E-med- Urology Flashcards
Most common type of kidney stone
Calcium stone
Kidney stone
Inc urinary frequency
Dark urine
N/v
Colicky pain, radiating from flank to groin
Who to use US in when suspecting Kidney stone
Pregnant
Children
Previous hx of stones
What test to order for kidney stone in normal population (not prego or kid)
Non contrast CT
Kidney stone tx if stone is <5 mm (pencil eraser size)
Nothing
will often pass on its own
At what size will kidney stone probably NOT pass on its own?
Greater than 8 mm
Tx: Lithotripsy "shock wave" PCNL- nephrolithotomy- 1 cm incision Ureteroscopy Open surgery (limited)
Abnormal amount (too much) urine in the bladder =
> 100-150 mL
Tx of Urinary Retention- catheter
if blood clots:
then do Continuous Bladder Irrigation
Pt has urinary retention and the rest of these sx….
Delirium
Dilated pupils
Tachycardia
Hyperthermia
He prob took an Anticholinergic
With Acute Simple Cystitis, UA is often not needed.. i.e.. in
Non pregnant healthy females 18-45 yo
can have Clinical dx
When do you need to have UA to support simple bladder infection diagnosis
Back pain- looks sick immunocomp hx of multi course abx hx abx resistance hx multi drug allergies
Make sure these are on your ddx when diagnosing acute simple cystitis
Gonorrhea
Chlamydia
including: urethritis, cervicitis, PID
Labs of Acute Simple cystisis
Leukocyte esterase (pyuria) Nitrite (gram neg bacteria)
Tx for simple cystitis
Macrobid x 5d
Fosfomycin 3g single dose
Keflex x7d
Bactrim (but not if high E.Coli resistance)
WBC casts on Urinalysis
Pyelonephritis
Pyelonephritis “Kidney infection”
FluoroQ
Cipro 500 BID x7d
Levoflox 750 qd x 5d
Acute Prostatitis
Acute bacterial infection of the prostate
younger than 35: G/C
older than 35: E.Coli
Sx of Prostatitis
general- fever, chills, muscle aches
LBP, pain in RECTUM or PERINEUM
Urinary retention, Dysuria
What will you find on exam with Prostatitis
Tender abdomen and Perineal area
Tender, boggy prostate
What NOT to do with prostate exam in setting of Prostatitis
MASSAGE the prostate
Tx for Prostatitis
Bed rest, stool softener, hydrate
FluoroQ if older than 35
- Cipro
- Levo
Azithro and Rocephin if younger than 35 (tx for G/C)
SIRS criteria!!! 2 or more is positive test
Temp >100.4 or <96.8 WBC >12,000 or <4,000 (or >10% bands) Tachy >90 bpm Tachypnea >20
ED Hematuria, if gross or >3 RBC on UA
If abnormal vitals, abnormal labs, or pain…. FURTHER workup
Further imaging or Catheter
How long to treat Prostatitis (acute bacterial)
6 WEEKS
very long
Tx of Prostatitis in older men
Bactrim or
Cipro
Testicular torsion de-torsed by 6 hours
80-100% salvage rate
High riding testicle
Loss of cremasteric reflex
Testicular Torsion
Epididymitis
Retrograde spread of infected URINE down the Vas Deferens
Relieved w testicular elevation
Epididymitis -yes
Testicular torsion- no
Is Cremasteric reflex intact with Epididymitis?
Yes
with torsion, cremasteric reflex is not intact
Tx for Epididymitis
Bedrest Scrotal elevation w rest Abx Pain med Stool softener
Tx for Epididy that is most likely caused by G/C
Rocephin IM +
Doxy x10 days
Tx for Epididy caused by G/C
Rocephin and Doxy
Tx for Epididy in MSM
Rocephin + Levofloxacin (stronger) x10d
If Epididy is only caused by Enteric organism
Levofloxacin
Epididymitis
Relieved w elevation
Cremasteric reflex intact
Paraphimosis
Foreskin becomes retracted behind glans of penis and cannot be placed over glans
Tx of Paraphimosis
Push on glans- pull on foreskin
Sugar Lidocaine warp
Dorsal slit in foreskin
Priapism
Erection >4 hours
Priapism tx
Phenylephrine injected into corpora cavernosa
Fourniers gangrene
Staph
Strep
E Coli
Clostridium
Simple UTI
Tx w Macrobid
Any time you suspect Epididymitis, what MUST you perform?
Ultrasound!!!
Have to r/o Testicular Torsion
