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Renal and Urology > Urological emergencies > Flashcards

Urological emergencies Flashcards

(92 cards)

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1
Q

acute urinary retention

A

the sudden inability to pass urine which causes significant pain

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2
Q

acute urinary retention is characterised as

A

spontaneous or precipitated

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3
Q

precipitated acute urinary retention is where

A

there is a triggering event i.e. non-prostate related surgery, catheterisation, urethral instrumentation, anaesthesia, medication with sympathomimetic or anti-cholinergic affects

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4
Q

causes of acute urinary retention in men

A

benign prostatic hyperplasia (most common), meatal stenosis, paraphymosis, prostate cancer

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5
Q

causes of acute urinary retention in woman

A

cysteocels (where the bladder bulges into the vagina), rectocele (where the rectum bulges into the vagina), pelvic mass (gynaecological malignancy, uterine fibrosis)

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6
Q

in both male and females acute urinary retention can be caused by

A

bladder calculi, blader cancer, faecal impacatation, GI or retro-peritoneal malignancy

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7
Q

infections and inflammatory causes of acute urinary retention in males

A

balanitits (inflammation of the glans penis), prostatitis, prostatic abscess

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8
Q

infections and inflammatory causes of acute urinary retention in females

A

acute vulvovaginitis, lichen sclerosus

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9
Q

infections and inflammatory causes of acute urinary retention which can occur in both males and females

A

schistosomiasis, cystitis, herpes simplex, peri-urethral abscess

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10
Q

drug related causes of acute urinary retention

A

anti-cholinergics, opioids, anaestheticis, alpha-adrenergic agonists, benzodiazepines

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11
Q

presentation of acute urinary retention

A

teder distended palpable bladder with inability to pass urine

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12
Q

management of acute urinary retention

A

immediate and complete bladder decompression using a catheter, if painful retention with less than 1 litre residue and normal serum electrolytes trial without cathetersitation is carried out during the same admission

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13
Q

what should be prescribed to increase success of trial without catheterisation

A

alpha blocker (tamsulosin)

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14
Q

how does tamsulosin work

A

it is a selective alpha blocker which causes relaxation of smooth muscles in the bladder neck and prostate

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15
Q

post obstructive diuresis

A

high urine output greater than 200ml per hour for more than 2 consecutive hours after an obstruction is relieved

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16
Q

post obstructive diuresis most often presents in patients with

A

chronic bladder outflow obstruction in associated with uraemia, oedema, congestive heart failure and hypertension

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17
Q

post-obstructive diuresis is a state of

A

polyuresis where there is excessive amount of water excreted in the urine after treatment of a urinary tract obstruction

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18
Q

diureisus is a normal physiological response

A

to help eliminate excessive volume and solutes which accumulated during the prolonged obstruction but the diuresis should resolve after solute and volume have been normalised but in POD the kidney continues to eliminated fluid after homeostasis has been achieved

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19
Q

in post-obstructive diuresis there is a risk of

A

dehydration, electrolyte imbalance and hypovolaemic shock

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20
Q

post-obstructive diuresis usually resolves after

A

24-48 hours but if severe requires IV fluids and sodium replacement

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21
Q

acute loin pain always consider what in your differentials

A

diagnosis outwith the urinary tract such as AAA

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22
Q

acute loin pain most commonly caused by

A

nephrolithiasis

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23
Q

the urerter has 3 sites of what

A

constriction where it contracts smooth muscle, narrowing can occur at these sites and calculi can get lodged here:

