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RENAL > Urinary Emergencies > Flashcards

Urinary Emergencies Flashcards

1
Q

What is Acute Urinary Retention and what is it often a complication of?

A

Inability to urinate
with increasing pain on peeing

Complication of BPH

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2
Q

What can precipitate urinary retention?

A
  • non-prostate related surgery
  • catheterisation
  • urethral anaesthesia
  • medication with sympathetic/anticholinergic effects (blocks ACh)
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3
Q

How is urinary retention treated when a patient is admitted?

A

catheterisation

Can also do a “Trial without a Catheter” in the same admission if:

  • painful retention
  • < 1 litre residue
  • serum electrolytes normal
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4
Q

What can improve the chance of voiding in a trial without a catheter?

A

introduction of alpha blocker drugs beforehand

e.g. Alfuzosin, Tamsulosin

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5
Q

What is a Post-obstructive diuresis and why does it occur?

A

excessive passing of urine after removal of a

chronic bladder outflow obstruction

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6
Q

Why is excessive urine passed in post obstructive diuresis?

A
  • retained urea, sodium and water

AND defect in concentrating ability of kidney

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7
Q

Why should urine output be monitored regularly in post-obstructive diuresis?

A

If urine output > 200ml/hr

Pt may require IV fluid and sodium replacement

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8
Q

What differential diagnosis should you always consider in acute loin pain?

A

Leaking AAA

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9
Q

What mediates the pain in a ureteric obstruction caused by a calculus?

A

prostaglandins released by ureter to say it is obstructed

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10
Q

What treatment can be given for renal stones which are causing acute loin pain?

A
  • NSAID +/- opiate

- alpha-blocker (Tamsulosin) for small stones that are expected to pass

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11
Q

Under what size are most renal stones expected to pass?

A

<4mm

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12
Q

After what length of time will a stone require intervention if it has not been passed?

A

1 month

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13
Q

What type of scan is best to view renal calculi and is therefore the most diagnostic?

A

Non-contrast CT

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14
Q

What symptoms would indicate that the renal stone should be treated urgently?

A
  • Pain unrelieved
  • Pyrexia
  • Persistent nausea/vomiting
  • High-grade obstruction
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15
Q

How are renal stones removed urgently?

A
  • ureteric stent to allow them to pass more easily
  • stone fragmentation (to make them smaller)
  • percutaneous nephrostomy for infected hydronephrosis
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16
Q

What can cause macroscopic or FRANK haematuria?

A
  • Infection
  • Stones
  • Tumours
  • BPH
  • Polycystic kidneys
  • Trauma
  • Coagulation/platelet deficiencies
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17
Q

How can a clot be removed if it is the cause of frank haematuria?

A

3 way irrigating haematuria catheter
- stiffer than normal catheter
=> can withstand the suction which aims to remove the clot

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18
Q

What investigations can be used in frank haematuria?

A

CT urogram

cystoscopy

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19
Q

Who usually suffers from testicular torsion and what can predispose to this?

A

Most common at puberty
Can occur after trauma or athletic activity
Teen often woken from sleep in pain

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20
Q

What is the normal presenting complaint in testicular torsion?

A
  • Sudden onset of pain
  • sometimes previous episodes of self-limiting pain
  • nausea/vomiting
  • Referral of pain to lower abdomen
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21
Q

What is usually found on examination of a patient with testicular torsion?

A
  • Testis high in scrotum
  • Lie transversely
  • absence of cremasteric reflex
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22
Q

What is the cremasteric reflex?

A

Stroking of the skin of the inner thigh causes the cremaster muscle to contract and pull the testicle up toward the inguinal canal on the same side

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23
Q

What complications of testicular torsion can make it difficult to visualise and obliterate landmarks?

A

Acute hydrocoele

oedema

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24
Q

What investigation can be used to visualise the blood supply to the testis believed to be affected?

A

Doppler USS

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25
Q

When treating testicular torsion, both sides require fixation, even if this has not occurred bilaterally. TRUE/FALSE?

