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(LUSUMA) Urinary System > S10) Obstruction > Flashcards

S10) Obstruction Flashcards

1
Q

How can haematuria be detected in a patient?

A
  • Visible haematuria
  • Microscopic (3, 5 or 10 RBC’s)
  • Dipstick +ve
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2
Q

Provide a differential diagnosis for haematuria

A
  • Cancer: renal cell carcinoma, bladder cancer, advanced prostate carcinoma
  • Stones
  • Infection
  • Inflammation
  • BPH (large)
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3
Q

What are the causes of haematuria?

A
  • Vascular
  • Inflammatory
  • Trauma
  • Autoimmune
  • Medications
  • Infection
  • Neoplasia
  • Congenital
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4
Q

Describe the history one must take for a patient presenting with haematuria

A

Full urological history:

  • SQITARS
  • Presenting complaint
  • Past medical history
  • Drug history (OTC, prescription, illicit)
  • Social and family history
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5
Q

What examinations are undertaken for a patient presenting with haematuria?

A
  • Cystoscopy (look into bladder)
  • Urological examination (abdomen, genitalia, PR exam, neurology)
  • CT urography
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6
Q

What investigations are requested for a patient presenting with haematuria?

A
  • Urine microscopy, culture & sensitivity
  • Urine cytology
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7
Q

How can one manage a patient presenting with haematuria other than treating the underlying cause?

A
  • ABCDE + stabillise
  • Bloods
  • 3 way catheter and irrigation
  • CT angiogram (if significant bleed)
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8
Q

What are the different types of urinary retention?

A
  • Acute urinary retention (painful)
  • Chronic urinary retention (not painful)
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9
Q

How can one differentiate between acute and chronic urinary retention?

A

History, examination, clinical picture:

  • Acute – painful, impaired eGFR (urological emergency)
  • Chronic – non-painful, oliguria, urine in residual scan
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10
Q

Identify 4 circumstances when one should catheterise a patient?

A
  • Painful acute urinary retention
  • Acute on chronic urinary retention (unable to pass urine)
  • High pressure chronic urinary retention (Pves > 30cmH2O)
  • To monitor fluid balance, sepsis, trauma
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11
Q

Outline the clinical approach for a patient with urinary retention

A
  • History
  • Examination
  • Bloods
  • Bladder scan
  • Neurological documentation
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12
Q

What is the mechanism for urinary retention?

A

⇒ Bladder outlet obstruction

⇒ Low bladder contractile power

⇒ Interrupted sensory or motor innervation of bladder (± sphincter)

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13
Q

What are the causes of urinary retention in men and women respectively?

A
  • Men: BPH, prostate cancer, urethral stricture, prostatic infection
  • Women: prolapses, masses, Fowlers syndrome
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14
Q

What are the causes of urinary retention in both men and women?

A
  • Clots
  • Drugs (anticholinergics, sympathomimetics)
  • Pain
  • Spinal cord compression/injury
  • UTI
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15
Q

Describe how one treats patients presenting with urinary retention

A

Urethral catheterisation:

⇒ Clean the area

⇒ Use gloves and instillagel

⇒ Gently insert into urethral meatus (women) / into straight penis (men)

⇒ Inflate catheter balloon (& replace foreskin if retracted)

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16
Q

What difficulties patients can pose towards catheterisation?

A
  • Men: phimosis, meatal stenosis, stricture, prostate, bladder neck
  • Women: masses, prolapses, pelvic cancer
17
Q

What is a suprapubic catheter?

A

A suprapubic catheter is a catheter that is left in place and involves the insertion of the catheter into the bladder through a hole in the abdomen

18
Q

When are suprapubic catheters used?

A
  • Long term conditions e.g. multiple sclerosis
  • Urethra is damaged/blocked
  • Patients have difficulties using an intermittent catheter
19
Q

Identify 5 locations where stones can form in the urinary tract

A
  • Kidney
  • Ureter
  • Bladder
  • Prostate
  • Urethra (men – rare)
20
Q

What is ureteric colic?

A

Ureteric colic is severe and acute pain in the loin area due to the obstruction of the ureter by calculi

21
Q

How does ureteric colic present?

A
  • Pain
  • Haematuria
  • Infection
  • Impaired renal function (obstruction)
22
Q

Outline the clinical approach for a patient presenting with ureteric colic

A
  • History
  • Examination
  • Urinalysis
  • CT KUB (kidneys, ureter, bladder)
  • Abdominal X-ray (if visible stone)
23
Q

Symptoms and stone size guides treatment for uteric colic.

Regardless, outline the basic management

A
  • Place a stent
  • Uteroscopy
  • Lasertripsy
  • Stone ablation
24
Q

What is pyonephrosis?

A

- Pyonephrosis is the infection of the kidney which leads to pus in the upper collecting system which can progress to obstruction

  • It has a very high mortality if untreated
25
Q

What happens when a patient presents with acute sepsis?

A

Patients with infected obstructed upper tract need urgent stabilisation and decompression

26
Q

What are some emergency procedures used on patients with acute sepsis in the upper urinary tract?

A
  • Nephrostomy
  • Stenting

(LUSUMA) Urinary System (23 decks)

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