  1. pelvics-ureteric junction
  2. pelvic brim
  3. vesico-ureteric orifice
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24
Q

the cells lining the renal tubules are predominantly

A

cuboidal epithelial cells

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25
within the renal tubules what can form
crystal like structures known as calculus
26
if the calculus are small enough
the pass out in urine without causing any problems, but if they are large they can cause obstruction
27
obstruction within the tubules causes
release prostaglandisng causing pain
28
presentation of calculi
- acute flank pain which can radiate to the groin | - nausea,vomiting, fever
29
risk factors for renal stones
- white caucasian - obesity - high sodium and protein diet - carbonic anhydrase inhibitors - sodium and calcium containing medication
30
some of the risk factors for renal stones
increase uurianry solute concentration (sodium, calcium, oxalate) and some risk factors reducing concentrations of salt forming inhibitors (citrate and magnesium)
31
these combined factors cause
urine super-saturation causing the formation of calculus
32
types of stones
- calcium oxalate (most common) and are radiopaque and more likely to form in acidic urine - calcium phosphate are radiopaque and most likely to form in alkaline urine - struvite are common in chronic UTIS and contain magnesium ammonia and phosphate and are radioopaue - uric acid stones are radiolucent - cystine stones are very rare and are radiopaque
33
investigations for renal stones
FBCS, CRP, urinalysis | - ULTRASOND IS INITIAL IMAGING OF CHOIDE AND THEN NON-CONTRAST CT
34
management of renal stones
- Intra-muscular diclofenace - tamsulosin - stones less than 5mm usually pass spontaneously within 4 weeks
35
indications to urgently treat renal stones
pain unrelieved, persistent causes, vomiting, high- grade obstruction - ureteric obstruction - renal abnormality such as horseshoe kidney - previous renal transplant URETERIC OBSTRUCTION CAUSED BY STONE COMBINDE WITH INFECTION IS A SURGICAL EMERGENCY options include nephrostomy tube insertion of ureteric catheter or ureteric stent
36
non-emergency treatment of renal stones
- shock wave lithotripsy - ureteroscopy (indicated in individuals where shock wave lithotripsy is contra-indicated i.e. pregnant females and in complex stone disease). In most cases a stent is left in situ for 4 weeks after the procedure - percutaneous nephroplithotomy
37
causes f acute scotrum
- testicualr torsion - torsion of the tesitucal appendix - epidydymitis - incarcerated inguinal hernia - hydroecels - trauma
38
testicular torsion most commonly occurs in who
pubertal boys
39
symptoms of testicualr torsion
extreme pain, nausea, vomtinting,
40
signs in testisuatl torsion
- loss of cremator reflex | - prehns sign negative (lifting the testes does not relieve the pain, but in epidydymitis this would receive the pain)
41
management of testicualr torsion
emergency surgery as ultrasound is not always diagnostic
42
what is important about contralateral testes in testicualr torsion
if the person has a bell clapper deformity (tunica vaginlais joins high on the spermatic cord) the contra-lateral testes must also be corrected as there is increased risk of testicualr torsion
43
torsion of the testicular appendage is
twisting of the testicular appendix around its own axis
44
torsion of the testicular appendage is
completely self-limiting however, you must rule out testicualr torsion
45
symptoms of torsion of the testicualr appendage
pain, swelling, blue dot sign, the cremaster reflex is PRESENT
46
epidydymitis
usually a sexually transmitted infection of the epididymis
47
2 most common organisms causing epidydymitis
- neisseria gonorrhoea | - chlamydia trachomatis
48
presentation of epidydymitis
scrotal pain, fever, dysuria and erythema
49
what sign differentiates epidydymitis from testicualr torsion
preens sign which is positive in epidydymitis, when you elevate the testis the pain is relieved
50
diagnosis of epidydymitis
doppler ultrasound to rule out testicualr torsion, urine culture and chlamydia PCR
51
treatment of epidydymitis
ofloxacin 400mg/day for 14 days analgesia and bed rest and scrotal elevation
52
phimosis
almost all boys have a retractable foreskin at birth, the inner foreskin is attached to the glans, foreskin adhesions then breakdown and the process of retraction is spontaneous and requires no manipulation which is called physiological phimosis, phimosis is not a problem unless it uses urinary obstruction haeamturia or local pain
53
paraphymosis occurs when
