Urinary: Obstruction Flashcards

1
Q

What is the management of a patient with Haematuria?

A
  • Stabilise the patients
  • Blood
  • 3 way catheter and irrigation
  • CT angiogram if significant bleed
  • If it doesn’t settle then intervention such as cystoscopy/interventional radiology
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2
Q

Which substances presents with false negatives?

A

-Vitamin C

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3
Q

What is the mechanism for acute urinary retention?

A
  • Bladder outlet obstruction
  • Low bladder contractile power
  • Interrupted sensory or motor innervation of bladder and/or sphincter
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4
Q

What are investigations done for acute urinary retention?

A
  • History and examination
  • Bloods
  • Bladder scan
  • Neurological documentation important
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5
Q

What are the causes of acute urinary retention in men?

A
  • BPH
  • Prostate cancer
  • Urethral stricture
  • Prostatic infection
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6
Q

What are the causes of acute urinary retention in women?

A
  • Prolapses
  • Masses
  • Post botox
  • Fowler’s syndrome
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7
Q

What are the causes of acute urinary retention in both males and females?

A
  • Clots
  • Drugs
  • Pain
  • Major abdominopelvic surgery
  • Spinal cord compression
  • Spinal cord injury
  • Spina bifida
  • Urinary tract infections
  • Constipation
  • Urethral damage/rupture
  • Diabetic nephropathy
  • Neurological degeneration
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8
Q

What are management options for acute urinary retention?

A
  • Urethral Catheterisation
  • Suprapubic (if difficult)
  • Preferable as long-term condition
  • Risk of bowel perforation with insertion
  • Should have ultrasound if laparotomy
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9
Q

What differentiates acute urinary retention from chronic?

A

It is very painful

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10
Q

Where can stones from in the urinary tract?

A
  • Renal
  • Ureteric (constrictions)
  • Bladder (due to incomplete emptying)
  • Prostatic calculi (no clinical significance )
  • Urethral calculi in men (rare)
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11
Q

What are the effects of a ureteric obstruction?

A
  • Therefore, a unilateral obstructive stone globally impairs renal function.
  • Can also get bilateral calculi of kidney or ureters
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12
Q

What are features of renal and ureteric colic?

A
  • Causes a lot of pain
  • Present with renal colic
  • Loin to groin pain
  • Testicular pain sometimes
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13
Q

What are the investigations dow for renal and ureteric colics?

A
  • History
  • Examination
  • Urinalysis
  • CT KUB non-contrast
  • Abdominal X-ray
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14
Q

What are the management options for renal and ureteric colics?

A
  • Conservative management
  • Non- Invasive management (Shockwave lithotripsy)
  • Invasive management (Cystoscopy + lasertripsy, Percutaneous nephrolithotomy, Uteroscopy)
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15
Q

What are signs and symptoms of ureteric stones?

A
  • Very painful
  • Impairment in renal function
  • May get stuck
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16
Q

What are the management options for ureteric stones?

A

Symptoms and stone size guide treatment

  • Most stone will pass if small enough (less than 4mm)
  • Pain mandates a stent and sometimes primary URS + lasertipsy
17
Q

What is the pathophysiology of urosepsis?

A
  • Blocked upper renal tract to ureteric orifice
  • Standing column of septic urine in the upper urinary tract including the kidney is called pyelonephroisis
  • Infection can spread to blood
18
Q

What is the management for urosepsis?

A
  • Stenting
  • Nephrostomy

To drain urine

19
Q

What are causes of AKI?

A
  • Pre-renal
  • Renal vein
  • Renal artery
  • Small vessel disease – intrinsic
  • Glomerular disease - intrinsic
  • Acute tubular necrosis – intrinsic
  • Acute interstitial nephritis - intrinsic
  • Intratubular obstruction
  • Post renal obstruction
20
Q

What is imaging undertaken in AKI?

