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Renal week 3 > Urological emergencies 1 > Flashcards

Urological emergencies 1 Flashcards

1
Q

What is acute urinary retention ?

A

It is the inability to voluntarily pass urine

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2
Q

What are the symptoms/signs of acute urinary retention ?

A
  • Inability to pass urine
  • Increasing pain
  • May see a palpable bladder
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3
Q

What is acute urinary retention usually due to and hence who does it most commonly affect ?

A

Most commonly affect men - due being commonly caused by BNH of the prostate

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4
Q

What is the treatment of acute urinary retention ?

A

1st line = Catheterisation

  • If painful retention with < 1 litre residue and normal serum electrolytes then trial without catheter (TWOC) during same admission.
  • prescribe a uroselective alphabocker (Alfuzosin, Tamsulosin) before TWOC improves chance of voiding success
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5
Q

What is post-obstructive diuresis ?

A

This is where copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction (>200mls/hr)

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6
Q

What are the patients at risk of developing post-obstructive diuresis ?

A

Patients with chronic bladder outflow obstruction in association with:

  • Uraemia
  • Oedema
  • CCF
  • Hypertension
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7
Q

What is the treatment of post-obstructive diuresis ?

A
  • Monitor fluid balance - match 50% of output as input with IVF or if the patient can manage then PO
  • It usually resolves by itself in 24-48hrs
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8
Q

What is a potential cause of loin pain outwidth the urinary tract which you need to be aware of ?

A

Leaking AAA

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9
Q

What is ureteric colic (nephrolithiasis) due to ?

A

Stones in the urinary tract (kidneys or ureter)

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10
Q

What is the typical presentation of ureteric colic ?

A
  • Acute severe loin pain +/- groin pain
  • Nausea and vomiting due to pain
  • urinary frequency/urgency
  • haematuria
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11
Q

What scan is used to diagnose ureteric colic due to stones diagnosed ?

A

Non-constrast CT-KUB

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12
Q

What is the treatment of ureteric colic ?

A

Most stones will pass so:

1st line = hydration (to flush them out) and NSAID (diclofenac PR) + paracetamol +/- opiate and alpha-blocker (Tamsulosin) (depends if stone might pass) or buscopan

Tamsulosin helps to relax alpha-1 smooth muscle cells and in theory might help pass the stone but also reduces muscle spasm pain, if not giving tamsulosin then use buscopan.

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13
Q

What would indiacte the need for urgent treatment of ureteric colic ?

A
  • Pain unrelieved
  • Pyrexia
  • Persistent nausea/vomiting
  • High-grade obstruction (hydronephrosis)
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14
Q

What additional blood tests should you add on for everyone presenting with ureteric calculi ?

A

A calcium and urate allows you then to potential find a cause for stone formation and if needed start e.g. allopurinol or lower their calcium.

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15
Q

What is the treatment urgent treatment for severe cases of ureteric colic?

Severe cases include - presence of ureteric obstruction, renal developmental abnormality such as horseshoe kidney and previous renal transplant.

A
  • No infection present - ureteric stent or stone fragmentation (Lithotripsy)/removal (nephrolithotomy)
  • Infection also present alongside urteric obstruction - percutaneous nephrostomy needed
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16
Q

What are some of the causes of frank haematuria ? (macroscopic)

A
  • Infection
  • Stones
  • Tumours
  • Benign prostatic hyperplasia (BPH)
  • Polycystic kidneys
  • Trauma
  • Coagulation/platelet deficiencies
17
Q

What is the investigation done in patients presenting with frank haematuria ?

A

CT urogram + cystoscopy

18
Q

Define what is meant by acute scrotum ?

A

Acute Scrotal Pain and Swelling +/- ischaemia

19
Q

What are the main causes of acute scrotum ?

A
  • Torsion of spermatic cord
  • Torsion of appendix testis
  • Epididymitis
20
Q

What causes torsion of the testes (hint this is a bit of a trick question)?

A

Torsion of the spermatic cord

21
Q

Who does torsion of the testes typically affect ?

A

Boys of pubertal age

22
Q

What is the typical presentation of torsion of the testes ?

A
  • Testicular pain +/- abdominal pain
  • Scrotal swelling or oedema
  • Scrotal erythema
  • Reactive hydrocele
  • High-riding fixed testicle
  • Horizontal lie
  • Absent cremasteric reflex
23
Q

What investigation may be useful in diagnosing torsion of the testis ?

A

Doppler USS (don’t wait on this if you think it is torsion of testis, rush straight for surgery and exploration)

24
Q

What is the treatment of torsion of the testis ?

A
  • Emergency scrotal exploration
  • Testis are then fixed (both sides) to prevent re-occurance

Renal week 3 (14 decks)

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