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URO > URGENTE > Flashcards

URGENTE Flashcards

1
Q

Retentie acuta de urina - def

A

imposibilitatea evacuarii VU prin mictiune

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2
Q

Retentie acuta de urina - mecanisme

A

obstructia traiectului de evacuare

disfunctionalitatea contractiei detrusorului

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3
Q

Retentie acuta de urina - cauze

A 
obstructii la nivelul colului VU, prostata, uretra
vezica neurogena (specifica femeilor)
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4
Q

Retentie acuta de urina - clinica

A

imperiozitate mictionala
durere suprapubiana (ac) (cr - nedureroasa)
imposibilitatea evacuarii VU
factori predispozanti
EO - VU dilatata dureroasa/nedureroasa, Pe matitate, poate ajunge pana la ombilic
TR

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5
Q

Retentie acuta de urina - US

A 
VU dilatata +/- identif cauza
ureterohidronefroza bilaterala (Cr)
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6
Q

Retentie acuta de urina - lab

A

ex urina
HLG
BUN, Cr

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7
Q

Retentie acuta de urina - ddx

A 
anurie obstructiva
ruptura VU
sarcina
fibroame uterine
chiste ovariene
peritonita blocata
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8
Q

Retentie acuta de urina - tratament

A

decompresia VU (progresiva - clampare 10 min la fiecare 500 ml -> previne hemoragia ex vacuo) prin cateterizare
cistostomie suprapubiana
! prevenirea sindromului de ridicare al obstacolului - diureza osmotica
rezolvarea cauzei

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9
Q

cistostomie suprapubiana - indicatii

A 
imposibilitatea cateterizarii transureterale
calea falsa urinara
ruptura uretrala, trauma pelvina
stenoza uretrei
protatita ac, abces prostatic
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10
Q

cistostomie suprapubiana - contraindicatii

A

chirurgie pelvina, bypass aorto-bifemural
anticoagulante, discrazii sanguine
tumori VU
hematurie in cantitate mare

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11
Q

hematuria - def

A

prezenta RBC in urina

micro/macroscopica

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12
Q

hematurie - cauze uro inalte

A

tu renale, uroteliale
litiaza reno-ureterala
necroza papilara, HN congenitala, chiste renale, PCKD, anomalii vasculare

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13
Q

hematurie - cauze uro joase

A

tu VU, litiaza vezicala
cistita hemoragica (virala, rad, chimioterapie, bilharioza, supradistensia vu neurologice)
HBP, cancer prostata
hematuria ex vacuo

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14
Q

hematurie - alte cauze uro

A 
infectii urinare nespecifice (PN, cistita, prostatita)
TBC urinar
traumatism
hematurie de efort
supradozare anticoagulante
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15
Q

ddx - pseudohematuria

A

contaminare - hemoragie uretrala (intermictionala), menstruatie, hematospermie
medicamente - ibuprofen, nitrofurantoin, sulfametoxazol, fenitoina, rifampicina, fenolftaleina
alimente - sfecla rosie
bandeleta urinara FP - hemoglobinurie, mioglobinurie, contaminare cu betadina

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16
Q

hematurie - clinc

A

FR tumora uroteliala
semne si simptome de TUI, TUS
sindrom de impregnare maligna

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17
Q

hematurie - localizare

A

initiala - uretra
terminala - trigon vezical
continua - renala, ureterala, VU

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18
Q

hematurie - paraclinic

A

parametrii hemodinamici
gr sg, rh, hlg + plt, coagulograma
bun, cr
ex microscopic urina - > 5 RBC/mm3, urocultura, citologie urinara
imagistic (US, Rx abd, urografie iv, cistoscopie, CT)

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19
Q

hematurie - masuri de urgenta

A

anemie acuta severa, soc hipovolemic -> reech volemica, transfuzie
retentie urinara acuta cu cheaguri -> cateter Foley cu 3 lumene, evacuare cheaguri, lavaj vezical continuu

20
Q

hematurie - tratament

A 
cateter Foley cu 3 lumene
lavaj vezical continuu
reech volemica
corectarea coagulopatiei
hemostaza endoscopica/ ligatura iliacei interne/ cistectomia de salvare
rezolvarea cauzei
21
Q

colica renala - def

A

durere colicativa cauzata de obstructia acuta a tractului urinar superior

22
Q

colica renala - etio

A

litiaza reno-ureterala
alte cauze - sdr de jonctiune uretero-pelvica, invazie tumorala, compresiune, fibroza retroperitoneala, cheag, pasaj fragment tumoral, corpi straini

23
Q

colica renala - clinic

A

durere cu debut brusc, caracter paroxistic (exacerbari si remisii), localizare lombara cu iradiere spre OGE
+ simptome digestive (greturi, varsaturi)
+ simptome urinare (polakiurie, imperiozitate, hematuria)

