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Foundations III > 6 Urologic Emergencies and Urolithiasis > Flashcards

6 Urologic Emergencies and Urolithiasis Flashcards

1
Q

What treatment woudl you give for your patient with obstructive stone with a fever?

A
  1. Drain (Nephrostomy tube, or ureteral stent)

2. IV antibiotics

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2
Q

Prehn’s Sign

A

elevation of the teste

if pain relief: + finding for epididymitis

if no pain relief: suggests testicular torsion

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3
Q

Fournier’s Gangrene

A

Necrotizing fasciitis of male genitalia and perineum

  • subcutaneous tissues
  • rapidly advancing
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4
Q

Fournier’s Gangrene: risk factors

A
  • Diabetes
  • Alcohol abuse
  • Immunocompromised
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5
Q

Fournier’s Gangrene: keys of the presentation

A
  • foul odor
  • fever
  • Gas in subcutaneous tissues (crepitus)***
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6
Q

Fournier’s Gangrene: Tx

A

IV antibiotics (aerobic and anerobic)

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7
Q

Priapism: duration

A

> 4 hours

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8
Q

Priapism: causes

A
  1. Sickle cell trait and disease
  2. Trazodone
  3. Cocaine
  4. ED drugs (ex. Papaverine/Prostaglandin E1/Phentolamine) (PDE-5 inhibitors)
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9
Q

Priapism: complications

A
  • ischemia/hypoxia
  • Progressive cavernosal fibrosis
  • ED
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10
Q

Priapism: TX

A

18 gauge needle into the corpus cavernosum –>aspirate!

  • Give phenylephrine
  • Last resort–>shunt
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11
Q

Which is an emergency: Paraphimosis or phimosis?

A

Paraphimosis because foreskin (prepuce) gets stuck proximal to the glans

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12
Q

Most common stone type?

A

calcium oxalate

  • radio-opaque
  • Resistant to dissolution
  • MCC is dehydration
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13
Q

Uric Acid stone

A
  • radiolucent
  • Forms in acidic urine <6
  • Dissolves readily if urine pH is increased (alkalinized)
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14
Q

Magnesium Ammonium phosphate (struvite, triple phosphate)

A
  • Caused by UTI
  • Radio-opaque
  • Forms in alkaline urine
  • Dissolved with acidification of the urine

(staghorn calculi)

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15
Q

Cystine Stones

A
  • Genetic defect: autosomal recessive

- Dissolves in alkaline environement

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16
Q

Matrix stones

A
  • caused by Proteus infection

- Radiolucent

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17
Q

Ammonium acid urate stone

A
  • Associated with UTI and laxative use

- Radiolucent

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18
Q

Protease inhibitor stone

A
  • HIV drug (ex. Indinavir)

- Radiolucent

19
Q

Name two substances that inhibit crystal formation?

A

Citrate (complexes with calcium)

Urea (increases solubility of uric acid)

20
Q

Medications causing Urolithiasis

A
  1. Vitamin C
  2. Vitamin D
  3. Triamterene (K+ sparing diuretic)
  4. Protease inhibitors
  5. Furosemide (increases urinary calcium excretion)
21
Q

Urolithiasis: presentation

A

Pain

  • Flank
  • Radiation
  • Colic (variable intensity, waves of intensity)
  • N/V
  • Hematuria
22
Q

Urolithiasis: Physical exam

A
  1. Fever
  2. Hyperkinetic
  3. CVA tenderness
23
Q

Stones smaller than _____ will be passable on their own

A

<5mm

24
Q

Name some treatment options for urolithiasis in the lower tract (bladder, urethra)

A
  1. Extracorporeal Shock Wave Lithotripsy
  2. Dissolve
  3. Cystourethroscopy/cystolitholapaxy
25
Q

Urolithiasis: candidates for passage

A
  • normal renal function
  • pain is controlled
  • Able to take things by mouth
  • No infection
26
Q

Treatment for stone passage

A
  1. Fluids by mouth
  2. Analgesics by mouth
  3. Alpha-blocker (ex. tamsulosin)
  4. Periodic imaging to assess for hydronephrosis
27
Q

If a patient has a uric acid stone, how much do you need to alkalinize the urine?

A
  • Sodium bicarb by mouth
  • Potassium citrate by mouth
  • pH needs to be greater than 6.5

(can take 3 months to work)

28
Q

How are Cystine stones dissolved

A

Alkalinize urine to above 7.5!

Potassium citrate by mouth

29
Q

How are struvite (calcium phosphate) stones dissolved

A

irrigation with acidic solution (Renacidin)

30
Q

Pros and Cons of Extracorporeal Shock Wave Lithotripsy

A

Pros: outpatient, non-invasive, sedation (not general anesthesia)

Cons: stone fragments are not removed

31
Q

Extracorporeal shock wave lithotripsy: contraindications

A
  • pregnancy
  • coagulopathy
  • UTI
  • Renal artery aneurysm
  • Abdominal aortic aneurysm

others:

  • cystine stones
  • chronic pancreatitis/pancreatic calcifications
  • distal obstruction
32
Q

What size must the stone be to use ESWL?

A

<2cm

also, must be visible on fluoroscopy

33
Q

How long is an ESWL done for and what else needs to be monitored?

A
  • Treatment for 60-90 minutes

- EKG (to avoid inducing dysrhythmias)

34
Q

Steinstrasse (urolithiasis complication)

A

“street of stones” largest stone falls to bottom and blocks exit of the smaller stones

35
Q

ESWL complications

A
  • renal hematoma
  • retroperitoneal hematoma
  • Steinstrasse
  • Pain
  • Ecchymosis
36
Q

Percutaneous Nephrolithotomy: indications

A

Large stone >2cm

37
Q

Prevention of future stones

A
  1. Fluid intake: urine volume 2500 mL/day
  2. Fluids with citrate
  3. No soda!
  4. Low animal protein
  5. Low sodium
  6. Low oxalate (beets, spinach, chocolate, liver, strawberries)
  7. Avoid high doses of Vitamin C and D
38
Q

To prevent future stones, reduce PRAL

A

PRAL - potential renal acid load

  • High PRAL lowers citrate in urine :(
  • Limit intake of cheese and egg yolks
39
Q

Name medications important in preventing future stones

A
  1. Potassium citrate
  2. Thiazide
  3. Allopurinol
  4. Pyridoxine (B6)
40
Q

Potassium citrate

A

corrects acidosis
-Decreases urinary calcium

Side effects: hyperkalemia, peptic ulcers

41
Q

Explain how Thiazides can help prevent future calcium stones

A
  • Correct acidosis

- Increases calcium reabsorption/decreases calcium excretion

42
Q

Explain how Pyridoxine (B6) helps prevent urolithiasis

A

Pyridoxine is involved in oxalate metabolism

43
Q

Explain how Cholestyramine helps prevent future stones

A

binds bile acids decreasing absorption of oxalate

44
Q

Thiols: Tiopronin and D-Penicillamine

A

treatment for cystinuria

Foundations III (34 decks)

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