A
  • Ultrasound – perform if obstruction suspected. Not need for pre-renal/ATN
  • Chest X-ray – to look for fluid overload
21
Q

Why is biopsy taken if AKI suspected?

A
  • Pre-renal and post-renal AKI ruled out
  • A confident diagnosis of ATN cannot be made
  • Systemic inflammatory symptoms/sign are present
22
Q

What is the pathophysiology of pre-renal failure in AKI?

A
  • Actual GFR is reduced due to decreased renal blood flow.
  • No cell damage so kidney works hard to restore blood flow
  • Avidly reabsorbs salt and water (ADH + Aldosterone)
  • Responds to fluid resuscitation
23
Q

What are causes of pre-renal failure in AKI?

A
  • Hypovolaemia – blood loss, fluid loss
  • Systemic vasodilation – sepsis, cirrhosis, anaphylaxis
  • Pre-glomerular vasoconstriction – sepsis, NSAIDs
  • Post glomerular vasodilation – Ang2 antagonist, ACE inhibitors
24
Q

How does the kidney attempt to correct pre-renal failure and what happens if it fails?

A
  • In mild hypo-perfusion, autoregulation ensures renal blood flow preserved
  • Dilation of afferent arteriole - prostaglandin
  • Constriction of efferent arteriole - RAAS
  • If compensatory responses overwhelmed, AKI occurs
  • Occurs below 80mmHg or higher if hypertensive
25
How do ACE inhibitor and NSAIDs affect renal perfusion to cause pre-renal failure?
- NSAIDs acts against vasodilators (prostaglandins) - ACE inhibitors act against formation of Ang 2 - The intrinsic auto-regulatory mechanism are overridden
26
What is the pathophysiology in acute tubular necrosis?
- Cells are damaged which cannot be reversed immediately but can be eventually if treated - Damaged cells cannot reabsorb salt and water efficiently or expel excess water - Proximal tubule is particularly at risk of ischaemia if pre-renal AKI persists
27
What are the causes of acute tubular necrosis?
- Ischaemia - Nephrotoxins - Sepsis - Thombotic-microangiopathy - Acute tubule-interstitial nephritis
28
What examples of endogenous nephrotoxins?
- Myoglobin - Urate - Bilirubin
29
What are examples of exogenous nephrotoxins?
- Endotoxin - X-ray - Drugs - Poisons
30
How can myoglobin cause damage to the kidney?
-Due to muscle necrosis leading to rhabdomyolysis. Myoglobin filtered at glomerulus and is toxic to tubule cells. Can also cause obstruction
31
What can increase myoglobin?
- Crush injury - AKI in wars and natural disasters - Drug users (unconscious so don’t move) - Elderly - fall
32
What is the pathophysiology of thrombotic microangiopathy?
- Caused by endothelial damage - Platelet thrombi - Partial obstruction of small arteries - Destruction of Red Blood cells - Leads to micro-angiopathic anaemia
33
What can cause acute tubule-insterstitial nephritis?
- Toxin induced (Many drugs) | - Infections (Caused by an inflammatory response)
34
What is the pathophysiology of post renal failure?
- Obstruction with continuous production - Rise in intraluminal pressure - Dilatation of renal pelvis (hydronephrosis) - Decrease in renal function
35
What are the causes of post renal failure?
- Within the lumen (stones, blod clot, tumours) - Within the wall (congenital megareter, stricture post TB) - Pressure from outside (enlarge prostate, tumour, aortic aneurysm, ligation of ureter)
36
How is AKI managed?
- Treat volume overload (restriction of sodium and water, diuretic) - Treat hyperkalemia (restrict dietary K, Calcium gluconate) - Treat acidosis - Dialysis
37
When is dialysis used in the AKI?
- High K+ refractory to treatment - Metabolic acidosis where the sodium bicarbonate is not appropriate - Fluid overlaod refractory to diuretic - Signs of uraemia - Presence of dialysable nephrotoxin