24
Q

colica renala - EO

A

dificil
contractura abd -> ddx cu peritonita
orificii herniare -> ddx cu herniile strangulate
TA crescuta -> infarct visceral

25
Q

colica renala - paraclinic

A

sumar urina, sediment - hematurie, leucocite, cristalurie

hlg, ionograma, bun, cr

26
Q

colica renala - ddx cu durere de origine extrarenala

A

afectare musculo-vertebrala
colica biliara, colecistita acuta
pancreatita acuta
apendicita acuta, ulcer peptic, diverticulita colonica, ocluzie intest
torsiune testiculara/ovarian, chist ovarian rupt, sarcina ectopica, epididimita acuta
afectiuni CV

27
Q

colica renala - ddx cu durerea de origine renala

A 
reflux V-U, tumora renala cu hrg intratu
chist renal simptomatic/infectat
PCKD cu hrg intrachistica
PNA
abces perirenal
embolie de a renala
tromboza de v renala
28
Q

colica renala - dg

A

US - HN
Rx abd - calculi
CT nativ - de prima intentie

29
Q

grade HN

A

1 - dilatatia pelvisului renal
2 - pelvis moderat dilatat, cateva calice vizibile
3 - aproape toate calicele viz, pelvis largit
4 - aproape toate calicele viz, parenchim subtiat/atrofiat

30
Q

colica renala - complicatii

A 
colica renala rebela
febrila -> PNA obstructiva
IRA obstructiva (bilat/ unilat pe rinichi unic)
intoleranta digestiva marcata
=> INTERNARE!
31
Q

colica renala - tratament

A

masuri gen - restrictie fluide, Q locala
medicatie - AINS (diclofenac, indometacin), antispastice, analgezice, alfa-bloc +/- ATB
indepartarea obstructiei
- !urgenta (hiperalgie, febra, anurie obstructiva) -> stent ureteral, nefrostomie
- ureteroscopie cu litotripsie, eswl (litotripsie extracorporeala cu unde de soc), nefrolitomie percutana (nlp), interventie chirurgicala scopica/clasica
! calculii <5mm se elimina spontan (80%)

32
Q

anuria obstructiva - def

A

absenta urinarii datorita obstructiei urinare bilaterale/ unilaterale pe rinichi unic => ureterohidronefroza bilaterala + VU goala

33
Q

anurie obstructiva - etio

A

comun - litiaza, cancere pelviene invazive, fibroza retroperitoneala, post radioterapie
altele - fibroza retroperitoneala idiopatica, sdr de jonct pielo-ureter, tu retroperitoneale bilat

34
Q

anurie obstructiva - clinic

A

absenta mictiunilor >12h, VU goala
colica lombara uni/bilaterala
febra, frisoane
greturi, varsaturi, stare gen alt, dispnee, HTA, aritmii

35
Q

anurie obstructiva - investigatii

A

lab - bun, cr, ionograma, hlg, astrup
US - HN/ UHN bilat
Rx abd - calculi opaci
CT

36
Q

anurie obstructiva - ddx

A

retentie acuta de urina
anurie prerenala
anurie renala

37
Q

anurie obstructie - complicatii

A

urosepsis
EPA
aritmii cardiace

38
Q

anurie obstructiva - trat ob

A

corectarea dezechilibrelor metabolice
drenaj urinar
tratament etiologic

39
Q

hemodializa de urgenta - indicatii

A

K+ > 7,5 mmol/l
acidoza metabolica <7,15
hiperhidratare cu semne de EPA

40
Q

anurie obstructiva - tratament

A

dezobstructie de urgenta - stent, nefrostomie percutana, ureteroscopie
tratament etio - al doilea timp

41
Q

torsiune de testicul - def

A

rotatia testiculului in jurul cordonului spermatic cu ischemie
reversibil -> 6h

42
Q

torsiune de testicul - etio

A

absenta/ laxitatea elementelor de fixare testiculara

43
Q

torsiune de testicul - clinic

A

durere scrotala cu debut brutal, iradiere inghinala si lombara, greata, varsaturi
debut in repaus, app de durere similare (torsiuni intermitente)
fara febra, simptome de TUi

44
Q

torsiune de testicul - eo

A

12-16 ani
cresterea in volum a scrotului, semne celsiene
palpare foarte dureroasa, epididim anterior, cordon spermatic ingrosat, sensibil
testicul ascensionat, retractat inspre inelul inghinal, orizontal

45
Q

torsiune de testicul - us

A

doppler - absenta vascularizatie

crestere dimensiuni

46
Q

torsiune de testicul - ddx

A 
epididimita, orhiepididimita acuta
varicocel simptomatic
traumatism testicular
hernie strangulata inghino-scrotal
colica renala
47
Q

torsiune de testicul - tratament

A

chir - descalcirea cordonului spermatic, testarea viabilitatii

  • sutura testiculului la scrot/orhiectomie
  • orhidopexie contralat profilactica

URO (4 decks)

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