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Renal SB > Haematuria and Urological Emergencies > Flashcards

Haematuria and Urological Emergencies Flashcards

1
Q

definition of haematuria

A

blood in the urine

- either microscopic or macroscopic

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2
Q

what is the diagnosis quota for haematuria

A

presence of 5 or more RBC per high-power field in 3 of 3 consecutive specimens obtained at least one week apart

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3
Q

what are the 2 categories of haematuria

A

visible/macroscopic/gross haematuria

non-visible/microscopic/dip-stick positive haematuria

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4
Q

what are the 2 categories of microscopic haematuria

A

symptomatic; hesitancy, frequency, urgency, dysuria
or
asymptomatic - incidental finding

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5
Q

what else can cause urine to be red that is not blood from urinary tract

A

Menstrual bleeding
Food - beetroot, blackberries, rhubarb
Myoglobin in urine - destruction of muscles, Crush syndrome
Drugs - Nitrofurantoin, Rifampicin, Chloroquine
Toxins - lead, mercury

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6
Q

what can cause brown coloured urine

A

urobilonogen in urine - hemolysis, liver dysfunction

porphyria

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7
Q

what can make people prone to bleeding

A

blood thinners - warfarin, heparin, aspirin

bleeding disorders

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8
Q

what percentage of people with frank haematuria will have cancer

A

20-30%

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9
Q

what percentage of people with microscopic haematuria will have cancer

A

asymptomatic + malignancy

- 2.6%

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10
Q

risk factors for malignancy

A 
smoking history
occupational exposure to chemical or dyes
Hx of gross haematuria
Age > 40
Hx of urological disorder/disease
Hx of irritative voiding symptoms
Hx of UTI
Analgesic abuse
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11
Q

common infections that can cause blood in the urine

A 
urethritis
prostatitis
cystitis
ureteritis
pyelonephritis 
glomerulonephritis
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12
Q

how can stones cause blood in the urine

A

kidney/ureter stones

on the way down can scratch mucous lining and cause bleeding

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13
Q

what Sx does renal tumour presents with

A

Haematuria - 50-60%
Pain - 40%
Kidney mass - 30-40%

Triad

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14
Q

how do tumours of urinary tract present

A

Haematuria - 75-85%
Retention of urine
Urinary irritative symptoms
Loin pain

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15
Q

what are the 2 types of cancers common in urology system

A

Renal Cell Carcinoma

Transition cell carcinoma

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16
Q

what is Sport haematuria

A

renal/bladder trauma from contact sports/running

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17
Q

what is the pathogenesis of sport haematuria

A

vasoconstriction of renal vessel
- hypoxic damage to nephrones

constriction of efferent glomerular arteriole
- increased filtration pressure

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18
Q

what is decompression haematuria

A

patient with retention, drained to quickly then some blood vessels with get broken and you get haematuria

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19
Q

what is pneumaturia

A

passage of gas mixed with urine, and may be as a result of a fistula between the bowel and the bladder
see bubbles in the urine

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20
Q

what is faecaluria

A

presence of fecal matter in the urine

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21
Q

What should be considered in the Hx of haematuria

A 
Trauma
Age
Gender
Nature of haematuria
Smoking
Occupation
Country
Urological Hx
FH of malignancy
Hx of bleeding disorders
Phenacetin abuse
Concomitant treatment e.g. Warfarin
Recent symptoms suggesting UTI
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22
Q

what can the nature of the blood in the urine appear

A

dark red with clots

fresh red blood

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23
Q

dark red with wormlike clots with colic loin pain - ?

A

hematuria is coming from upper urinary tract

- blood from kidney, down the ureter

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24
Q

what are the timing stages of bleeding and what can it suggest

A

initial/start of void - suggest bleeding is coming from urethra or prostate gland
terminal/end of void
total/throughout void

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25
Q

what is seen in Egypt land water that can cause urinary problems

A

schistosoma

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26
Q

what flower is seen in china and can cause urinary problems

A

Aristolochia

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27
Q

what drug can cause Transition cell cancer if abused

A

phenacetin

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28
Q

Ix of haematuria

A

urinalysis
culture and sensitivity
cytology

tenderness in abdo
mass in abdo
prostate exam

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29
Q 
frank haematuria
urinary uregency + frequency
smoker 
female - aged 24
sexually active
USS + cytology normal

