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2 Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

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1
Q

main complication of BPH

A

acute retention

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2
Q

causes of acute urinary retention

A 
prostate infection
BPH
bladder overdistension
excessive fluid intake
alcohol
prostatic infarction
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3
Q

name the 2 types of acute retention

A

precipitated

spontaneous

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4
Q

what can cause precipitated urinary retention

A

non-prostate related surgery
catheterisation
anaesthesia
anticholinergic medication

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5
Q

Tx of acute retention

A

catheter if >1l in bladder

trial without catheter + tamsulosin if <1l residue in bladder

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6
Q

patient with uraemia, oedema, CCF, hypertension who presents with oliguria?

A

post obstructive diuresis

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7
Q

what is solute diuresis?

A

retained urea, Na and water + inability of kidney to concentrate urine

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8
Q

urine output over __ ml/hr is unusual in a patient who hasnt been drinking

A

200

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9
Q

Tx of post obstructive diuresis?

A

monitor fluids and UO

give IV fluids and Na replacement if not resolved within 2 days

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10
Q

pre surgical Tx of stones?

A

IM diclofenac if no renal failure +/- opiates

give tamsulosin if small stone too

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11
Q

differential for acute loin pain?

A

stones

AAA

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12
Q

if stone hasn’t passed in _ __ it is likely to require intervention

A

1 month

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13
Q

the ureters can be found in line with what bony structures?

A

transverse processes of the spine

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14
Q

if a patient with stones is very sick how should you treat them?

A

ureteric stent/stone fragmentation if no infection

percutaneous nephrostomy if infected hydronephrosis

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15
Q

painless frank haematuria makes you think…

A

bladder cancer

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16
Q

what type of catheter is used for clot retention?

A

3 way irrigating haematuria catheter

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17
Q

Ix for frank haematuria?

A

CT urogram

cystoscopy

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18
Q

causes of frank haematuria?

A 
stones
infection
tumour
BPH
polycystic kidneys
trauma
coagulation deficiency
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19
Q

what 2 structures can be torted in the scrotum?

A

spermatic cord

appendix testis

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20
Q

main infectious conditions of the scrotum?

A

epididymitis

epididymo-orchitis

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21
Q

most common causes of epididymo-orchitis?

A

young men- STI

older men- catheter

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22
Q

of the 2 structures in the scrotum that can be torted, which is the most painful and severe?

A

spermatic cord

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23
Q

most common time for testicular torsion and why?

A

puberty as this is when testicular volume gets bigger

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24
Q

pain in scrotum waking teenage boy up from sleep; has nausea and vomiting…

A

testicular torsion

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25
on examination the testicle is found where in testicular torsion?
lies high in the scrotum and is facing sideways
26
what is the onset of the pain in torsion?
sudden
27
where can pain refer in torsion?
lower abdoemn
28
there is loss of what reflex in torsion?
cremasteric reflex
29
Ix of torsion?
doppler USS
30
Tx of torsion?
fix it if get it in time if dead remove fix the other side
31
what sign can be found in early torsion?
blue dot sign (appendix testis is engorged with blood)
32
who gets epididymitis?
adults
33
pyrexial patient with urinary symptoms with increased blood flow on imaging and a swollen scrotum...
epididymitis
34
important things to ask in PMH for a suspected epididymitis?
UTI urethritis catheterisation
35
Ix for epididymitis?
doppler- INC blood flow urine culture chlamydia PCR
36
Tx of epididymitis?
analgesia scrotal support bed rest ofloxacin 400mg/day for 2 weeks
37
antibiotic for epididymitis?
ofloxacin for 2 weeks
38
child presents with swollen scrotum without fever or tenderness, slightly itchy..
idiopathic scrotal oedema
39
what is paraphimosis?
painful swelling of the foreskin distal to a phimotic ring
40
what can cause a paraphimosis?
after foreskin is retracted for catherisation or cystoscopy and it isnt brought back to normal
41
Tx of paraphimosis
iced glove for 2hrs puncture edematous skin compress glans dorsal slit
42
what condition is called "compartment syndrome of the penis"?
priapism
43
main signs and symptoms of priapism?
prolonged erection over 4hrs | painful and NO sexual arousal
44
causes of priapism?
``` erectile dysfuncton injecton trauma sickle cell anaemia neuro conditions idiopathic ```
45
main pathophysiology of priapism?
ischaemia of the penis due to vascular stasis and lack of venous outflow OR disrupted penile vasculature (non-ischaemic)
46
Ix of priapism?
aspirate blood- if it looks dark it could be ischaemic | colour duplex USS- minimal or absent flow in ischaemic, normal to high flow in non-ischaemic
47
Tx of ischaemic priapism?
aspiration +/- irrigation with saline inject alpha blocker insert shunt
48
Tx of non-ischaemic priapism?
observe, may resolve spontaneously | selective arterial embolisation
49
fournier's gangrene is the penile form of what condition?
necrotising fasciitis
50
Tx of fournier's gangrene
surgical debridement | antibiotics
51
predisposing factors to fournier's gangrene?
infection around this area diabetes trauma
52
pathophysiology of fournier's gangrene?
begins as cellulitis, then get swelling and crepitus of scrotum (looks dark purple)
53
Ix of fournier's gangrene?
X ray or USS to confirm gas in tissue
54
causative organism of emphysematous pyelonephritis?
gas forming uropathogen eg e coli
55
who gets emphysematous pyelonephritis?
diabetics
56
associated symptom of emphysematous pyelo?
ureteric obstruction
57
diabetic man presents with obstruction, fever, vomiting and flank pain with gas on KUB imaging...
emphysematous pyelo
58
Ix of emphysematous pyelo?
KUB for gas | CT for extent of emphysema
59
Tx of emphysematous pyelo?
nephrectomy
60
findings on bloods in someone with a pyelonephric abscess?
high WCC | high creatinine
61
Ix of pyelonephric abscess?
bloods | CT
62
Tx of perinephric abscess?
antibiotics | percutaneous or surgical drainage
63
which kidney problem will present with a flank mass?
perinephric abscess
64
main test for frank haematuria
CT with contrast always
65
bladder injury is commonly associated with what problem?
pelvic fracture
66
main symptoms of a bladder injury?
subrapubic pain and tenderness inability to void guarding diminished bowel sounds
67
there will be gross haematuria in bladder injury T or F
T
68
Ix of bladder injury
CT cystography
69
Tx of bladder injury?
large bore catheter antibiotics repeat cystogram in 14 days if bad, needs surgery
70
a "flame shaped collection of contrast in the pelvis" is likely to be an intra or extraperitoneal injury?
extraperitoneal
71
the prostate is attached to what ligament?
puboprostatic ligaement
72
posterior urethral injury is often associated with fracture of what structure?
pubic rami
73
signs and symptoms of urethral injury?
``` blood at meatus cant urinate palpable full bladder high prostate haematoma ```
74
what is the haematoma from a urethral injury said to look like?
butterfly perineal haematoma
75
Tx of urethral injury?
suprapubic catheter
76
main cause of penile fracture
intercourse
77
man experiences popping sound followed by pain whilst having sex...
suspected penile fracture
78
main signs and symptoms of penile fracture
pain discolouration swelling
79
Ix of testicular injury?
USS
80
main symptoms of testicular injury?
pain and nausea

2 Renal (34 decks)

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