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AY Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

Presentation of acute urinary retention

A

Inability to urinate with increasing pain

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2
Q

What is acute urinary retention a complication of?

A

BPH

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3
Q

Treatment of acute urinary retention?

A

Catheterisation

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4
Q

If painful retention with

A

Trial without catheter (TWOC)

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5
Q

What should be prescribed before TWOC for best chance of success?

A

Uroselective alphablocker (Alfuzosin, Tamsulosin)

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6
Q

Why do patients get postobstructive diuresis?

A

Solute diuresis (retained irea, sodium & water) + defect in concentrating ability of kidney

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7
Q

How long does post-obstructive diuresis take to resolve?

A

Approx. 24 hrs

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8
Q

Potential diagnosis of loin pain outwith urinary tract

A

AAA

Muscular pain

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9
Q

What causes pain in ureteric colic secondary t calculus?

A

Pain mediated by prostaglandins released by ureter in response to obstruction

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10
Q

Treatment of ureteric colic

A

NSAID +/- opiate

Alphablocker (tamsulosin) for small stones that are expected to pass

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11
Q

What are the indications to treat ureteric colic urgently

A

Pain unrelieved
Pyrexia
Persistant nausea/vomiting
High-grade obstruction

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12
Q

Treatment of urgent stones in the abscence of infection

A

Ureteric stent or stone fragmentation/removal

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13
Q

Treatment for infected hydronephrosis

A

Percutaneous nephrostomy

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14
Q

Causes of frank haematuria

A 
Infection 
Stones 
Tumours 
BPH 
Polycystic kidneys 
Trauma 
Coagulation/platelet deficiencies
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15
Q

Investigation of frank haematuria?

A

CT urogram + cystoscopy

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16
Q

Causes of acute scrotal pain

A 
Torsion of spermatic cord 
Torsion of appendix testis 
Epidymitis/epididymo-orchitis 
Inguinal hernia 
Hydrocoele 
Trauma/insect bite 
Dermatological lesions 
Inflammatory vasculitis 
Tumour
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17
Q

When is torsion of the spermatic most common?

A

Puberty

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18
Q

Presentation of torsion fo spermatic cord

A

Sudden onset pain
(sometimes previous episodes of self-limiting pain)
Referra of pain to lower abdomen
May be nausea/vomtiting

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19
Q

Examination findings of testicular torsion

A

Testis high in scrotum
Transverse lie
Abscence of cremasteric reflex
(Acute hydrocoele + oedema may obliterate landmarks)

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20
Q

Investigation of testicular torsion

A

Doppler USS

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21
Q

Treatment of testicular torsion

A

Prompt exploration (

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22
Q

Why must the contralateral side be fixed in testicular torsion

A

Bell clapper deformity

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23
Q

What is the blue dot sign indicative of?

A

Torsion of appendage of testis

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24
Q

If there is a torsion of the appendage of testis is the cremasteric reflex present?

A

Yes

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25
Q

What features of a history would suggest epididymitis rather than testicular torsion?

A

Hx of UTI, uretheritis, catherterization/instrumentation

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26
Q

Examination findings of epidiymitis

A

Cremasteric refle present

Pyuria

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27
Q

Doppkler findings od epididymitis

A

Swollen epididymis

Increased blood flow

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28
Q

Investigations for epididymitis

A

urine for culture + Chlamydia PCR

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29
Q

Treatment of epididymitis

A

Analgesia + scrotal support

Ofloxacin for 14 days

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30
Q

s idiopathic scrotal oedema associated with erythema?

A

Not usually

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31
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to a phimotic ring

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32
Q

What does paraphimosis usually occur after?

A

Foreskin retracted for surgery or ytoscopy and staff member forgets to replace it in its natural replacement

33
Q

Treatment of paraphimosis

A

Iced glove
Granulated sugar for 1-2 hrs
Multiple punctures in oedematous skin

34
Q

What is priapism?

A

Prolonged erection (>4hrs) often painful and not asociated with sexual arousal

35
Q

Causes of paraphimosis

A

Intracorporeal injection for ED
Trauma
Haematologic dyscrasias
Neurological conditions

36
Q

Pathogenesis of ischaemic (low flow) paraphimosis

A

Vascular stasis in penis - decreased venous outflow - compartment syndrome

37
Q

Pathogenesis of non-ischaemic (high flow) paraphimosis

A

Traumatic disruption of penile vasculature results in unregulated blood entry

38
Q

How can different types of paaphimosis be distinguished

A

Aspirated blood

Duplex USS

39
Q

Treatment of ischaemic paraphimosis

A

Apiraation +/_ irrigation with saline

Injection of alpha-agonist (e.g. phenyl epinephrine) Surgical shunt

40
Q

Treatment for very delayed presentation of ischaemic priapism

A

Consider immediate placement of penile prosthesis

41
Q

Treatment of non-ischaemic priapism

A

Observe - may resolve spontaneously

42
Q

What is Fourneirs gangrene?

