Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal > 3.8: Urological Emergencies > Flashcards

3.8: Urological Emergencies Flashcards

1
Q

Describe acute urinary retention?

A

This is a urological emergency

Sudden inability to pass urine with increasing pain

The abdomen may become distended

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

Acute urinary retention is a complication of..?

A

BPH (Benign Prostatic Hyperplasia)

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

Name some causes of acute urinary retention?

A

Prostate Infection

Bladder Overdistension

Excessive Fluid Intake

Alcohol

Prostatic Infarction

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

What are the two types of acute urinary retention?

A

Spontaneous (no precipitating factor)

Precipitated - There is a triggering event (Eg: Surgery, catheter, anaesthesia, medications)

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

Treatment for acute urinary retention?

A

If serum electrolytes are normal and there is less than 1 litre of residual fluid then trial without catheter. Give uroselective alphablockers before (Eg: Alfuzosin, Tamsulosin)

Catheter

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

Describe the presentation of renal stones?

A

Acute loin to groin pain (ureteric colic)

Possible haematuria

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

Treatment for renal stones?

A

NSAIDs (plus or minus opiates)

Alpha Blocker (Tamusolin) for small stones

<4mm = Will pass

4-6mm = Probably pass

>6mm = Unlikely to pass

If it hasn’t passed in one month then intervention required (Eg; Stent)

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

What would be some indiciations for immediate intervention in renal stones?

How would you treat this?

A

Pyrexia

Pain unrelieved

Persistent nausea/vomiting

High grade obstruction

NO INFECTION: Stent or Stone Fragmentation/Removal

INFECTION: Percutaneous Neprostomy (catheter under skin)

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

Name some causes of frank haematuria?

A

Stones

Infection

Tumour

Benign Prostatic Hyperplasia

Polycystic Kidneys

Trauma

Coagulation/Platelet Deficiencies

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

Investigation of frank haemturia?

A

CT Urogram

Cystoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name some acute scrotal presentations?

A

Torsion

Hydrocele

Trauma

Epididymitis

Inguinal Hernia

Tumour

Vasculitis

Dermatological lesions

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

Describe torsion of the spermatic cord?

A

This presents with pain

Often seen at puberty

Can be caused by trauma or athletic injury although usually spontaneous

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

Symptoms of testicular torsion?

A

Sudden onset pain

May have nausea and vomiting

Pain referred to lower abdomen

High riding testis

Transverse lying testis

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

Investigations of suspected testicular torsion?

A

Doppler May be helpful

Exploratory

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

What happens if a testicular torsion is left untreated?

A

If not treated rapidly (within 4 hours) ischaemia of the testis and necrosis can occur

Results in removal

Infertility problems

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

Describe testicular appendage torsion?

A

Similar presentation to testicular (spermatic cord) torsion

Pain is more gradual

No vomiting or nausea

Pain in the superior pole of the testis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you determine between testicular spermatic cord torsion and testicular appendage torsion?

A

Spermatic Cord = Vomiting, Nausea

Appendage = No vomiting or nausea

Appendage = At superior pole

Spermatic Cord = Cremasteric reflx absent

Appendage = Cremasteric reflex present

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

Diagnosis?

  • Gradual onset testicular pain (over days)
  • No vomiting or nausea
  • Pain in superior pole
  • Cremasteric Reflex present
A

Testicular Appendage Torsion

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

Diagnosis?

  • Sudden onset testicular pain
  • Vomiting
  • Nausea
  • Cremasteric reflex absent
  • High riding testicle
  • Transverse lying testicle
A

Testicular Spermatic Cord Torsion

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

What is epididymitis?

Who is it seen in?

Cause?

A

Inflammation of the epididymis

Any age but rare in children

Usually caused by infection (History of UTI, STI, Catheterization)

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

Describe the presentation of epididmyitis?

A

Painful

Dysuria

Pyrexia

Similar to testicular torsion

Cremasteric Reflex present

Pyuria

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

Investigation of epididmyitis?

A

Urine sample (Pyuria)

Doppler - Swollen epididmyis, increased bloodflow

Urine Culture and Chalmydia PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of Epididmyitis?

A

Analgesia

Scrotal Support

Bed Rest

Ofloxacin 400mg/day for 14 days

24
Q

What is idiopathic scrotal oedema?

Is fever present?

Is pain present?

A

Oedema of the superficial layers of the testes

Presents as swelling and erythema of the scrotal wall

No fever

Often painless (maybe mildly tender)

Possibly itchiness

25
Q

Treatment of idiopathic scrotal oedema?

A

None

It is self limiting and will resolve in 3-5 days

26
Q

What is Paraphimosis?

A

Painfull swelling of the foreskin

Foreskin cannot be retracted back to its anatomical position over the glans of the penis

27
Q

What can cause paraphimosis?

A

Ofter after catherisation when foreskin is not replaced in the correct anatomical position

28
Q

Treatment of Paraphimosis?

