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3B week 5 - LUTS, The Scrotum and Genitalia > urological emergencies > Flashcards

urological emergencies Flashcards

1
Q

what are the 5 commonest urological emergencies

A
  1. stones
  2. infection (urosepsis, pyelonephritis)
  3. testis pain
  4. retention of urine
  5. urological trauma
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2
Q

pain characteristics seen in renal colic (5)

A
  1. loin to groin
  2. restlessness -> have to walk off the pain (if present then assume stone until proven otherwise, even in absence of haematuria)
  3. sudden onset
  4. persistent pain
  5. unilateral
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3
Q

what is the first line imaging for renal colic

A

CT KUB -> all stones will show up on CT even if radio-opaque

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4
Q

what common drug should be avoided in emergency mgx with poor renal function

A

NSAIDs

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5
Q

indications for admission of a pt w renal colic (3)

A
  1. uncontrolled pain
  2. vomiting
  3. sepsis
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6
Q

pyonephrosis vs pyelonephritis

A

pyelonephritis - inflammation of the kidneys due to infection
pyonephrosis - a severe complication of pyelonephritis where there is pus in the renal collecting system

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7
Q

pyonephrosis mgx

A
  1. treat sepsis (sepsis 6)
  2. stent or nephropstomy
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8
Q

what is a nephrostomy

A

the implantation of a tube that lets urine drain from the kidney through an opening in the skin on the back

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9
Q

investigations for pyelonephritis

A
  1. MSU
  2. culture screen
  3. USS
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10
Q

pyelonephritis mgx

A
  1. IV abx (gentamicin or piperacillin/tazobactam)
  2. fluids (if vomiting)
  3. CT (if not setting after 3/7) -> look for abscess etc.
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11
Q

what is acute urinary retention

A

the sudden inability to pass urine

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12
Q

acute urinary retention presentation (4)

A
  1. suprapubic pain
  2. sudden onset anuria
  3. palpably distended bladder
  4. cause related symptoms (e.g. fever, rigors et. associated with urinary tract infection)
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13
Q

acute urinary retention mgx

A
  1. immediate catheterisation
  2. alpha blockers at home
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14
Q

risk factors for acute urinary retention

A
  1. age
  2. poorer flow
  3. large prostate
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15
Q

chronic urinary retention presentation

A
  1. usually painless
  2. nocturnal enuresis (overflow incontinence at night due to laxity of sphincter muscle)
  3. significant bladder distension
  4. may have associated voiding LUTS e.g. weak stream and hesitancy, with a reduced functional capacity
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16
Q

chronic urinary retention mgx

A
  1. catheterisation - long term or intermittent self catheterisation
  2. outflow surgery
  3. alpha 1 adrenergic antagonists
17
Q

what electrolytes need to be watched for with catheterisation

A

Na+ Cl- ->can be lost with catheterisation

18
Q

what are special tests for testicular torsion (2)

A
  1. cremasteric reflex -> absence of this is seen in torsion (stoke inner thigh and causes raising of scrotum on that side)
  2. Prehn’s sign NEGATIVE -> pain relieved by elevation of testis
19
Q

what is the ddx if prenh’s sign is +ve

A

epipdidymitis

20
Q

mgx of orchitis/epididymitis

A

abx -
1. doxycycline (100mg BDS)
2. ceftriaxone (1 g IM) one off dose

21
Q

causes of blunt urological trauma

A
  1. high energy e.g. RTA, fall from height, horse riding, crush
  2. low energy e.g. fall from standing
22
Q

causes of penetrating urological trauma

A

knife, handgun, rifle

23
Q

what is the blunt renal trauma grading system

A

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

24
Q

why might renal tamponade be difficult to detect on A-E assessment

A

BP remains the same

25
Q

what is renal tamponade

A

compression of renal structures caused by the limited space for expansion

26
Q

what is “pie in the sky” bladder

A

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

3B week 5 - LUTS, The Scrotum and Genitalia (6 decks)

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