a tight prepuce (foreskin) is retracted and unable to be replaced as the glans swells
54
treatment of paraphymosis
iced glove, manual decompression of glans and last line is dorsal incision if this fails
55
priapism
prolonged erection which lasts longer than 4 hours it is often painful and is not associated with sexual arousal
56
priapism can be
low flow of high flow piapism
57
low flow priapism
- painful - ischaemic corpora= dark blood on corporal aspiration - no evidence of trauma
58
high flow priapism
- not painful - well-oxygenated corpora - evidence of trauma
59
diagnosis of priapism
aspiration of blood from the corpus cavernous and a colour duplex ultrasound
60
treatment of non-ischaemic priapism
observe as usually resolves spontaneously if not selective arterial embolisation with non-pernament materials
61
treatment of ischaemic priapism
aspiration +/- irrigation with saline, injection of alpha agonist (Phenylephrine) 100-200 micrograms every 5-10 mins up to max of 1000 micrograms - surgical shunt if person presents after 48 hours from onset
62
fournies gangrene
type of necrotising fasciitis occurring at the male genitalis
63
fournies gangrene most commonly arises from
the skin, urethra or rectal region
64
who is at increased risk of mourners gangrene
diabetics, local trauma, peri- urethral extravasation, peri-anal infection
65
fournies gangrene is usually caused by a mixture of
aerobes and anaerobes
66
fournies gangrene begins as
cellulitis with redness, pain and fever and then it causes dark purple areas and crepitus of the scrotum
67
treatment of mourners gangrene
iv fluid and surgical debridement
68
emphysematous pyelonephritis
acute necrotising parenchymal and peri- renal infection caused by gas forming uropathogens usually E.coli
69
emphysematous pyelonephritis usually occurs in
diabetics and is often associated with a urinary obstruction
70
symptoms of emphysematous pyelnephritis
fever, vomiting, flank pain, gas seen on KUB X-ray, CT shows extent of emphysematous process
71
peri-nephric abscess
usually results from rupture of an acute cortical abscess into the peri-nephric space or from haematogneous spread
72
peri-nephric abscess onset
is insidious with one third not having a fever, 50% have a flank mass, high WCC and creatinine in serum is high
73
diagnosis of a peri-nephric abscess
CT
74
Treatment of a peri-nephric abscess
IV antibiotics and percutaneous drainage
75
renal trauma classification
1= haematoma, sub-capsular, non-expanding, no parenchymal laceration 2= laceration less than 1cm of parenchymal depth without utinary involvement 3= laceration greater than 1cm parenchymal depth, no collecting system rupture of extravasation 4= laceration greater through cortex, medulla and collecting system but haemorrhage is contained 5=shattered kidney, avulsion of the hilum, devascularisation of kidney
76
investigation of renal trauma
CT CONTRAST
77
Treatment of renal trauma
majority are managed with angiography and embolisation but for persistent bleeding, expanding or pulsatile peri-renal haematoma requires surgery
78
bladder injury commonly is associated with
a pelvic fracture
79
presentation of bladder trauma
supra-pubic pain, distended bladder inability to void
80
in bladder trauma
catheterisation shows gross haematuria, if there is blood at the external meatus or if the catheter does not pass easily this could indicate a urethral injury so stop what you are doing and get a retrograde urethrogram
81
investigations for bladder trauma
CT cystography
82
treatment of bladder trauma
IV antibiotics, large bore catheter and repeat ct CYSTOGRAPHY IN 2 WEEEKS
83
indications for immediate repair of bladder trauma
- intra-peritoneal injury/ penetrating injury - inadequate urinary drainage or clots in urine - bladder neck or vaginal injury - open pelvic fracture
84
urethral injury
posterior urethral injury is often associated with fracture of the pubic rami,
85
most vulnerable part of the urethra in trauma
bulbomembranous junction
86
signs of urethral trauma
blood at the meatus, inability to urinate, palpable bladder, high-riding prostate, butterfly peri-renal heamatoma
87
investigation of urethral trauma
retrograde urethrogram
88
treatment of urethral injury
supra-pubic catheter and delayed repair after 3 months §
89
penile fracture classical occurs
during sex
90
during a penile fracture
a cracking sound followed by pain, scrotal swelling and discolouration is heard
91
in a penile fracture there is
20% incidence of a urethral injury
92
treatment of a penile fracture
emergency surgery

Renal and Urology (51 decks)

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