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Renal / Urology > Urinary Obstruction > Flashcards

Urinary Obstruction Flashcards

1
Q

Where is your upper urinary tract

A

Pelvic ureteric junction to vesicoureteric junction

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2
Q

What causes upper tract obstruction at PUJ, ureter and VUJ

A 
Scar tissue causing ureteric stricture 
Stone
Tumour - ureteric / kidney 
Blood clot 
Abdominal / pelvic mass causing external compression 
Prostate / cervical tumour near VUJ
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3
Q

What can obstruction be

A

Luminal e.g. clot / stone / tumour
Mural e.g. stricture / neuromuscular
Extra-mural e.g. compression tumour / fibrosis

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4
Q

What is an emergency and when do you consider it

A

Obstructed kidney with infection
Bilateral obstruction
Consider in any patient with impaired renal function

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5
Q

What are symptoms of acute obstruction

A 
Loin pain radiating to groin
Frank haematuria
Vomiting
Microscopic haematuria
Reduced urine output 
Sepsis / infection
Renal failure 
May have enlarged kidney
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6
Q

What can the haematuria be

A

Intermittent so beware of this

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7
Q

What are signs of infected acute obstruction

A 
Sepsis
Fever
Low BP
Low O2 
N+V
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8
Q

What does intermittent frank haematuria suggest

A

Can query UTI
But if comes back after Rx
think obstruction

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9
Q

What can chronic upper tract obstruction present with

A

Flank pain
Renal failure
Infection
Polyuria may occur due to impaired concentration

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10
Q

What investigations should you do for obstruction

A 
FBC, U+E
ABG if hypoxic
PSA
Urine dip and MC+S 
Blood culture if fever
Imaging
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11
Q

What imaging

A

USS if middle of night and no CT

CT KUB = gold standard for determining level

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12
Q

How do you treat obstruction

A 
ABC
IV access
IV fluid
Broad Ax
Analgesia
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13
Q

What is emergency Rx for obstruction

A

Percutaenous nephrostomy into back or stent

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14
Q

What should you never give if septic

A

Shockwave therapy

Do when well

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15
Q

What is definite treatment of obstruction

A

Depends on cause
Stone = ESWL or utereoscopy if doesn’t work
Tumour = nephro-ureterectomy
PIJ obstruction = pyeloplasty to widen PUJ

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16
Q

What ae complications of placement of a stent

A 
Pain 
Irritation
Haematuria
Infection
Biofilm 
Obstruction
Ureteric rupture
Misplacement
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17
Q

What causes lower urinary tract obstruction (bladder to urethral meatus)

A 
Obstruction at
Bladder neck - neurogenic bladder 
Prostate - BPH / prostate cancer 
Urethra - stricture 
Urethral meatus
Foreskin
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18
Q

What are the symptoms of lower urinary tract obstruction

A 
Acute urinary retnetion
Voiding and storage Sx
Incontinence
Recurrent UTI
Frank haematuria
Sepsis 
Renal failure on bloods
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19
Q

How do you investigate

A

Bloods
ABG
Bladder USS as retention

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20
Q

How do you treat lower urinary tract obstruction

A

Catheterise IMMEDIATELY to relieve retnetion

Treat cause

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21
Q

What do you do for BPE

A

TURP

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22
Q

How do you treat urethral stricture

A

Urethrotomy

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23
Q

How do you treat mental stenosis or phimosis

A

Meatal dilatation

Circumcision

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24
Q

What are complications of obstruction

A 
Pain 
Sepsis
Bladder stones
Hydronephrosis 
Renal failure -> CKD
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25
Q

What can trigger acute urinary retention

A

Constipation
Alcohol
Post op

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26
Q

What should you think if acute urinary retention

A 
Obstruction 
Drugs
Infection 
Neurogenic
Post-op
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27
Q

What can cause acute urinary retention

A 
BPH = most common 
CAUDA EQUINA
Constipation
Drugs
UTI / infection - enough to cause if predisposed 
Blocked catheter
Urethal stricture
Meatal stenosis / phimosis 
Blood clot
Pelvic trauma or surgery
Pelvic mass 
Prolapse 
Fouler sundrome
MS / Parkinson
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28
Q

What drugs can cause acute urinary retention

A 
ANTI-CHOLINERGIC  - TCA / anti-psychotic / anti-histamine 
Diuretic
CCB 
Opiates
Benzo 
Alcohol 
Spinal / Epidural
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29
Q

What is fouler syndrome

A

Urethra doesn’t relax

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30
Q

What causes a stricture

A 
Iatrogenic
STI
Hydrospadia
Lichen sclerous
Lichen Planus
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31
Q

What are the symptoms of acute urinary retention

A 
Painful - extreme
SUDDEN - over a few hours 
Inability to void
Palpable or perusable bladder
Restless
May have tachycardia from the pain
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32
Q

If someone had a background of retention how would it present

A

Overflow

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33
Q

What are red flags in acute urinary retention

A

Cauda equina - pain / saddle dysathesia / weakness
Weight loss
Bone pain - mets
Blood

34
Q

Who is at risk of retention

A 
BPH 
Catheter removed
Constipation
Immobility
Opiates
Infection
Haematuria - as can clot 
Rare in women
35
Q