A

TRUE

don’t want to risk it occurring on the opposite side

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26
Q

What is Bell Clapper Deformity?

A

Both testes lie transversely

=> predisposing the patient to torsion

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27
Q

What is Torsion of an appendage?

A

Torsion of an appendix on the testis
Appendages are common but have no function
Torsion of an appendage can still be very painful

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28
Q

Torsion of an appendage can present very similarly to torsion of the testes themselves. TRUE/FALSE?

A

TRUE

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29
Q

If appendage torsion is caught early, how may it present?

A

localised tenderness at upper pole

“blue dot” sign

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30
Q

How can a testicular and appendage torsion be differentiated?

A

Appendage torsion involves mobile testis and intact cremasteric reflex

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31
Q

Torsion of an appendage can resolve spontaneously without surgery. TRUE/FALSE?

32
Q

What rare condition presents in a similar way to testicular torsion?

A

epididymitis

33
Q

How do the presentations of testicular torsion and epididymitis differ?

A

Epididymitis usually also present with:

  • Dysuria (pain on peeing)
  • pyrexia

Hx of STI/ UTI/ catheterisation

34
Q

What investigations may be used to diagnose epididymitis?

A

Doppler

  • swollen epididymis
  • increased blood flow

Send urine for culture + Chlamydia PCR (STI causes)

35
Q

What treatment can be given in epididymitis?

A

Analgesia + scrotal support
bed rest

If STI is the cause: Ofloxacin 400mg/day for 14 days
If UTI is the cause: Ciprofloxacin or Trimethoprim in some cases

36
Q

Idiopathic scrotal oedema is NOT usually associated with any erythema. TRUE/FALSE?

A

TRUE

does not really cause any additional symptoms except sometimes itching

37
Q

What is a paraphimosis?

A
  • Painful swelling of the foreskin distal to a phimotic ring

- Happens after foreskin retracted and not replaced into its natural position (e.g. catheterisation)

38
Q

How can a paraphimosis be treated?

A
  • Ice
  • sugar (to draw fluid out by osmosis)
  • multiple punctures in oedematous skin to let fluid out
  • Manual compression of glans to force fluid out
  • Dorsal slit to relieve pressure
39
Q

What is priapism?

A
  • prolonged erection (> 4hrs)
  • painful
  • not associated with sexual arousal
40
Q

What can cause priapism?

A 
Intracorporeal injection for Erectile Dysfunction (no longer a Tx option)
Trauma (penile or perineal)
Sickle cell
Neurological conditions
Idiopathic
41
Q

Describe the difference between ischaemic and non-ischaemic priapism?

A

Ischaemic (veno-occlusive or LOW-FLOW)

Vascular stasis in penis and decreased venous outflow
=> COMPARTMENT SYNDROME
=> Corpora cavernosa are rigid and tender

Non-ischaemic (arterial or HIGH-FLOW)
Trauma disrupts penile blood vessels
=> unregulated blood entry (too much)

42
Q

How can ischaemic/non-ischaemic priapism be diagnosed?

A

Blood aspirate - dark blood = low O2 => LOW FLOW => ischaemic

Colour duplex US - minimal/ absent blood flow => LOW-FLOW

43
Q

How is ischaemic priapism treated?

A
  • Aspiration +/- irrigation with saline
  • Injection of alpha-agonist to reduce inflow
  • Surgical shunt
44
Q

What can be considered if ischaemic priapism has presented extremely late?

A

immediate placement of a penile prosthesis

45
Q

If non-ischaemic priapism does not respond spontaneously, what treaments can be used?

A

Selective arterial embolization

46
Q

What is Fournier’s Gangrene?

A

necrotizing fasciitis occurring about the male genitalia

Usually skin in the urethra or rectal region

47
Q

Who is predisposed to fournier’s gangrene?

A
  • diabetes
  • local trauma
  • perianal infection
48
Q

What type of microbes are found in Fournier’s gangrene?