A

Analgesia (Eg: Lidocaine)

Manual Reduction (With ice glove)

Needle Punctures in Oedmatous Skin

Dorsal Slit (Circumcision)

29
Q

Complications of paraphimosis?

A

There can be ischaemia to the glans of the penis leading to necrosis and requiring amputation

30
Q

What does this photo show?

A

Paraphimosis

31
Q

What is Priapism?

A

Persistent (<4hrs) and often painful erection of the penis

32
Q

Describe the presentation of priapism?

Common causes?

A

Prolonged erection

Pain

Caused by trauma, penile injection, idiopathic, neurological conditions, sickle cell anaemia

33
Q

What are the types of priapism?

Which is most common?

A

Ischaemic (Like compartment syndrome, venous stasis, very painful)

Non Ischaemic (Caused by trauma, unregulated blood flow)

Ischaemic is much more common

34
Q

Diagnosis of Priapism?

A

Aspiration of blood - dark blood with low O2 in iscahemic, red blood with normal O2 in non ischaemic

Colour duplex ultrasound

35
Q

Treatment of the different types of Priapism?

A

Ischaemic:

  • Aspiration (then saline irrigation)
  • Alpha Agonist Injection (Eg: Phenylephrine)
  • Surgical Shunt

Non Ischaemic;

  • May resolve spontaneously
36
Q

What is Fournier’s Gangrene?

A

This is a type of necrotizing fasciitis that affects the male genitalia

37
Q

Describe presentation in Fournier’s Gangrene?

A

Usually starts as cellulitis

Progresses to scrotal tenderness, swelling, dark purple areas

Pain out of proportion to systemic findings

38
Q

Cause of Fournier’s Gangrene?

A

Usually mixed anaerobes and aerobes

Mixed infection

39
Q

Diagnosis of Fournier’s Gangrene?

Treatment of Fournier’s Gangrene?

Mortality?

A

Plain X-Ray or Ultrasound

Treatment: Antibiotics and surgical debridement

About 20% - higher in diabetics and alcoholics

40
Q

What does this photo show?

A

Fournier’s Gangrene

41
Q

Describe Emphysematous Pyleonephritis?

Who is this seen in commonly?

A

Urological emergency

An acute necrotizing infection of the renal paranchyma that causes gas accumulation in the tissues

Seen in Diabetics

42
Q

Presentation of emphysematous pyleonephritis?

A

Fever

Vomiting

Nausea

Flank Pain

Ureteric Obstruction

Renal Impairment

43
Q

Diagnosis of Emphysematous Pyleonephritis?

A

Pyuria

Leukocytes

Infected urine

Gas on kidney, ureter and bladder X-Ray (KUB)

CT shows gas

44
Q

Treatment of emphysematous pyleonephritis?

A

IF PATIENT IS WELL ENOUGH

Fluid Resucitiation

IV Antibiotics (Ampicillin, Gentamicin, Metronidazole)

Stent

MOST PATIENTS:

Nephrectomy

45
Q

What does this photo show?

A

Gas in the kidney

Emphysematous Pyleonephritis

46
Q

Describe a perinephric abscess?

A

Urological emergency

Usually caused by a cortical abscess rupturing into the perinephric space

47
Q

Presentation of a perinephric abscess?

A

Pyrexia (Only present in 2/3rds)

Insidious Onset

Flank Mass in 50%

Pyuria

48
Q

Diagnosis of perinephric abscess?

Treatment of perinephric abscess?

A

CT

Antibiotics
Drainage

49
Q

Bladder injury is commonly associated with..?

A

Pelvic Fracture

50
Q

Describe presentation of bladder injury?

A

Suprapubic Pain

Inabiilty to void

Rigidity/Guarding

Haematuria

51
Q

Diagnosis of bladder injury?

Treatment?

A

CT Cytoscopy

Treatment:

Large bore catheter

Antibiotics

52
Q

Urethral injury is often associated with..?

A

Fracture of Pubic Rami

53
Q

Presentation of urethral injury?

A

Blood at meatus

Inability to urinate

Palpably full bladder

High Riding Prostate

Butterfly perineal haematoma

54
Q

Diagnosis of Urethral injury?

Treatment of urethral injury?

A

Diagnosis: Retrograde Urethrogram

Treatment: Suprapubic Catheter

55
Q

What does this photo suggest?

What is this called?

A

Urethral Injury

Butterfly Perineal Haematoma

56
Q

Describe a penile fracture presentation

When does this occur?

Treatment?

A

Popping sound followed by pain, discolouration and swelling

During sexual intercourse (penis slips out of vagina and hits pubis)

Prompt Exploration and repair

Circumcision incision with degloving (to explore properly)

57
Q

Presentation of testicular injury?

Diagnosis?

Treatment?

A

Intense pain and nausea

Swelling and bruising

Diagnosis: Ultrasound

Treatment: Early exploratory improves survival of testis and prevents necrosis

Renal (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions