Urinary retention

Question 1

What the main categories of urinary retention?

Answer 1

Prerenal
Renal
Postrenal

Question 2

Give some pre-renal causes of urinary retention

Answer 2

Hypovolemia
Low BP
HF
Reduced local perfusion of the kidneys

Question 3

What are the renal causes of urinary retention?

Answer 3

Acute tubular necrosis (e.g. ischaemia, nephrotoxic drugs)
Glomerulonephritis
Interstitial nephritis
Vascular causes
Infectious causes
Multiple myeloma

Question 4

What is glomerulonephritis

Answer 4

Damage to glomeruli after infection, vascular causes or autoimmune causes

Question 5

Drugs that cause interstitial nephritis

Answer 5

NSAIDS

antibiotics

Question 6

Give examples of vascular causes of renal disease

Answer 6

Malignant hypertension
DIC
TTP
HUS

Question 7

Give infectious causes of renal disease

Answer 7

Malaria

Legionairre’s diseaes

Question 8

What is multiple myeloma?

Answer 8

Proliferation of plasma cells

Question 9

What is the mnemonic for multiple myeloma?

Answer 9

Calcium is high
Renal impairement
Anaemia
Bone pain

Question 10

What is nephrotic syndrome?

Answer 10

Proteinuria >????
Low serum albumin
Oedema

Question 11

What is nephritic syndrome

Answer 11

Blood in urine
HTN
Haematuria

Question 12

How do you classify vasculitis?

Answer 12

Large vessel
Medium vessel
Small vessel

Question 13

What is HUS and what do these cause?

Answer 13

Haemolysis -> MAHA and thrombocytopenia causing jaundice and conjunctival pallor
Urinary problems -> oliguria
Shits -> abdo pain and bloody diarrhoea

Question 14

What is TTP

Answer 14

Basically all of HUS plus the following:
Temperature
Fever
Fluctuating CNS signs

Question 15

What is dysfunctional in TTP?

Answer 15

ADAMS13 protein dysnfuction

normally cleaves vWF

Question 16

What do you need to diagnose DIC?

Answer 16

Evidence of bleeding at three unrelated sites

Question 17

What is associated with DIC?

Answer 17

MAHA
Sepsis signs
Bleeding and clots

Question 18

What post renal causes classifications

Answer 18

Ureter
Bladder
Urethra

Question 19

Post renal causes of urinary retention is due to

Answer 19

obstruction of urinary flow

Question 20

Ureter causes

Answer 20

Abdo/pelvic pain

Bilateral calculi

Question 21

Bladder causes

Answer 21

Drugs e.g. anticholinergic drugs
Bladder stones
Tumour

Question 22

What are the three types of tumours in the bladder?

Answer 22

Transitional cell - most common
Squamous cell
Adenocarcinoma

Question 23

Urethra causes

Answer 23

BPH
Blocked catheter
Prostate cancer
Infection (HSV) - > painful urination means patients don’t urinate

Question 24

Which ethnicity is prostate cancer common in?

Answer 24

Afro Caribbeans

Question 25

Hx questions

Answer 25

When did it start? Has this happened before? Sudden or gradual? Intermittent or continuous?

Question 26

If the symptoms are gradual, what does it suggest?

Answer 26

Gradual - prerenal

Question 27

If the symptoms are intermittent, what does it suggest?

Answer 27

Intermittent - malaria

Question 28

What other questions would you screen for if you're thinking HF?

Answer 28

HF - orthopnoea, fatigue, weight loss, pink/frothy sputum

Question 29

What other questions would you screen for if you're thinking glomerulonephritis?

Answer 29

Haematuria, oedema, polyuria/oliguria

Question 30

What other questions would you screen for if you're thinking vasculitis?

Answer 30

Vasculitis - anoything e.g. fever, malaise, weight loss, rash, ulcers, arthraliga, abdo pain, cough, sob

Question 31

What other questions would you screen for if you're thinking DIC?

Answer 31

Petechiae, epistaxis, mucousal bleeding, hypotension, tachycardia

Question 32

What other questions would you screen for if you're thinking malaria?

Answer 32

High fever, sweating, rigors, vomiting, jaundice, hepatomegaly, anaemia, consciousness, fits

Question 33

What other questions would you screen for if you're thinking HUS?

Answer 33

Jaundice Conjuntival pallor ABDO PAIN bloody diahorea

Question 34

What other questions would you screen for if you're thinking TTP?

Answer 34

Jaundice Conjuntival pallor ABDO PAIN bloody diahorea + fever fluctuating CNS symp

Question 35

What other questions would you screen for if you're thinking multiple myeloma?

Answer 35

Bone pain Lethargy Aneamia

Question 36

What other questions would you screen for if you're thinking BPH?

Answer 36

``` Poor flow Hesitancy Incomplete voiding Painful urination UTI ```

Question 37

What other questions would you screen for if you're thinking prostate cancer?

Answer 37

Pain with ejaculation Painless macroscopic haematuria more pain depending on

Question 38

What other questions would you screen for if you're thinking paraneoplastic syndrome?

Answer 38

Constipation Crampy abdo pain High calcium

Question 39

What are the relevant pre-existing conditions?

Answer 39

``` HF Malignancy Cirrhosis Hepatitis CKD PVD DM Pancreatitis Recent trauma Recent infections Blocked catheter Schistosomiasis Abnormal androgens (causing bladder hyperplasia) ```

Question 40

Schistosomiasis increases your risk of?

Answer 40

Squamous cell carcinoma

Question 41

Relevant drugs

Answer 41

``` Antibiotics - gentamycin Streptomycin ACEi Contrast agents NSAIDs Anticholinergics Sympathomimetics ```

Question 42

Why is occupation relevant?

Answer 42

Cadmium - (e.g. smelting metals, manufacturing, making batteries) increases risk of prostate cancer Aromatic amines increase risk of bladder cancer e.g. in

Question 43

What increases the risk of

Answer 43

Low fibre diet