A
  • mixture of aerobes/anaerobes
49
Q

What local signs are significatn indications of Fournier’s Gangrene?

A

Swelling + crepitus of scrotum (gas)
dark purple areas
marked toxicity out of proportion to the local findings

50
Q

What do investigations of Fournier’s gangrene show?

A

Plain X-ray or US may confirm gas in tissues

51
Q

What is used to Treat Fournier’s Gangrene?

A

Antibiotics and surgical debridement

52
Q

What is the mortality rate for Fournier’s gangrene?

A

20%

but higher if diabetic/alcoholic

53
Q

Is Emphysematous pyelonephritis an infective emergency?

54
Q

What is Emphysematous pyelonephritis?

A

acute necrotizing parenchymal and peri-renal infection

caused by gas-forming uropathogens,
- usually E coli

55
Q

What other conditions is Emphysematous pyelonephritis linked to?

A

Usually occurs in diabetics

Often associated with ureteric obstruction

56
Q

What three main symptoms do patients experience in emphysematous pyeonephritis?

A

Fever, vomiting, flank pain

57
Q

What causes a perinephric abscess?

A
  • rupture of acute cortex abscess into the perinephric space
    OR
  • infection travelled in the bloodstream to site
58
Q

How should a perinephric abscess be investigated and treated?

A

Ix: CT
Tx: Antibiotics + percutaneous/surgical drainage

59
Q

Describe the progression of renal trauma classifications

A

Classifications 1-5

Stage 1 = subcapsular haematoma

Stage 3 = no rupture into collecting system

Stage 5 = Shattered kidney and Avulsion of hilum

60
Q

What indicates imaging is required in renal trauma?

A
  • Macroscopic haematuria in adult
  • Macroscopic OR occult haematuria in child
  • Occult haematuria + shock (systolic <90mmHg)
  • Penetrating injury with any degree of haematuria
61
Q

How are blunt renal injuries managed non-operatively?

A

angiography

embolization

62
Q

When is surgery required in renal/urological trauma?

A

Persistent renal bleeding
expanding perirenal haematoma
pulsatile perirenal haematoma

63
Q

Bladder injuries are commonly caused by what other trauma?

A

pelvic fracture

64
Q

What are the main presenting complaint in bladder injury?

A

Suprapubic/abdominal pain + inability to void

65
Q

Catheterisation after a bladder injury usually results in gross haematuria. TRUE/FALSE?

A

TRUE

some catheters wont go in due to urethral injury

66
Q

If a catheter cannot be passed in easily after a bladder injury, what must you do first?

A

retrograde urethrogram – may well have urethral injury

67
Q

What sign shows an extraperitoneal injury on a CT scan?

A

flame-shaped collection of contrast in pelvis

68
Q

How is a bladder injury treated?

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days

69
Q

What reasons would warrant immediate repair of a bladder injury?

A 
Intraperitoneal injury
Bladder neck injury
Rectal or vaginal injury
Open pelvic fracture
Bone fragments projecting into bladder
70
Q

Fracture of the pubic rami can cause what structure to be damaged?

A

Posterior urethral injury

71
Q

How does a posterior urethral injury usually present?

A 
Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate
Butterfly perineal haematoma
72
Q

What investigations and treatment should be completed in a posterior urethral injury?

A

Retrograde urethrogram

Suprapubic catheter (as urethra is injured)
- Delayed reconstruction after at least 3 months
73
Q

When does a penile fracture usually occur?

A

during intercourse – buckling injury when penis slips out of vagina and strikes pubis

Cracking or popping sound
followed by pain, discolouration and swelling

74
Q

How is a penile fracture treated?

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

75
Q

What symptoms are consistent with a testicular injury?

A

pain + nausea

76
Q

How are testicular injuries investigated and managed?

A

ix: US to assess integrity / remaining blood supply
Early exploration/repair
- to preserve fertility, hormonal function etc

RENAL (24 decks)

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