Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Renal > Urology Emergencies > Flashcards

Urology Emergencies Flashcards

(69 cards)

Start Studying
1
Q

what is acute urinary retention

A

inability to urinate
increasing pain
a complication with BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what causes acute urinary retention

A 
prostate infection 
bladder overdistention 
excessive fluid intake 
alcohol 
prostatic infarction

can be sponatenous or precipitated (non prostate related surgery, catheterisation, urethral instrumentation, anaesthesia, medication w/ sympathomimetic/ anticholinergic effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the Rx for acute urinary rentention

A

catheter
uroselective alphablocker (alfuzosin, tamsulosin)
trial without catheter (if <1 litre residue, painful, normal serum electrolytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is post-obstructive diuresis

A

polyuric (increased urine output) response initiated by the kidneys after the relief of a substantial bladder outlet obstruction. In severe cases this condition can become pathologic, resulting in dehydration, electrolyte imbalances, and death if not adequately treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

who gets post obstructive diuresis

A

patients with chronic bladder outflow obstruction in associated with uraemia, oedema, CCF, hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what causes post obstructive diuresis

A

solute diuresis (higher solute volume) retained urea, sodium and water + defect in concentrating ability of kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the treatment of post obstructive diuresis

A

monitor fluid balance and beware if urine output > 200 ml/hr

usually resolves in 24-48 hrs, severe cases may need IV fluid and sodium replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

is haematuria common in acute urinary retention

A

yes- usually settles in 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the differentials for acute loin pain

A

renal stones

AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the Rx for ureteric colic

A 
NSAID +/- opiate 
alpha blocker (tamsulosin) for small stones that are expected to pass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what sizes of stone are likely to pass

A

<4 mm 80%
4-6 mm 59%
>6 mm 21%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how long do you give a stone to pass spontaneously

A

1 month, if not then intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

are renal stones radio opaque

A

90% are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the indications to treat renal stones urgently

A

pain unrelieved by analgesia
pyrexia (infection)
persistent N/V
high grade obstruction (affect urine outflow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the urgent treatment for a renal stone

A

ureteric stent
stone fragmentation/ removal if no infection
percutaneous nephrostomy for infected hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what can cause frank haematuria

A 
infection 
stones
tumours
BPH
polycystic kidneys 
trauma 
coagulation/ platelet deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what investigations for frank haematuria

A

CT urogram + cystoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can be used to treat clot retention

A

3 way irrigating haematuria catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the acute scrotum presentation you should always rule out

A

torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

who is torsion most common in

A

teenagers- most common at puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can cause acute scrotum

A

Torsion of spermatic cord
Torsion of appendix testis
Epididymitis / epididymo-orchitis (infective)
Inguinal hernia
Hydrocoele can appear in relation to infection, trauma, torsion)
Trauma / insect bite
Dermatological lesions
Inflammatory vasculitis
Tumour (usually don’t present acutely but can do)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the presentation of torsion of the spermatic chord

A 
most occur spontaneously 
can occur with trauma/ athletic activity
adolescent woken from sleep 
usually sudden onset of pain 
sometime previous episode of self limiting pain 
N/V
pain can refer to lower abdomen/ groin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the clinical signs of torsion of the spermatic chord

A

testes high in scrotum
transverse lie of testes (bell clapper deformity)
absence of cremasteric reflex

acute hydrocoele + scrotal oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the Rx for torsion of the spermatic cord

