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Therapeutics II > GU emergencies > Flashcards

GU emergencies Flashcards

1
Q

what is the most common urologic emergency

A
  • acute urinary retention
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2
Q

acute urinary retention

A
  • inability to voluntarily pass urine
  • either acute or chronic
  • men > women
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3
Q

when does the brain normally signal to void?

A
  • 200-300 cc of urine
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4
Q

common drug causes of acute urinary retention

A
  • narcotics
  • diphenhydramine
  • pseudoephedrine
  • oxybutynin/detrol- anticholinergics for OAB
  • ETOH ingestion
  • anesthesia
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5
Q

common causes of acute urinary retention in men

A
  • BPH/ prostatitis
  • carcinoma of prostate
  • urethral stricture
  • prostatic abscess
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6
Q

common causes of acute urinary retention in women

A
  • pelvic prolapse
  • urethral stricture
  • urethral diverticulum
  • post op
  • pelvic mass
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7
Q

common causes of acute urinary retention in general

A
  • clot retention
  • drugs
  • pain
  • nerve damage
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8
Q

acute urinary retention treatment

A
  • urethral catheterization
  • suprapubic cath if foley cath cannot be placed
  • send urine for UA and culture
  • check serum Cr to r/o serious obstructive uropathy
  • ALL pts need f/u with urology in 3-7 days for voiding trial
  • treat underlying cause
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9
Q

post obstructive diuresis

A
  • excessive loss of water and salt in urine after urinary obstruction is relieved
  • usually occurs within 24 hours
  • results in dehydration, electrolyte imbalance, hypovolemic shock, death
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10
Q

pts at risk of post obstructive diuresis

A
  • renal insufficiency
  • heart failure
  • evidence of volume overload
  • CNS depression
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11
Q

treatment for post obstructive diuresis

A
  • monitor serum and urine electrolytes
  • monitor urine osmolality
  • if urine Na > 40, suggests renal tubular injury
  • measure strict ins and outs
  • IVF 75% of cc/hour rate of diuresis
  • ok to eat and drink
  • likely need longer time before attempted voiding trial
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12
Q

what are alpha 1 blockers used for

A
  • BPH
  • incomplete bladder emptying
  • acute urinary retention
  • generally relax smooth muscle of GU sys within 72 hours
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13
Q

ADRs of alpha 1 blockers

A
  • dizziness
  • orthostatic hypotension
  • tamsulosin has higher risk ejaculatory dysfunction
  • terazosin and doxazosin interact with ED meds
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14
Q

5 alpha reductase inhibitors

A
  • shrink size of prostate over a 6 mo period
  • no indication in acute urinary retention
  • reduces need for prostate surgery
  • reduce PSA levels by 50%- caution if monitoring levels
  • finasteride* and dutasteride
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15
Q

ADRs of 5 alpha reductase inhibitors

A
  • reduced sex drive
  • difficulty with erection or ejaculation
  • sx of depression
  • sx not super common
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16
Q

nephrolithiasis

A
  • presence of crystalline stones in GU sys

- almost always originate in kidney then travel down ureter and bladder

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17
Q

risk factors for nephrolithiasis

A
  • previous stones
  • male gender
  • high protein
  • high salt
  • obese
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18
Q

work up for nephrolithiasis

A
  • labs
  • KUB xray- cant dx uric acid stones
  • renal US- not sensitive for ureteral stones
  • gold std= CT without contrast
  • IV pyelograms and spot urine for cystine not often used
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19
Q

pain for ureteropelvic junction stone

A
  • mild to severe deep flank pain

- without radiation to groin

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20
Q

pain for ureteral stone

A
  • abrupt onset colicky pain in flank and ipsilateral lower abdomen
  • may radiate to testicles/ vulvar area
  • nausea
21
Q

pain for mid ureteral stone

A
  • pain radiates anteriorly
  • on right may mimic appendicitis
  • on left may mimic diverticultis
22
Q

pain for distal ureter and ureterovesicular junction stones

A
  • pain radiates to groin

- may have cystitis sx

23
Q

types of stones

A
  • calcium oxalate
  • uric acid
  • struvite stones (staghorn calculi)
24
Q

calcium oxalate stones

A
  • most common

- risk factors= dehydration, hypercalciuria, hyperoxaluria

25
Q

uric acid stones

A
  • highly acidic urine- pH< 5.5
  • persistent metabolic acidosis
  • hyperuricemia leading to hperuricosuria
26
Q

