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Renal Week 3 2017/18 > 2: Urological emergencies > Flashcards

2: Urological emergencies Flashcards

1
Q

What is the most common urological emergency presenting to A&E?

A

Acute urine retention

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2
Q

What are the symptoms of acute urine retention?

A

No urine output

Increasing bladder pain - midline, suprapubic

Abdominal mass

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3
Q

What commonly causes acute urine retention in men?

A

Benign prostatic hyperplasia

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4
Q

Apart from BPH, what are some other causes of acute urine retention?

A

Prostate infection

Prostate infarction

Excessive fluid intake - think alcohol

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5
Q

Acute urine retention is either ___ or ___.

A

spontaneous , precipitated

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6
Q

What are some events which can precipitate acute urine retention?

A

Surgery

Catheterisation

Anaesthesia

Sympathomimemetic / anticholinergic medication

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7
Q

How is acute urine retention treated?

A

Catheter

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8
Q

What can be prescribed along with a catheter to treat acute urine retention?

A

Alpha blocker

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9
Q

What are some consequences following treated acute urine retention?

A

Post-obstructive diuresis (risk of dehydration)

Haematuria

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10
Q

What is a common renal cause of loin pain?

A

Renal calculus causing ureteric colic

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11
Q

How is the pain of ureteric colic managed?

A

NSAID - diclofenac, inhibits prostaglandins which mediate ureteric pain

Opiate analgesia if NSAIDs not effective

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12
Q

What drug can be prescribed to encourage the passing of small renal calculi?

A

Alpha blocker

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13
Q

If a renal calculus is large, how is it likely to be treated?

A

Surgery

ureteric stent, stone removal

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14
Q

What imaging method is gold standard for finding renal stones?

A

CT scan +/- contrast

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15
Q

What signs and symptoms would encourage you to intervene to remove a renal stone?

A

Unrelieved pain

Fever and other signs of infection and sepsis

N&V

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16
Q

Haematuria is a common presentation - what investigation is used to find the cause?

A

CT urogram

Cystoscopy

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17
Q

What special type of catheter is used to treat frank haematuria?

A

3-way irrigated catheter

helps to break up clots

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18
Q

What is a presentation caused by twisting of the spermatic cord?

A

Testicular torsion

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19
Q

What usually causes testicular torison?

Which group is it common in?

A

Spontaneous

Adolescent boys

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20
Q

Where is pain felt in testicular torsion?

A

Scrotum

may radiate to lower abdomen

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21
Q

How is suspected testicular torison investigated?

A

Doppler USS

22
Q

How is testicular torsion treated?

A

Surgically, within 4-6 hours of onset

23
Q

What must be done if the testis is black on exploration?

A

Remove it

24
Q

What sign is produced by torsion of the appendix testis?

A

Blue dot sign

25
Q

What infectious disease presents like testicular torsion?

How do you tell the difference?

A

Epididimytis

Signs of infection, history of infectio,n, pyuria cremasteric reflex PRESENT

26
Q

How is suspected epididimytis investigated?

A

Urine culture

Chlamydia PCR

27
Q

How is epididimytis treated?

A

If confirmed to be an STI: oral doxycycline

If confirmed to be a UTI: oral oxfloxacin or ciprofloxacin

28
Q

What is a common cause of scrotal tenderness and pruritus in children which self-resolves?

A

Idiopathic scrotal oedema

29
Q

What is painful swelling of the foreskin called?

A

Paraphimosis

30
Q

How is paraphimosis (painful swelling of the foreskin) treated?

A

Attempt to reduce swelling to move foreskin back over glans:

iced glove, punctures, compression, dorsal slit

31
Q

What is priapism?

A

Prolonged erection (> 4hrs)

painful

not associated with arousal

32
Q

I mean how likely is it that priapism will come up in exams

A
33
Q

How is priapism investigated?

A

Blood sample from corpus cavernosum

USS

34
Q

How is priapism treated?

A

Aspirate and irrigate with saline

Alpha agonist

Surgical shunt

35
Q

What is Fournier’s gangrene?

A

Necrotising fasciitis of male genitalia

36
Q

How is Fournier’s gangrene treated?

A

Surgical debridement

Antibiotics

37
Q

What is the mortality rate of Fournier’s gangrene?

A

20%

38
Q

What organism commonly causes pyelonephritis?

A

E. coli

39
Q

emphysematous pyelonephritis

emergency form of “” with assoc gas

A
40
Q

How is emphyematous pyelonephritis treated?

A

Nephrectomy

41
Q

What is a perinephric abscess?

How is it investigated?

How is it treated?

A

Collection of pus in kidney, mass, symptoms of infection

CT scan

Antibiotics and drainage

42
Q

Renal trauma is ___ depending on its severity.

A

graded

43
Q

How does renal trauma tend to present?

A

Haematuria

or obvious on examination

44
Q

How is renal trauma investigated?

A

CT with contrast

45
Q

How is 98% of renal trauma managed?

A

Non-operatively

otherwise surgery

46
Q

Which type of fracture can cause bladder trauma?

A

Pelvic fracture

47
Q

What are the symptoms of bladder trauma?

A

Suprapubic pain

Urine retention

Haematuria

48
Q

How is bladder trauma investigated?

A

CT cystography

49
Q

What is a sign of bladder trauma on CT cystography with contrast?

A

Flame shape

50
Q

How is bladder trauma treated?

A

Catheterise

Antibiotics

Repeat CT cystography in 2 weeks

51
Q

Urethral trauma often presents with a distinctive ___-shaped haematoma in the perineum.

How is it managed?

A

butterfly haematoma

suprapubic catheter then reconstruction

Renal Week 3 2017/18 (12 decks)

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