Diagnosis

A

UTI

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30
Q 
frank haematuria
urinary uregency + frequency
smoker 
female - aged 40
paraplegic 
bladder stones 
USS + Cytology normal

Diagnosis

A

SCC in the bladder

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31
Q 
frank haematuria
urinary uregency + frequency
smoker 
female - aged 60
USS normal 
cytology suspicious
A

Cancer

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32
Q

what is acute urinary retensiont and what causes it commonly

A

inability to urinate with increasing pain

complication of BPH

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33
Q

what are precipitated/triggering events of acute urinary retention

A
  • non-prostate related surgery,
  • catheterization or urethral instrumentation
  • anaesthesia
  • medication with sympathomimetic or anticholinergic effects
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34
Q

Tx of acute urinary retention

A

Catheter

Alpha blocker - Tamsulosin

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35
Q

who gets post-obstructive diuresis (peeing more)

A

chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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36
Q

Mx of post-obstructive diuresis

A

monitor fluid balance
beware urine output > 200ml/hf
usually resolves in 24-48hrs
if severe IV fluid and sodium replacement

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37
Q

DDx of acute loin pain

A

Ureteric colic secondary to calculus

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38
Q

Tx of stones that do not require surgery

A

NSAID +/- opiate

Alpha-blocker (Tamsulosin) for small stone expected to pass

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39
Q

what are the sizes of stones that are likely to pass themselves and what size is not

A

6mm 21%

40
Q

at what point if a stone hasn’t passed then intervention is required

A

1 month

41
Q

what are indications to treat stones urgently

A

pain unrelieved
pyrexia
persistent nausea/vomiting
high-grade obstruction

42
Q

Tx for stones that require surgery

A

ureteric stent or stone fragmentation/removal if no infection

percutaneous nephrostomy for infected hydronephrosis

43
Q

what can cause frank haematuria

A 
Infection
Stones
Tumours
Benign prostatic hyperplasia (BPH)
Polycystic kidneys
Trauma
Coagulation/platelet deficiencies
44
Q

Ix for frank haematuria

A

CT urogram + cystoscopy

45
Q

what are acute causes of scrotum pain

A 
Torsion of spermatic cord
Torsion of appendix testis
Epididymitis / epididymo-orchitis
Inguinal hernia
Hydrocoele
Trauma / insect bite
Dermatological lesions
Inflammatory vasculitis
Tumour
46
Q

what are features of a torsion of spermatic cord

A
  • Most common at puberty
  • Can occur with trauma or athletic activity but usually spontaneous. Adolescent often woken from sleep

Usually sudden onset of pain, sometimes previous episodes of self-limiting pain
May be nausea/vomiting
May be referral of pain to lower abdomen

47
Q

Ix for torsion of spermatic cord

A

Doppler USS

48
Q

Tx for torsion of spermatic cord

A
  • Prompt exploration
  • 2 or 3-point fixation with fine non-absorbable sutures
  • If testis necrotic then remove
  • MUST fix contralateral side (bell clapper deformity)
49
Q

how long does it take necrosis to begin in torsion of spermatic cord

A

4 hours

50
Q

what is the ‘blue dot’ sign a sign for

A

torsion of appendage

51
Q

what is Epididymitis

A

inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm

52
Q

what does a Hx of epididymitis commonly

A

Dysuria / pyrexia more common

Hx of UTI, urethritis, catheterization/instrumentation

53
Q

Ix for Epididymitis

A

Doppler USS

send urine for culture + chlamydia PCR

54
Q

Tx for Epididymitis

A

Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

55
Q

Swelling, with no fever, mild tenderness and some pruritis the scrotal region - diagnosis?

A

idiopathic scrotal oedema

56
Q

what is paraphimosis and when does it happen

A

Painful swelling of the foreskin distal to a phimotic ring

Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position

57
Q

Tx for paraphimosis

A

Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin

Manual compression of glans with distal traction on oedematous foreskin

Dorsal slit

58
Q

what is priapism

A

Prolonged erection (> 4hrs), often painful and not associated with sexual arousal

59
Q

what can cause priapism

A 
Intracorporeal injection for ED, e.g. papaverine
Trauma (penile / perineal)
Haematologic dyscrasias e.g. sickle cell
Neurological conditions
Idiopathic
60
Q

what are the classifications of priapism

A

Ischaemic

Non-ischaemic

61
Q

what happens in ischaemic priapism

A

Vascular stasis in penis and decreased venous outflow, a true compartment syndrome.

corpus cavernosum is rigid and tender, penis often painful

62
Q

what happens in non-ischaemic priapism

A

Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora.

