Urology tutorial - Haematuria/Renal colic/Quiz Flashcards
(31 cards)
Causes/presentation/investigations/indication & interpretation of each/principles of initial & definitive management
Haematuria types and causes?
Visible or Invisible (detectable w dipstick)
if symptomatic (pain), think infection or stone; if asymptomatic (not painful), think tumours
can also be idiopathic
What happens in visible haematuria?
Should be seen by specialist within 2 weeks, due to high risk of cancer
List some causes of haematuria from each part of the urinary tract.
Kidney
Glomerular - GN, IgA nephropathy, thin basement membrane disease, Alport’s syndrome
Extraglomerular - tumour, sickle cell disease, pyelonephritis, stones, renal papillary necrosis, trauma
Ureters - tumour, stones, stricture, infection, trauma
Bladder - similar to ureters
Prostate - stu
Urethra - stu
How to investigate lower/upper urinary tract?
Lower - flexible cystoscopy
Upper - CT/US
Common Qs in haematuria history?
Pain - SOCRATEs (esp back, flank, suprapubic, urethral tip)
Bleeding specific -
before (probably from urethra or prostate)/after(most commonly in bladder stones or other things affecting the neck)/mix?
Clots (can obstruct and go into retention) - suggest some sort of urgency
Voiding issue - LUTS/retention
Co-morbidities? - DM, HTN, CKD, AF (these patients need more attention)
Meds? - anticoagulants/NSAIDs
Smoking
Radiotherapy (eg tx for cervical cancer) - can cause bleeding, cancer, fibrosis/necrosis of small vessels (can lead to strictures)
Occupation - motor/dye/lead
Previous GU surgery
Systemic enqueries - SLE/PAN/autoimmune diseases; haemophilia
What examination would you do for haematuria patient?
Abdomen - palpable bladder/flank or back masses?
DRE
Penile exam - urethral meatus (eg narrowing), foreskin, palpable abnormality
PV exam - blood may be from vagina, need to rule out
What investigations to do with haematuria?
Urinalysis (dip/ cytology - rarely done)
Bloods (renal function, FBC, Hb)
For upper GU tract -
CT urogram (MRU if Iodine allergy) - contrast can be good to identify obstruction/leakage sites if needed; recommended for VISIBLE haematuria
USS - recommended for non-visible haematuria and younger patients (due to lower possibility for malignancy)
For lower GU tract -
Cystoscopy
What are the percentage distribution of causes identified for a patient with haematuria?
Emergency management for someone with haematuria and urinary retention
Bloods (FBC, RF, Clotting profile)
3-way catheter insertion with bladder washout
monitor output and Hb
Once settled, review indication for catheter
Outpatient CT/USS and cystoscopy within 2 weeks
What is the commonest cause for symptomatic non-visible haematuria?
Infection
Why would haematuria occur in ultra-runners?
Vasoconstriction of renal artery leads to a hypoxic environment, the kidneys then constrict the efferent arteriole in an attempt to introduce more blood flow, which increases GFR
Which drugs can lead to haematuria?
Doxyrubicine, chloroquine, rifampicin, nitrofurantoin, senna-containing laxatives
What does colicky pain stem from and how to manage it generally?
Peristaltic spasms (intermittent gripping pain) and ischaemia of certain tissue - changing position does not give relief - so pt tends to be rolling
Mainly from prostaglandins - give NSAIDs one dose, there will be inflammation and oedema (reducing this can help obstruction) - only continue NSAID if renal function comes back normal
Give anti-spasms/anti-cholinergic to relief peristalsis
What are the emergency indicators in renal colicky?
Unmanageable pain
Sepsis
Compromised renal function
What are differentials for renal colicky pain?
Renal stones
Pyelonephritis
Diverticulitis
AAA rupture
Investigation and initial management in renal colic?
ABCDE
MSU
Analgesia - Diclofenac IM/PR (NSAID)
Bloods - FBC, U&E, CRP, urate, Calcium
CT KUB WITHOUT contrast (so you can see the stone) - gold standard
Treat Sepsis
Treatment options for a stone?
Timeframe for retention of urine?
Bladder can hold about 700ml of urine
Acute - usually painful (under 800ml)
Chronic - usually not painful, bladder capacity would be increased across time (up till maybe 2.5 litres)
Common causes of urinary retention in men and women?
Men - much more common
BPH, prostate cancer, stricture
Women - less common
Qs to ask in history of urinary retention?
Acute/chronic?
Previous LUT symptoms
Previous urological interventions
Precipitating factors - constipation, UTI, haematuria, alcohol, drugs (eg anticholinergics in nasodecongestants - relax bladder detrusor muscle), neurological Hx
How is kidney countercurrent mulplication disturbed in chronic retention?
What kind of questionnaire is given in storage problems in male?
Bladder diary which includes volume intake/output and characters of symptoms
What kind of questionnaire is given in urinary flow problem in male?
IPSS score
