Ross GUT Flashcards
Renal stones (renal colic) is often misdiagnosed as what?
AAA
What are signs of AAA that get confused with renal colic?
- Stones don’t usually present for the first time in people over the age of 60
- don’t usually present with hypotension
What are symptoms of renal colic?
flank pain that radiates to the groin or CV angle and lateral ab pain
Does renal colic produce rebound, guarding, or abdominal tenderness?
No
Risk factors for nephrolithiasis?
obesity, diabetics, gout, immobilization, family hx and inflammatory bowel disease
What is the imaging of choice for nephrolithiasis?
Non contrast CT
If we want to know about kidney function, what is the imaging of choice?
IVP
-Signs of a stone on IVP are delayed filling and dilation of the affected collecting system.
What are the two types of stones?
Calcium oxalate and phosphate
What is the mc site of a stone impaction?
Uteropelvic junction is the most common location of obstructed stone, the pelvic brim (ureter crosses the iliac vessels) and the uterovesical junction.
On CT, these are signs of what?
stranding of perinephric fat, hydronephrosis and nephromegaly
kidney stone
Stones greater than ____ mm are unlikely to pass on their own and will need a urology consult.
8
Basic tx for kidney stones?
IV lidocaine, nsaids and narcaotics
Also antiemetic (ondansteron) as well as IV hydration
T/F: You can have an increased leukocytosis w/ a stone without infection (look for a band shift)
True
Do you need to image uncomplicated nephrolithiasis?
If no infection, no hydronephrosis, normal Cr, then you can send the patient home with a f/u
What is a pregnant patient has stones? What imaging do you do?
Start with U/S then if hydro, do a low dose CT or MRI
Can you give NSAIDs to a pregnant woman with nephrolithiasis?
No
Anyone with an infected stone needs a ________ _____
urine culture
Treatment for infected stone?
Cefuroxime or FQ
UTI (positive UA) with a stone: infected stone treatment?
Cipro 500 mg PO x 14 days
What is medical expulsive therapy for kidney stones?
Stones that are larger than 6 mm can have trial of CCB (Nifedipine x 8 weeks) or Tamsulosin x 3 weeks
Fever, flank pain and + UA
pyelonephritis
You will see an increased _______ in urosepsis (infection in the urinary tract)
lactate
Treatment for pregnant woman with UTI?
Macrobid
Treatment for UTI if not pregnant?
FQ
What is the rule of 2 for pyelonephritis?
- 2 L of NS
- 2 g ceftriaxone
- 2 mg morphine
How long do you treat an uncomplicated UTI for?
3-5 days
How long do you treat pyelo for?
14 days
Tx for asymptomatic bacturia in pregnancy? (treat as UTI)
Macrobid or Keflex
This will transilluminate
hydrocele
Imaging for hydrocele?
U/S
Difference between epididymitis and orchitis?
Epididymitis is swelling or pain in the back of the testicle in the coiled tube (epididymis) that stores and carries sperm. Orchitis is swelling or pain in one or both testicles, usually from an infection or virus.
Imaging for epididymitis?
U/S
Treatment for epididymitis?
Ceftriaxone IM then doxy x 10 days
Treatment for a partner with epididymitis?
Floxacin (ofloxacin or levofloxacin)
How do we treat orchitis?
Same as epididymitis because often in conjunction
A patient presents with prostate bogginess and pain, what is the most likely dx?
acute prostatitis
Treatment for acute prostatitis?
Fluroquinolones
A patient >65 years old presents with painful urination, discharge from penis, and pain. What imaging should be done?
U/S for Epididymitis/epididymo-orchitis
In patients <35 who present with symptoms of Epididymitis/epididymo-orchitis what could be the cause and what test should you consider?
Gonorrhea/chlamidya and get a urine culture
A patient presents with discharge from penis, UA may be positive for wbc. What is the most likely diagnosis?
Urethritis: typically STI
Make sure to look for Herptic lesions.
Can be either gonococcal or non-gonococcal
A patient presents with perineal and or low back pain and fever. WHat is the first test you should do?
Urine culture
What is the tx for prostatitis?
Treat with fluoroquinolones or cephalosporins for more than 28 days.
painful inguinal mass + empty scrotum =
testicular torsion
14 yr old male presents with one hour of scrotal pain and vomiting. There is no fever or urinary sxs. On his exam his cremasteric reflex is absent and the painful testicle has a horizontal lie. What is the appropriate management?
Call urology and order U/S
With a testicular torsion, the cremasteric reflex is present or absent?
absent
What is a blue dot sign?
In testicular torsion- the ischemic necrotic appendix.
What are two RF of fournier’s gangrene?
diabetics and alcohol abusers
What lab is helpful to dx fournier’s gangrene?
Lactate level
Be suspicious of this when you see any bullae on the sctroum or groin intense pain associated with fever.
fournier’s gangrene
Imaging for fournier’s gangrene?
If stable a CT with contrast of abdomen and pelvis is the imaging modality of the initial assessment.
What is the tx for fournier’s gangrene?
Pip-taz IV or meropenem IV plus vanco
Addition to either regimen = ADD clindamycin IV
Foreskin pulled back and entrapping the glans.
Paraphimosis and entrapment
Treatment of paraphimosis and entrapment?
reduce it forward because can cause gangrene if not
prolonged erection of the penis that is usually painful. The persistent erection continues hours beyond or isn’t caused by sexual stimulation
Priapism
Non-invasive treatment for priapism?
Terbutaline PO or pseudoephedrine PO
If non-invasive tx for priapism doesn’t work (terbutaline or pseudoephedrine), what is the next step?
Injection of lidocaine and injection of epi or phenylepherine into the corpus cavernosum
What procedure needs to be done for a GU trauma?
Tears in the tunica albuginea and or corpus cavernosa are associated with direct blunt trauma. The problem is that these are often associated with urethral tears and will need a retrograde urethrogram (inject dye into the urethra and take xrays to see where it goes).
If you suspect a UTI in a neonate, what should you do?
Need to get a cath urine if can’t get a clean catch with a bag
