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Emergency & Acute > Urinary problems > Flashcards

Urinary problems Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Pathophysiology of testicular torsion (TT)

A

When the spermatic cord (blood flow to the testicle) rotates + becomes twisted
This causes testicular ischaemia

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2
Q

What is the most common age for TT

A

<30 years

Peak age is 13 years

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3
Q

What is bell-clapper deformity? (TT)

A

Caused by abnormal fixation of the tunica vaginalis to the testicle - so the testicle can rotate freely in the tunica vagninalis

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4
Q

Presentation of TT

A

Acute onset testicular pain
Abdo pain (+/- vomiting)
PAINFUL TO WALK!!

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5
Q

How may the testical appear in TT?

A

Red, swollen, tender hemi-scrotum

Affected testis is higher + transverse

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6
Q

What reflex is absent in TT?

A

Cremasteric reflex is absent in TT

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7
Q

Initial managment of TT

A

Analgesia (?anti-emetic)

KEEP FASTED!! they will need surgical intervention

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8
Q

Should you image in suspected TT?

A

NO! this will delay treatment

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9
Q

Surgical managment of TT

A

Orchidopexy (detorsion + fixation with suture) of BOTH SIDES!! the other testis is at increased risk of torsion

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10
Q

What is the most common cause of scrotal pain in men?

A

Epididymitis

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11
Q

How does epididymitis differ from torsion?

Think onset, symptoms, management etc

A 
Epididymitis:
Usually more gradual onset
Can progress to testis
Usually urinary symptoms too 
Treated with antibiotics
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12
Q

What are the most common causes of epididymitis in older men, sexually-active men and pre-pubescent boys

A

Old: usually enteric (e. coli)

Sexually active men: usually STI (chlamydia/ gonorrhoea)

Pre-pubescent: usually non-infective cause

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13
Q

What is another infective cause of epididymitis?

A

Mumps

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14
Q

How is epididymitis managed?

A

Treat the underlying cause!

e.g. treat STI with ceftriaxone + doxycycline

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15
Q

What is the most common type of renal stones?

What are these associated with?

A

Calcium oxalate (60%)

Associated with:
low urine volume, raised urine pH (alkalotic)

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16
Q

Give 4 other type of renal stones

A

Calcium phosphate (20%)
Struvite (stag horn calculi)
Uric acid (gout)
Cysteine (genetic disorders)

17
Q

What are the 3 most common sites of renal stone obstruction?

A

Pelvi-uteric junction (PUJ)
Mid-ureter
Vesico-uteric junction (VUJ)

18
Q

Renal stone obstruction leads to vasodilation and ureteric smooth muscle spasm - how do these present?

A

Vasodilation: leads to diuresis (increased urine production)

Muscle contraction: colicky pain

19
Q

Give 4 risk factors for renal stones

A

Dehydration
Poor diet
Obesity
Gout

20
Q

What analgesic is recommended for renal colic?

A

75mg Diclofenac (PR or IM)

21
Q

What other immediate management is there for renal colic?

A

Anti-emetic (e.g. metaclopramide IM)
IV fluids
Antibiotics if co-existing infection

22
Q

Investigations in suspected renal colic

A

Urine dip and MSU

Us+Es, creatinine, glucose, calcium phosphate + urate levels

Imaging

23
Q

If renal stone is small enough to pass naturally, what should you tell the patient to do

A

Try and catch the stone in a sieve so it can be sent for analysis

24
Q

If hospital admission is not required, what analgesia can be prescribed

A

NSAID

25
Q

How big do stones have to be for interventional management (usually)

A

> 5mm diameter

26
Q

What is MET and what drugs can be used for it?

A

Medical expulsive therapy

Alpha blocker or CCB - when stones are <10mm

27
Q

With MET, how long should it take for stones to apss?

A

within 48 hours

28
Q

If a patient with renal stones is unsuitable for medical management, what surgical options are there?

A

ESWL (extracorporeal shock wave lithotripsy) - outpatient

Percutaneous nephrolithotomy - stone fragmentation through a neohroscope

29
Q

In renal colic, what are 3 indications for early intervention and admission?

A

Infection + obstruction (ureteric stent may be required)
Urosepsis
Impending AKI

30
Q

What foods (oxalate rich) would you advise reduced consumption of in someone who has had renal stones?

A

Rhubarb, spinach, cocoa, tea leaves, nuts, soy, strawberries, wheat bran

31
Q

General advice to someone who has had renal stones

A

Increase fluid intake (to produce 2-3L of urine a day, or to maintain colourless urine)

Balanced diet - reduce salt intake

Maintain a healthy weight

Emergency & Acute (21 decks)

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