascular stasis in penis - decreased venous outflow - compartment syndrome
37
Pathogenesis of non-ischaemic (high flow) paraphimosis
Traumatic disruption of penile vasculature results in unregulated blood entry
38
How can different types of paaphimosis be distinguished
Aspirated blood | Duplex USS
39
Treatment of ischaemic paraphimosis
Apiraation +/_ irrigation with saline | Injection of alpha-agonist (e.g. phenyl epinephrine) Surgical shunt
40
Treatment for very delayed presentation of ischaemic priapism
Consider immediate placement of penile prosthesis
41
Treatment of non-ischaemic priapism
Observe - may resolve spontaneously
42
What is Fourneirs gangrene?
A form of necrotizing fasciitis occuring about the male genitalia
43
Predisposing factors to fourneir's gangrene
Diabetes Local trauma Periurethral etravasation Perianal infection
44
What does fourniers gangrene start as?
Cellulitis (swollen, erythematous, tednder, marked pain, fever, systemic toxicity)
45
Presentation of Fourneir's gangrene?
Swelling + crepitus of scorum Dark purple aras often marked toxicity out of proporion of local findgins
46
Investigations of Fourneir's gangrene
X-ray or USS (confirm gas is tissues)
47
Treatment of Fourneir's gangrene
Antibiotics + surgical debridement
48
Mortality from Fournier's gangrene is 20% higher in which 2 groups
Diabetics | Alcoholics
49
What is emphysematous pyelonephritis?
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens
50
What is most common causal organism in emphysematous pyelonephritis?
E. coli
51
Why group is most prone to emphysematous pyelonephritis?
Diabetics
52
What is emphysematous pyelonephritis often associated with?
Ureteric obstruction
53
Clinical presentation of emphysematous pyelonephritis
Fever Vomiting Flank pain
54
Investigations for emphysematous pyelonephritis
X-ray (see gas_ | CT (defines extent of ephysematous process)
55
Treatment of emphysematous pyelonephritis
Often nephrectomy
56
What is the most likely causes of perinephric abscess?
Rupture of acute cortical abscess into the perinephric space OR haematogenous seeding from sites of infection
57
Investibgation for perinephric abscess
CT | will also be high WCC, high serum creatinine, pyuria
58
Treatment of perinephric abscess
Antibiotics + percutaneous or surgical drainage
59
What is grade I renal trauma?
Haematoma, subcapsular, non-expanding, no parechymal laceration
60
What is grade II renal trauma?
Laceration
61
What is grade III renal truma?
>1cm depth of parenchymal laceration, no collecting system rupture of extravasation
62
What is grade IV renal trauma?
Laceration through corte, medulla and collecting system | Main arterial/venous injury with contained haemorrhage
63
What is grade V renal trauma?
Shattered kidney | Avulsion of hilum, devascularizing kidney
64
Indications for imaging in renal trauma
Frank haematuria in adult Frank or occult haematuria in child Occult haematuria + shock Penetrating injury with any degree of haematuria
65
What is the first line investigation for renal truma
CT with contrast
66
What would indicate that surgery is needed in renal trauma?
Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma, urinary extravasation, non-viable tissue, incomplete staging
67
Which fracture is bladder injury commonly associated with?
Pelvic fracture
68
Clinical presentation of bladder injry
``` Suprapubic/abdominal pain Inability to void Suprapubic tenderness Lower abdo bruising Guarding/rigidity Diminished bowel sounds ```
69
Imaging for bladder injury
CT cystography
70
Management of bladder injury
Large bore catheter Antibiotics Repeat cystogram in 14 days
71
What is posterior urethral injury often associated with?
Fracture of pubic rami
72
Which part of the urethra is most prone to injury
Bulbomembranous junction
73
Clinical findings of urethral injury
``` Blood at meatus Inability to urinate Palpably full bladder "High-riding" prostate Butterfly perineal haematoma ```
74
Investigation for urethral injury
Retrograde urethrogram
75
Management of urethral injury
Suprapubic catheter | Delayed reconstruction after at least months
76
What is the most common cause of penile fracture?
Sex buckling injury as penis slips out of agina and strikes pubis
77
Clinical presentation of penile fracture
Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
78
Treatment of penile fracture
Prompt exploration & repair | Circumcision incision with degloving to expose all 3 compartments
79
Investigaion of choice for testicular injury
USS to asses integrity/vascularity

AY Renal (15 decks)

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