A

A form of necrotizing fasciitis occuring about the male genitalia

43
Q

Predisposing factors to fourneir’s gangrene

A

Diabetes
Local trauma
Periurethral etravasation
Perianal infection

44
Q

What does fourniers gangrene start as?

A

Cellulitis (swollen, erythematous, tednder, marked pain, fever, systemic toxicity)

45
Q

Presentation of Fourneir’s gangrene?

A

Swelling + crepitus of scorum
Dark purple aras
often marked toxicity out of proporion of local findgins

46
Q

Investigations of Fourneir’s gangrene

A

X-ray or USS (confirm gas is tissues)

47
Q

Treatment of Fourneir’s gangrene

A

Antibiotics + surgical debridement

48
Q

Mortality from Fournier’s gangrene is 20% higher in which 2 groups

A

Diabetics

Alcoholics

49
Q

What is emphysematous pyelonephritis?

A

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens

50
Q

What is most common causal organism in emphysematous pyelonephritis?

A

E. coli

51
Q

Why group is most prone to emphysematous pyelonephritis?

A

Diabetics

52
Q

What is emphysematous pyelonephritis often associated with?

A

Ureteric obstruction

53
Q

Clinical presentation of emphysematous pyelonephritis

A

Fever
Vomiting
Flank pain

54
Q

Investigations for emphysematous pyelonephritis

A

X-ray (see gas_

CT (defines extent of ephysematous process)

55
Q

Treatment of emphysematous pyelonephritis

A

Often nephrectomy

56
Q

What is the most likely causes of perinephric abscess?

A

Rupture of acute cortical abscess into the perinephric space OR haematogenous seeding from sites of infection

57
Q

Investibgation for perinephric abscess

A

CT

will also be high WCC, high serum creatinine, pyuria

58
Q

Treatment of perinephric abscess

A

Antibiotics + percutaneous or surgical drainage

59
Q

What is grade I renal trauma?

A

Haematoma, subcapsular, non-expanding, no parechymal laceration

60
Q

What is grade II renal trauma?

A

Laceration

61
Q

What is grade III renal truma?

A

> 1cm depth of parenchymal laceration, no collecting system rupture of extravasation

62
Q

What is grade IV renal trauma?

A

Laceration through corte, medulla and collecting system

Main arterial/venous injury with contained haemorrhage

63
Q

What is grade V renal trauma?

A

Shattered kidney

Avulsion of hilum, devascularizing kidney

64
Q

Indications for imaging in renal trauma

A

Frank haematuria in adult
Frank or occult haematuria in child
Occult haematuria + shock
Penetrating injury with any degree of haematuria

65
Q

What is the first line investigation for renal truma

A

CT with contrast

66
Q

What would indicate that surgery is needed in renal trauma?

A

Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma, urinary extravasation, non-viable tissue, incomplete staging

67
Q

Which fracture is bladder injury commonly associated with?

A

Pelvic fracture

68
Q

Clinical presentation of bladder injry

A 
Suprapubic/abdominal pain 
Inability to void 
Suprapubic tenderness
Lower abdo bruising 
Guarding/rigidity 
Diminished bowel sounds
69
Q

Imaging for bladder injury

A

CT cystography

70
Q

Management of bladder injury

A

Large bore catheter
Antibiotics
Repeat cystogram in 14 days

71
Q

What is posterior urethral injury often associated with?

A

Fracture of pubic rami

72
Q

Which part of the urethra is most prone to injury

A

Bulbomembranous junction

73
Q

Clinical findings of urethral injury

A 
Blood at meatus 
Inability to urinate 
Palpably full bladder 
"High-riding" prostate 
Butterfly perineal haematoma
74
Q

Investigation for urethral injury

A

Retrograde urethrogram

75
Q

Management of urethral injury

A

Suprapubic catheter

Delayed reconstruction after at least months

76
Q

What is the most common cause of penile fracture?

A

Sex buckling injury as penis slips out of agina and strikes pubis

77
Q

Clinical presentation of penile fracture

A

Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling

78
Q

Treatment of penile fracture

A

Prompt exploration & repair

Circumcision incision with degloving to expose all 3 compartments

79
Q

Investigaion of choice for testicular injury

A

USS to asses integrity/vascularity

AY Renal (15 decks)

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