Renal And Urological Emergincies Flashcards
Kidney stones - Renal colic
OVERVIEW:
Characterised by severe , sudden flank pain radiating to the groin.
PATHOPSYHIOLOGY:
Occurs due to obstruction of urine flow, typically by a kidney stone, leading to distension (hard and swollen, pulsating mass) and spasm of the ureter causing intense pain. Kidney stones form when minerals and salts in the urine crystalline and clump together, forming hard stones. This can lead to obstruction, causing swelling and pressure, leading to nausea and vomiting.
SYMPTOMS:
- intense pain in the side or back, below the ribs , that can radiate to the groin or testicle in men.
- Nausea and vomiting
- haematuria (blood in urine)
- Dysuria (painful urination)
- urinary frequency or urgency
- fever and chills (if infection is present)
- cloudy or foul smelling urine
- inability to lie still
TREATMENT:
NSAID’s and potentially morphine for pain relief
Most likely differential = leaking abdominal aortic aneurysm
RISK FACTORS:
Drug use
One kidney
Kidney failure
Dialysis
High dairy intake
ACUTE URINARY RETENTION
OVERVIEW:
- sudden inability to urinate, despite a full bladder , arises from either a blockage preventing urine flow or a failure of the bladder to contract strongly enough to expel urine.
CAUSES:
Men = Benign Prostatic Hyperplasia (BPH), prostate cancer , prostatic and prostatic abscess, penile trauma.
Women = Pelican mass, Bladder Prolapse , Vulvovaginitis , Post partum (period after child birth)
BOTH SEXES = renal colic, bladder cancer , MS , GI cancer ; UTI and STIs
DRUG RELATED =
Antichilinergics: Ipratropium and Chlorphenamine , NSAIDs and opiates
NEURO:
Disk prolapse, spinal abscess , spinal cord injury , Parkinson’s
SYMPTOMS:
- flank pain/costovertebral angle tenderness
- inability to micturate (urinate)
- symptoms of lower UTI
- Fever
- painful, palpable , sustained bladder - DULL TO PERCUSSION
- Men ~ urethral discharge
- women ~ Vaginal inflammation, Uterine prolapse, Pelvic mass.
- back pain, disk prolapse , cord compression
Paracetamol , potentially morphine for pain, antibiotics if caused by a UTI
Acute Kidney Injury
OVERVIEW/PATHOPHSYIOLOGY:
A sudden decline in kidney function , it can occur due to various factors including reduced blood flow (Ischaemia) , kidney damage, or urinary tract obstruction causing impaired filtration and waste removal.
CAUSES:
-hypovolaemia
-cardiac output such as heart failure , liver failure
- inflammation/blockage
-drugs such as NSAIDs and Diuretics
- specific kidney problems such as tumour or kidney stones
SYMPTOMS:
- reduced urine output
-Haematuria (urine in blood) - nausea and vomiting
- abdominal pain/ mild backache
- confusion
- hypertension
- Oedema - pulmonary or peripheral
Haematuria
Rarely immediate life threatening
But must be investigated
Causes: URI, renal colic . BHL, cancer , trauma
