Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SYSTEMS - Urinary > Urinary Tract Obstruction > Flashcards

Urinary Tract Obstruction Flashcards

1
Q

What are the McNeals Zones of the prostate?

A

1) Transition Zone (wraps around urethra)
2) Central Zone
3) Peripheral Zone (Where most cancers are!!!!!)
4) Anterior Fibromuscular Stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are Lower Urinary Tract Symptoms (LUTS)?

A

Voiding:

  • Incomplete Emptying
  • Hesitancy
  • Poor Stream
  • Dribbling

Storage:

  • Frequency
  • Nocturia
  • Urgency/urge incontinence

Other:

  • Intermittency
  • Straining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What physical signs can you detect on exam of a Bladder outflow obstruction (BOO)?

A

Palpable/percussible Bladder
External urethral meatus stricture
Phimosis
Mass on Digital Rectal Exam (mostly BPH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What tests can you do for a UTO?

A

MSSU
Flow Rate Study

Post-void bladder Ultrasound (looking for residual)
Renal tract Ultrasound
Cystoscopy - Good for BPE, cancer & strictures

Bloods:

  • PSA
  • U&C (only if in chronic retention)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is BPH?

A

Benign Prostatic Hyperplasia.
Its a combination of fibromuscualr & glandular hyperplasia mainly affecting the transition zone, occurs in most men as they age
It can lead to BOO.

Presents with LUTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is BPH treated?

A

Medically:

  • Alpha blockers (relax smooth muscle)
  • 5Alpha Reductase Inhibitors (reduces prostate size by metabolising testosterone)

Surgically:

  • TURP (transurethral Resection of Upethra)
  • Open Prostatectomy (If >100cc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Example of alpha blocker and 5 alpha reductase inhibitor?

A

Alpha Blocker - Tamsulosin

5 AR inhibitor - Dutasteride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can a BPH be complicated?

A 
Acute or chronic urinary retention
Urinary Incontinence
UTI
Bladder Stone
Renal Failure (due to hydronephrosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can we treat a complicated BPH if they’re not fit for TURP?

A
  • Long term urethral catheter

- CISC (clean intermittent self Catheterisation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Whats the difference between acute & chronic urinary retention?

A

Acute is a painfull inability to void bladder

Chronic is painless incomplete voiding. Chronic may come with progressive LUTS, UTIs or overflow incontinence (bed wetting)

Both have a palpable and percussible bladder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes Acute Urinary Retention?

A

Generally BPH, either as part of the natural progression or paired with some trigger like constipation or a urological procedure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you treat Acute Urinary Retention?

A

Catheterise and start treatment for BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes Chronic Urinary Retention?

A

Detrusor underactivity.

Largely due to primary bladder failure or a longstanding BOO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat chronic urinary retention?

A

Catheterisation followed by CISC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chronic urinary retention can be fairly ok or very dangerous, how do you tell?

A

High pressure CUR is incontinent, raised Cr and causes bilateral hydronephrosis

Low pressure CUR is less dangerous. Its usually dry, Cr is normal and the kidneys are ok.

Both are painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the major complications when you treat a BOO/urinary retention?

A

Post-obstructive Diuresis

Decompression haematuria

17
Q

What is post-obstructive diuresis and how do you manage it?

A

Massive UO >200ml/hr which can lead to life-threatening hypotension, weight loss and Electrolyte abnormalities

IV fluids resus and then a long term catheter, CISC or TURP.

18
Q

What is decompression haematuria?

A

Shearing of the small vessles during decompression because of different compliance between different tissue layers.
Usually self-limiting

19
Q

UTOs are split into upper and lower tract. What causes each?

A

Upper Tract:

  • TCC tumours
  • Stones
  • Blood clots
  • Scar tissue at the PUJ
  • Abdominal/pelvic mass

Lower Tract:

  • Mainly BPH
  • Bladder Stones
  • Phimosis
  • Urethral Strictures
  • Urethral Meatal Stenosis
20
Q

How would an upper tract obstruction present?

A
  • Pain in the flank or loin
  • Haematuria (Frank or Micro)
  • Palpable mass (maybe)
  • Infection/sepsis, renal failure or tumour symptoms
21
Q

What initial management would you use for any obstruction?

A
  • Fluids
  • Bloods, ABGs & cultures
  • Analgesia
  • Broad Spec Abx if signs of infection
22
Q

What investigations can be used for Upper tract obstructions?

A

US

CT-KUB

23
Q

How do you manage an upper tract obstruction?

A

So initial resus (fluids, analgesia, Abx etc)

Emergency bypass of the obstruction i.e. percutaneous nephrostomy or retrograde stent

Definitive treatment depends on the cause

24
Q

How do you treat a kidney stone?

A

Ureteroscopy + Laser Lithotripsy

25
Q

How do you treat a TCC in the upper tract?

A

Nephroureterectomy

26
Q

How do you treat an obstruction at the PUJ?

A

Laparscopic Pyeloplasty

27
Q

So what tests can you do for a lower urinary obstruction?

A
  • Bladder Scan
  • US renal tract
  • Cystoscopy
  • Digital Rectal Exam
  • Urine Flow rate study
28
Q

How do manage a lower urinary tract obstruction?

A

Initial resus = Abx, analgesia, fluids as relevant

Emergency management with a catheter to relieve pain etc.

Then treat the cause

29
Q

How do you treat a urethral stricture?

A

Optical Urethrotomy

30
Q

How do you treat meatal stenosis?

A

Meatal Dilatation

31
Q

How do you treat phimosis?

A

Circumcision

SYSTEMS - Urinary (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions