session 9 obstruction Flashcards
causes urinary obstruction
tumours of pelvis/ureter, strictures, calculus, blood clot, endometriosis, pregnancy
why does pregnancy cause obstruction
high levels of progesterone relax muscle fibres in renal pelvis and ureters and cause a functional obstruction
causes urinary retention
pelviureteric junction obstruction, pelvic masses, constipation, inflammation, tumours, neurogenic disorders
examples of neurogenic disorders causing urinary retention
cogenital abnormalities, external pressure on cord or lumbar nerve roots, trauma to spinal cord
acute urinary retention cause and presentation
painful inability to void, residual volume 300-1500ml. flare up BPH, strictures
chronic urinary retention cause and presentation
painless, may still void, RV 300-4000ml. BPH, neurological condition
how to manage acute urinary retention
catheterise and record residual volume, history, abdo genetalia and rectum exam, urine dip, U and E
how to treat acute urinary retention
alpha blockers for BPH, catheter
how to manage chronic urinary retention
catheterise and record residual volume, history, exam, urine dip, u and e
what is high pressure chronic urinary retention
kidney swells due to build up or urine. has abnormal U+E and hydronephrosis.
what can high pressure chronic urinary retention cause
permanent renal scarring. CKD, AKI
what is low pressure chronic urinary retention
normal renal function with no hydronephrosis. bladder is compliant but won’t empty
how to treat chronic urinary retention
long term catheterisation or intermittent self catheterisation
what is post obstructive diuresis
over diuresis of kidneys following catheterisation of bladder to treat urine retention. worsens AKI as excess water and ions are lost causing hypovolaemia
what is hydronephrosis
dilation of the renal pelvis and calyces due to obstruction at any point along urinary tract causing increased pressure and blockage.
cause of unilateral hydronephrosis
upper tract blockage
cause of bilateral hydronephrosis
lower tract blockage
consequences of hydronephrosis on kidney
progressive atrophy, GFR declines and if bilateral renal failure occurs
what does obstruction at pelviureteric junction cause
hydronephrosis
what does obstruction at ureter cause
hydroureter then hydronephrosis
what does obstruction at bladder neck cause
bladder distension with hypertrophy then hydrourteter then hydronephrosis
what is acute ureteric obstruction
calculus blocks the ureter, causes renal colic. normally unilateral
concequences acute ureteric obstruction
acute renal failure if bilateral, anuria/oliguria, pyonephrosis
pyonephrosis
infected obstructed kidney. causes death from sepsis and loss of renal function
what test tests for upper urinary tract obstruction
diuretic venography (MAG3)
how to drain upper urinary tract
nephrostomy, JJ stent
what is urolithiasis
urinary calculi.
risk factors urolithiasis
male, dehydrated, caucasion
3 most common places for urolithiasis
pelviureteric junction, pelvic brim, vesicoureteric junction
5 types of urinary calculi
calcium oxalate, calcium phosphate/calcium oxalate, magnesium ammonium phosphate, uric acid, cysteine
how do ureteric stones present
renal colic, sweaty, pale, restless, nausea, vomiting.
how do bladder stones present
strangury. urge to pass something that will not pass. untreatable UTIs. hematureia and renal failure
treatment urolithiasis
analgesia, fluid intake, ESWL, ureteroscopic destruction. PCNL, open surgery
what is acute prostatitis
infection of prostate.
causative organisms prostatitis
e coli, C. trachomatis, Neisseria gonorrhoea
symptoms prostatitis
soft, tender, enlarged prostate. malaise, rigours, fever. cannot pass urine, dysuria, perineal tenderness
what causes chronic prostatitis
inadequately treated infection.
how to diagnose chronic prostatitis
histology shows neutrophils, plasma cells and lymphocytes. positive culture
what is non bacterial prostatitis
enlargement of prostate due to C trachomatis affecting sexually active men
what does histology show non bacterial prostatitis
fibrosis and chronic inflammation
what is BPH
non-neoplastic enlargement of the prostate gland, leads to bladder outflow obstruction.
symptoms BPH
difficulty starting urination, poor stream, dribbling post micturition, frequency and nocturia
what does rectum feel like BPH
firm, smooth, rubbery
what an untreated BPH cause
acute urinary retention,
progressive bladder distension causing chronic painless retention and overflow incontenence,
bilateral upper tract obstruction and renal impairment causing CKD.
treatment BPH
a blockers to relax smooth muscle at bladder neck and in prostate.
finasteride (5a-reductase inhibitor) to prevent conversion of testosterone to androgen dihydrotestosterone.