If a hx of pelvic fracture + retention what do you suspect

A

Bladder or urethral injury

Bladder perforation is peritonitis / no UO

36
Q

How do you investigate acute urinary retention / examine

A 
Bloods - FBC, U+E, PSA, glucose
Urine dip + MC+S
Abdo exam
DRE for BPH 
Neuro exam
Pelvic exam in women 
Bladder scan >300ml
USS 
MRI / CT head if neurological suspected
37
Q

What volume in bladder

A

500ml-1l

38
Q

What do you do if abnormal U+E

A

USS to rule out hydronephrosis

CT KUB if USS shows hydronephrosis

39
Q

If >1l residual in bladder what do you do

A

Check U+E

Monitor for post obstructive diuresis

40
Q

How do you treat acute urnary retention

A

CATHETER - always needed

3 way catheter if clot retention

41
Q

What do you monitor

A

Weight
Urine output
Fluid balance
U+E

42
Q

What bloods

A

FBC, U+E, CRP, PSA

ABG

43
Q

What is low risk

A

<1000ml residual
Normal U+E
Uncomplicated

44
Q

What do you do for low risk

A

Discharge
Treat cause i.e. AX or laxatives
TWOC

45
Q

If due to BPE

A

A blocker
Remove catheter in 2 days
TURP if this fails

46
Q

If due to clot retention

A

3 way catheter

Bladder wash out

47
Q

What suggests clot retention

A

Haematuria

No longer peeing

48
Q

What is high risk

A

> 1000ml
Abnormal U+E
Complications e.g. UTI

49
Q

How do you treat

A

Admit
Hourly urine output
Monitor for post obstructive diuresis
IV fluid if >200ml / hr for 2 hours

50
Q

What do you do if failure to void

A

Catheterise

51
Q

What do you do if renal impairment

A

Surgery

No medical

52
Q

What are complications of urinary retention

A

UTI
Bladder stone
Renal failure
Electrolyte imbalance

53
Q

What can happen after the catheter is put in

A

Post obstructive diuresis
Haematuria
Na and bicarbonate losing nephropathy

54
Q

What causes pathological diuresis

A

Urea, ADH and altered tubular function

Na and H20 released after catheter inserted

55
Q

What are the symptoms

A

AKI due to dehydration
Postural hypo
Weight loss

56
Q

How do you treat

A

Monitor UO to make sure not increasing
Monitor U+E
Give IV fluids to match output

57
Q

What is Na and bicarb losing nephropathy

A

Lost in urine when catheter inserted
Replace
Withhold nephrotoxin
Can cause metabolic acidosis

58
Q

What causes chronic urinary retention

A 
BPH = very common
Detrusor under activity 
Neuropathic bladder - MS /nerve / mets / CNS / DM
Infection
Obstruction/ pelvic mass
59
Q

What are symptoms of chronic urinary retention

A

Painless
Palpable and percussion bladder
May have large prostate
Often able to void but left with residual urine
LUTS e.g. frequency, hesitancy, poor stream
Overflow due to high pressure
Abnormal U+E

60
Q

When should you worry

A

Patients with high pressure retention or hydronephrosis

61
Q

How do you investigate

A 
Bloods inc ABG
MSSU
Post void bladder scan / USS 
Flow rate study - if high pressure worry 
Cystoscopy for bladder
CT
62
Q

When do you Catherterise

A

If pain, infection or renal impairment

1st line = CISC before long term / suprapubic

63
Q

What requires immediate treatment

A

High pressure retnetion

64
Q

When do you do CISC

A

Neuro

Renal

65
Q

What are complications

A

UTI
Bladder stone
Renal failure if bilateral uropathy / hydronephrosis
Hyperkalaemia
Acidosis due to renal failure? / loss of bicarb - resp compensated

66
Q

What are CI to suparapubic catheter

A

Any surgery or scar tissue
Bladder cancer
Anti-coagulant

67
Q

How does acute on chronic cpresent

A

May go unnoticed
Overflow
Pain

68
Q

How do you investigate

A

Bloods

Bladder scan

69
Q

What should you do if abnormal U+E

A

Renal USS

70
Q

How do you treat

A

Catheterise

Renal function should return to baseline

71
Q

What can residual volume and creatinine be in chronic

A

1.5l

1000

72
Q

What is normal residual volume

A

<50ml

73
Q

What are causes of urethral stricture

A

Hydrospasia
Iatrogenic
STI
Lichen sclerous

74
Q

How does it present

A

LUTS

75
Q

If patient has urethral injury due to pelvic injury what is Rx if bladder distended

A

Suprapubic catheter

76
Q

What is classified as high pressure retention

A

If renal function impaired or there is hydronephrosis

77
Q

What do you do before TWOC

A

Give tamsulosin to prepare (A blocker)

24-72 hours before

78
Q

What can you do if suspect neurogenic cause

A

MRI / CT head

79
Q

How does urethral injury present

A

Inability to pass urine
Blood at meatus
Palpable bladder
Perineal bruising

80
Q

What is Rx of bladder distension

A

Suprapubic catheter under USS

Can try one pass at urethral

81
Q

How do you Dx

A

Urethrogram

- Contrast into bladder

Renal / Urology (16 decks)

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