08 - urethral obstruction

Question 1

(urethral obstruction)

(causes)

1. structural by anything that physically blocks the urethral lumen or compresses from outside
2. functional: secondary to neurologic suprasacral spinal lesions, inflammation, idiopathic

Question 2

(urethral obstruction)

functional urethral obstruction results in normal initation of voiding, followed by a decrease in urine flow with typical signs of partical urinary obstruction

Question 3

(urethral obstruction)

(physical examination)

1. urinary bladder distended, turgid, and painful
2. can’t express bladder

Question 4

(urethral obstruction)

(dx)

1. what three things on chem?
2. UA: hematuria, proteinuria, pyuria, bacteriuria (depends on uderlying cause)
3. can get cardiac arrhythmias resulting from what?
4. radio/ultrasound

Answer 4

1. hyperkalemia, metabolic acidosis, azotemia
2. hyperkalemia and metabolic acidosis

Question 5

(urethral obstruction)

(tx)

1. give K free fluids
2. if cardiac arrythmia, assume hyperkalemia and metabolic acidosis -> IV fluids, dextrose, calcium salts, sodium bicarbonate
3. decompress the bladder by cystocentesis before passing a urinary catheter
4. may be able to pass a urinary catheter pass a stone
5. maintain an indwelling urinary catheter until azotemia and postobstructive diuresis have resolved and urethral swelling has diminished

Question 6

(uroabdomen)

1. can enter peritoneal cavities from tears in what structures?
2. retroperitoneal?
3. tears of what are most common?

Answer 6

1. bladder, urethra, kidneys
2. kidney and ureter
3. bladder

Question 7

(uroabdomen)

1. sometimes no urine output, sometimes there is some

Question 8

(uroabdomen)

(dx)

1. if urethral tear - might not be able to pass catheter
2. UA - may show hematuria, proteinuria, and pyuria from trauma or chemical peritonitis

Question 9

(uroabdomen)

(serum biochemistry)

1. CK, AST, may ^ if trauma
2. what values increase as uroabdomen develops?

Answer 9

2. BUN, creatinine, and phosphorus (postrenal azotemia)

Question 10

(uroabdomen)

(radiographs)

1. positive contrast cystography to see leakage
2. loss of retroperitoneal detail

Question 11

(uroabdomen)

(analysis of abdominal fluid)

1. what shoud be higher in abdominal fluid vs serum?

Answer 11

1. BUN and creatinine

Question 12

(uroabdomen)

(tx)

1. if small bladder tear -> ?

if large?

2. rupture of urethra?
3. of kidney?
4. ureter?

Answer 12

1. indwelling urinary catheter

surgical closure

2. surgical closure
3. nephrectomy
4. reimplantation into bladder