A

prompt surgical exploration
if necrotic them removed
if bell clapper deformity must fix contralateral side aswell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the symptoms of torsion of appendage
may be insidious onset or identical to torsion of cord if early may have localised tenderness at upper pole and blue dot sign (necrotic tissue showing through the skin) testes should be mobile and cremasteric reflex should be present
26
what is the treatment for torsion of appendage
should resolve spontaneously without surgery
27
what are the features of epididymitis
rare in children hard to distinguish from torsion dysuria/ pyresxia more common
28
who gets epididymitis
people with a history of UTI, urethritis, catheterisation/ instrumentation
29
what are the signs of epididymitis
cremasteric reflex present suspect if pyuria (puss or WBC in urine) doppler (swollen epididymis, increased blood flow) do urine culture + chlamydia PCR
30
what is the treatment for epidymitis
analgesia + scrotal support, bed rest | ofloxacin for 14 days
31
what is idiopathic scrotal oedema
self limiting, unknown cause
32
what are the symptoms of idiopathic scrotal erythema
no scrotal erythema no fever tenderness minimal may be pruritis
33
what is paraphimosis
painful swelling of the foreskin distal to a phimotic ring
34
what causes a paraphimosis
often happens after foreskin is retracted for catheterisation or cytoscopy and staff members forget to replace it to its natural position
35
what is the treatment for a paraphimosis
``` iced glove granulates sugar for 1-2 hrs multiple punctures in oedematous skin manual compression on glans with distal traction on oedematous foreskin dorsal slit ```
36
what is priaprism
a prolonged erection >4 hrs, often painful, not associated with sexual arousal
37
what causes priapism
``` erectile dysfunction treatments (intracorporeal injection e.g. papverine) trauma (penile/ perineal) heamatologic dyscrasias (sickle cell) neurological conditions idiopathic ```
38
what are the types of priapism
ischaemic: (veno occlusive/ low flow) - vascular stasis in penis-decreased venous outflow - compartment syndrome - corpora carvenosa are rigid and tender, penis painful non ischaemic: (arterial or high flow) - traumatic disruption of penile vasculature = unregulated blood entry and filling or corpora - fistula formation can allow blood to bypass the normal helicine arteriolar bed
39
how do you distinguish the forms of priapism
aspirate blood from corpus cavernosum: - dark blood, low O2, high CO2 = low flow (ischaemic) - normal arterial blood = high flow (non ischaemic) colour duplex USS: - minimal/absent flow= ischaemic - normal/high flow= non ischaemic
40
what is the treatment for ischaemic priapism
aspiration +/- irrigation with saline injection of alpha- agonist (phenylephrine) surgical shunt Ischaemic priapism > 48-72hrs unlikely to respond to intracavernosal treatment- get firbsosis, permanent erectile dysfunction For very delayed presentation, may even consider immediate placement of a penile prosthesis
41
what is the treatment for non-ischaemic
observe - can spontaneously resolve | selective arterial embolisation with non permanent materials
42
what is fourniers gangrene
NF occurring about the male genitalia
43
what causes fourniers gangrene
arises from skin, urethra or rectal lesion Predisposing factors – diabetes, local trauma, periurethral extravasation, perianal infection, alcoholic/ immunocompromised in some way Usually a mixture of aerobes/anaerobes (gas forming organisms) Starts as cellulitis – swollen, erythematous, tender. Marked pain, fever, systemic toxicity
44
what are the symptoms of fourniers gangrene
swelling + crepitus of scrotum, dark purple areas
45
what is the treatment for fourniers gangrene
antibiotics + surgical debridement mortality 20%- higher in diabetics and alcoholics can spread into abdominal wall
46
what is emphysematous pyelonephritis
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli Usually occurs in diabetics
47
what are the symptoms of emphysematous pyelonephritis
Often associated with ureteric obstruction Fever, vomiting, flank pain See gas on KUB CT defines extent of emphysematous process
48
what is the treatment of emphysemtous pyelonephritis
emergency nephrectomy
49
what is a perinephric abscess
infective emergency Usually results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
50
what are the features of a perinephric abscess
Insidious onset, approx 33% not pyrexial Flank mass in 50% High WCC, high serum creatinine, pyuria
51
what is the treatment for a perinephric asbcess
Ix - CT Rx - Antibiotics + percutaneous or surgical drainage (infective emergency)
52
what are the classifications of renal trauma
I Haematoma, subcapsular, non-expanding, no parenchymal laceration II Laceration <1cm parenchymal depth without urinary extravasation III >1cm depth, no collecting system rupture or extravasation IV Laceration through cortex, medulla and collecting system Main arterial/venous injury with contained haemorrhage V Shattered kidney Avulsion of hilum, devascularizing kidney
53
when in renal trauma do you need to image
frank haematuria in adult occult/frank haematuria in child occult haematuria + shock penetrating injury (do CT with contrast)
54
what is the treatment for renal injury
90% conservatively with angiography/embolisation surgery if persistent bleeding, expanding haematoma, pulsatile haematoma, urinary extravasation, non viable tissue, incomplete staging
55
what is bladder injury most commonly associated with
pelvic fracture
56
what is the presentation of a bladder injury
Suprapubic/abdominal pain + inability to void Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds Catheterization – gross haematuria in 90-100% If blood at external meatus or if catheter doesn’t pass easily then perform retrograde urethrogram – may well have urethral injury
57
what imaging for a bladder injury
CT cytography
58
what is the treatment for a bladder injury
large bore catheter to keep the bladder empty antibiotics repeat cystogram in 14 days
59
when would you need to immediately repair a bladder injury
``` Intraperitoneal injury Penetrating injury Inadequate drainage or clots in urine Bladder neck injury Rectal or vaginal injury Open pelvic fracture Pelvic fracture requiring open reduction/fixation Patients undergoing laparotomy for other reasons Bone fragments projecting into bladder ```
60
what are posterior uretheral injuries associated with
fracture of pubic rami
61
what part of urethra is most vulnerable to injury
bulbomembranous
62
what are the signs of a urethral injury
``` Blood at meatus Inability to urinate Palpably full bladder “High-riding” prostate Butterfly perineal haematoma ```
63
what investigations for a urethral injury
retrograde urethrogram
64
what is the Tx for a urethral injury
suprapubic catheter | delayed reconstruction after at least 3 months
65
what is a penile fracture
Typically happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis
66
what are the signs of a penile fracture
Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling 20% incidence of urethral injury (frank haematuria/blood at meatus)
67
what is the treatment for a penile fracture
Prompt exploration and repair | Circumcision incision with degloving of penis to expose all 3 compartments
68
how does a testicular injury present
Usually presents with exquisite pain + nausea | Swelling / bruising variable
69
what is the treatment for a testicular injury
USS to assess integrity / vascularity Early exploration/repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

Renal (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions