urological emergencies Flashcards
what are the 5 commonest urological emergencies
- stones
- infection (urosepsis, pyelonephritis)
- testis pain
- retention of urine
- urological trauma
pain characteristics seen in renal colic (5)
- loin to groin
- restlessness -> have to walk off the pain (if present then assume stone until proven otherwise, even in absence of haematuria)
- sudden onset
- persistent pain
- unilateral
what is the first line imaging for renal colic
CT KUB -> all stones will show up on CT even if radio-opaque
what common drug should be avoided in emergency mgx with poor renal function
NSAIDs
indications for admission of a pt w renal colic (3)
- uncontrolled pain
- vomiting
- sepsis
pyonephrosis vs pyelonephritis
pyelonephritis - inflammation of the kidneys due to infection
pyonephrosis - a severe complication of pyelonephritis where there is pus in the renal collecting system
pyonephrosis mgx
- treat sepsis (sepsis 6)
- stent or nephropstomy
what is a nephrostomy
the implantation of a tube that lets urine drain from the kidney through an opening in the skin on the back
investigations for pyelonephritis
- MSU
- culture screen
- USS
pyelonephritis mgx
- IV abx (gentamicin or piperacillin/tazobactam)
- fluids (if vomiting)
- CT (if not setting after 3/7) -> look for abscess etc.
what is acute urinary retention
the sudden inability to pass urine
acute urinary retention presentation (4)
- suprapubic pain
- sudden onset anuria
- palpably distended bladder
- cause related symptoms (e.g. fever, rigors et. associated with urinary tract infection)
acute urinary retention mgx
- immediate catheterisation
- alpha blockers at home
risk factors for acute urinary retention
- age
- poorer flow
- large prostate
chronic urinary retention presentation
- usually painless
- nocturnal enuresis (overflow incontinence at night due to laxity of sphincter muscle)
- significant bladder distension
- may have associated voiding LUTS e.g. weak stream and hesitancy, with a reduced functional capacity
chronic urinary retention mgx
- catheterisation - long term or intermittent self catheterisation
- outflow surgery
- alpha 1 adrenergic antagonists
what electrolytes need to be watched for with catheterisation
Na+ Cl- ->can be lost with catheterisation
what are special tests for testicular torsion (2)
- cremasteric reflex -> absence of this is seen in torsion (stoke inner thigh and causes raising of scrotum on that side)
- Prehn’s sign NEGATIVE -> pain relieved by elevation of testis
what is the ddx if prenh’s sign is +ve
epipdidymitis
mgx of orchitis/epididymitis
abx -
1. doxycycline (100mg BDS)
2. ceftriaxone (1 g IM) one off dose
causes of blunt urological trauma
- high energy e.g. RTA, fall from height, horse riding, crush
- low energy e.g. fall from standing
causes of penetrating urological trauma
knife, handgun, rifle
what is the blunt renal trauma grading system
American Association for the Surgery of Trauma (AAST) renal injury scale
grade I - subcapsular haematoma and/or contusion, without laceration
grade II - superficial laceration ≤1 cm depth not involving the collecting system; perirenal haematoma confined within the perirenal fascia
grade III - laceration >1 cm not involving the collecting system, vascular injury or active bleeding confined within the perirenal fascia
grade IV - laceration involving the collecting system with urinary extravasation; laceration of the renal pelvis and/or complete ureteropelvic disruption; active bleeding extending beyond the perirenal fascia
grade V - shattered kidney; avulsion of renal hilum or laceration of the main renal artery or vein: devascularisation of a kidney due to hilar injury
why might renal tamponade be difficult to detect on A-E assessment
BP remains the same
what is renal tamponade
compression of renal structures caused by the limited space for expansion
what is “pie in the sky” bladder
the appearance of a contrast-opacified floating bladder seen high in the pelvis due to the presence of a large pelvic haematoma and the sheering of the ureter from the pelvic floor