Fistula formation between cavernous artery and lacunar spaces allows blood to by-pass the normal helicine arteriolar bed

63
Q

Ix of priapism and what results would indicate what type of priapism

A

Aspirate blood from corpus cavernosum
– dark blood, low O2 , high CO2 in low-flow
- normal arterial blood in high-flow

Colour duplex USS

  • minimal or absent flow in cavernosal arteries in low-flow
  • normal to high flow in non-ischaemic priapism
64
Q

Tx of ischaemic priapism

A

Aspiration +/- irrigation with saline
Injection of alpha-agonist
Surgical shunt

65
Q

Tx of non-schaemic priapism

A

Observe, may resolve spontaneously

Selective arterial embolization with non-permanent materials

66
Q

what is Fournier’s gangrene

A

form of necrotizing fasciitis occurring about the male genitalia
Most commonly arises from skin, urethra or rectal region

67
Q

what are predisposing factors for Fournier’s gangrene

A

diabetes
local trauma
periurethral extravasation perianal infection

68
Q

how does Fournier’s gangrene first start

A

as cellulitis

  • swollen, erythematous, tender
  • marked pain, fever, systemic toxicity
69
Q

how does Fournier’s gangrene progressive

A

Swelling + crepitus of scrotum, dark purple areas

70
Q

Ix of Fournier’s gangrene

A

Plain X-ray or USS may confirm gas in tissues

71
Q

Tx of Fournier’s gangrene

A

Antibiotics and surgical debridement

72
Q

what is Emphysematous pyelonephritis

A

severe, necrotizing infection of the renal parenchyma

caused by gas-forming uropathogens, usually E coli

73
Q

how does Emphysematous pyelonephritis present and what is it associated with

A

fever, vomiting, flank pain

associated with diabetes and ureteric obstruction

74
Q

Ix of Emphysematous pyelonephritis

A

KUB - see gas

CT

75
Q

Tx of Emphysematous pyelonephritis

A

nephrectomy

76
Q

what causes a perinephric abscess

A

results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection

77
Q

features of perinephric abscess

A

high WCC
high serum creatinine
pyuria

78
Q

IX of perinephric abscess

A

CT

79
Q

Tx of perinephric abscess

A

Antibiotics + percutaneous or surgical drainage

80
Q

what are the 5 levels of renal trauma

A

I Haematoma, subcapsular, non-expanding, no parenchymal laceration

II Laceration 1cm depth, no collecting system rupture or extravasation

IV Laceration through cortex, medulla and collecting system
Main arterial/venous injury with contained haemorrhage

V Shattered kidney
Avulsion of hilum, devascularizing kidney

81
Q

what are indications for imaging in trauma

A

Frank haematuria in adult
Frank or occult haematuria in child
Occult haematuria + shock (systolic

82
Q

what is the gold standard Ix for kidney trauma

A

CT with contrast

83
Q

what is features of bladder injury and what is it associated with

A

Suprapubic/abdominal pain + inability to void
Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

Associated with pelvic fracture and catheterisation

84
Q

Ix for bladder injury

A

CT cystography

85
Q

how does an extraperitoneal injury appear in a contrast of the pelvis

A

as a flame-shaped collection

86
Q

Tx for bladder injury

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days

87
Q

how can the urethra be injured

A

fracture of pubic rami

88
Q

what is seen O/E to urethral injury

A 
Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate
Butterfly perineal haematoma
89
Q

what is Ix for urethral injury

A

retrograde urethrogram

90
Q

Tx of urethral injury

A

Suprapubic catheter

91
Q

MOI of penile fracture

A

happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis

Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling

92
Q

Tx for penile fracture

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

93
Q

presentation of testicular injury

A

presents with extremely pain and nausea

swelling/bruising variable

94
Q

Ix of testicular injury

A

USS

95
Q

when is early exploration/repair important in testicular injury

A

improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

Renal SB (15 decks)

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