struvite stones

A
  • aka staghorn calculi
  • due to bacteria proteus
  • usually found after recurrent UTI from proteus infections
27
Q

conservative therapy for stones

A
  • attempt to shorten duration of time to pass stone
  • alpha blockers
  • analgesics
  • LOTS of fluids- 2L per day
  • strain urine and send stone for analysis
  • if pt has UTI then treat with abx
28
Q

types of intervetions for stones

A
  • dissolve uric acid stones with potassium citrate
  • extracorporeal shock wave lithotripsy (ESWL)
  • ureteroscopy and laser lithotripsy
  • percutaneous nephrolithotripsy
29
Q

extracorporeal shock wave lithotripsy

A
  • for stones < 3 cm
  • shock wave sent through flank breaks up stones
  • pass stone fragments
30
Q

ureteroscopy and laser lithotripsy

A
  • cystoscopy into ureter
  • break up stone with laser
  • extract pieces and place stent
  • usually for stones in middle of ureter
31
Q

percutaneous nephrolithotripsy

A
  • for large kidney staghorn calculi

- direct entry into kidney at CVA

32
Q

who needs urgent intervention for kidney stones

A
  • stone with urinary obstruction
  • si of infection/ sepsis
  • renal deterioration
  • bilat hydronephrosis
  • intractable nausea and vomiting
  • pain refractory to analgesics
  • stone in solitary kidney
33
Q

what stones have the highest morbidity and mortality?

A
  • urinary tract obstruction + upper urinary infection
34
Q

management of stones with signs of infection or bilat obstruction

A
  • STAT urology consult
  • NPO, IVF, pain meds
  • urology does cystoscopy and ureteroscopy to place stent
  • **DO NOT want to break up stone- will release bacteria and worsen sx
35
Q

preventing future kidney stones

A
  • increase fluid intake
  • low salt diet
  • moderate animal protein
  • moderate calcium
  • increase dietary citrate
  • 2 tbsp pure lemon juice a day
36
Q

fournier’s gangrene

A
  • polymicrobial necrotizing fasciitis of perineum and genitalia
  • 10X more common in men
  • risk in diabetics/ immunocomp
  • high mortality rates
37
Q

GU exam findings for fournier’s gangrene

A
  • erythema that extends towards bilat inner thighs
  • edematous scrotum
  • tender
  • odor
  • necrosis on penile shaft and scrotum
  • no active drainage
38
Q

etiology of fournier’s gangrene

A
  • mucosal breakdown in urethra or colon
  • perineal or genital skin infx
  • urethral stricture
  • trauma
  • iatrogenic
  • paraphimosis
  • septic abortion
  • STI
39
Q

how many organisms do you usually find for fournier’s gangrene

A
  • usually at least 3
40
Q

diagnosis of fournier’s gangrene

A
  • clinical dx
  • need surgical consult STAT
  • 100% mortality if tx with abx only
  • imaging may be needed in atypical presentation
41
Q

treatment for fournier’s gangrene

A
  • debridement- avg of 3.5 surgical interventions per pt
  • hemodynamic stabilization with IVF
  • abx- zosyn + vanco + clinda
  • plastics consult
42
Q

urological emergencies

A
  • testicular torsion
  • priapism
  • paraphimosis
  • penile fx
  • bilateral hydronephrosis
  • acute urinary retention
  • fournier’s gangrene
43
Q

testicular torsion

A
  • twisting of spermatic cord -> venous occulsion and engorgement
  • usually 720 degrees of twisting
  • common in young men and kids
44
Q

sx of testicular torsion

A
  • rapid onset severe pain from trauma, physical activity, or nothing
  • 12-24 hours whole scrotum appears as confluent mass
  • afebrile
  • no voiding sx
  • normal UA and WBC
45
Q

PE for testicular torsion

A
  • high riding testicle
  • absent cremasteric reflex
  • get US to confirm dx
46
Q

treatment for testicular torsion

A
  • urology consult- vascular emergency

- good prognosis if treated within 4-6 hours of pain

47
Q

paraphimosis

A
  • foreskin of uncircumcised male becomes retracted behind glans penis
  • venous and lymphatic outflow obstructed -> necrosis, gangrene, autoamputation
48
Q

treatment for paraphimosis

A
  • pain control
  • topical lidocaine
  • NO epi
  • urology consult for manual reduction

Therapeutics II (8 decks)

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