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Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is acute urinary retention a complication of?

A

BNH

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2
Q

What are the symptoms of acute retention?

A

inability to urinate with increasing pain

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3
Q

What can cause acute urinary retention?

A

prostate infection, bladder overdistension, excessive fluid intake, alcohol, antimuscarinic drugs

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4
Q

What is the treatment for acute retention?

A

catheterisation

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5
Q

What can be prescribed to imrpvoe chance of voiding success following acute retention?

A

uroselective alphablocker- alfuzosin; tamsulosin

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6
Q

When can trial withou catheter be trailled during same admission as acute retention?

A

less than 1 litre residue and normal electrolytes

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7
Q

What is post-obstructive diuresis?

A

poly-uric state post the relief of a urinary tract obstruction- defect in concentrating ability of the kidney

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8
Q

What is the treatmnet for post-obstructive diuresis?

A

monitor fluid blaance, usually resolves within 24-48hrs

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9
Q

How long does it take haematuria after acute retention to resolve?

A

24 hours

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10
Q

What is a differential in acute loin pain outwith urinary tract?

A

AAA

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11
Q

What mediates the pain with ureteric colic?

A

prostaglandins released by the ureter in response to obstruction

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12
Q

What is the treatment for acute loin pain?

A

NSAIDs +/- opiate

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13
Q

What drug may be given for stones that are expected to pass?

A

alphablockers

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14
Q

What is the chance of a stone less than 4mm of spontaneous passage?

A

80%

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15
Q

What is the chance of a stone between 4-6mm of spontaneous passage?

A

59%

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16
Q

What is the chance of a stone greater than 6mm of spontaneous passage?

A

21%

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17
Q

In addition to he size of the stone, what also impacts chance of spontaneous passage?

A

site of stone at first presentation

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18
Q

After what length of time if the stone has not passed is it unlikley to do so?

A

1 month

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19
Q

What are the indications to treat acute loin pain urgently?

A

pain unrelieved, pyrexia, persistnet N&V; high-grade obstruction

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20
Q

What is urgent treatmnet for acute loin pain if no infection?

A

ureteric stent or stone fragmentation/removal

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21
Q

What is the urgent treatmnet for acute loin pain with infection?

A

percutaneous nephrostomy

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22
Q

What are teh causes of frank haematuria?

A

infection; stones; tumours; BNH; polycystic kidneys; trauma; coag/plateley deficiencies

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23
Q

What is the treatment if a clot is causing acute retention?

A

using a 3-way irrigating haematuria catheter

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24
Q

What is the investigation for frank haematuria?

A

CT urogram and cystoscopy

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25
Q

What are teh causes of acute scrotum?

A

torsion of spermatic cord; torsion of appendix testis; epididymitis; inguinal hernia; hydrocele; trauma/insect bite; derm; inflam vasculitis; tumour

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26
Q

When is testicular torsion most common?

A

puberty

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27
Q

What is the typical onset of pain with testicular torsion?

A

woken from sleep

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28
Q

What is the presentation of testicular torsion?

A

sudden onset pain; seomtimes previous self-limiting pain; may have N and V; reffered to lower abdo

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29
Q

What is seen on exam with testicular torsion?

A

testis high in scrotum; transverse lie and absence of cremasteric reflex

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30
Q

What is the investigation for testicular torsion?

A

doppler USS

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31
Q

What is the treatment for testciular torsion?

A

prompt exploration and 2/3 point fixation with non-absorbable sutures, and fix contralateral side

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32
Q

How soon can irreversbile ischaemia begin with testicular torsion?

A

4 hours

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33
Q

What is seen on torsion of appendage?

A

loacalised tenderness at upper pole and blue dot sign

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34
Q

What is seen on exam of torsion of appendage?

A

testis mobile and cremasteric reflec present

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35
Q

what is the treatment for torsion of appendage?

A

reoslves spontaneously

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36
Q

What symptoms are seen more in epididymitis compared with torsion?

A

dysuria and pyrexia

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37
Q

What is typically seen in the patient history of those with epididymitis?

A

hx of UTI, urethritisi, catheterisation/instrumentation

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38
Q

What is seen on exam with epididymitis?

A

cremasteric reflex present; pyrexia; doppler- increased bloodflow and swollen epididymis

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39
Q

What is the invesigations for epididymitis?

A

doppler USS and urine culture and chlamydia PCR

40
Q

What is the treatment for epididymitis?

A

analgesia and scrotal support; ofloxacin

41
Q

What is idiopathic scrotal oedema?

A

self-limiting; no erythema or fever, child is usually happy

42
Q

What is paraphimosis?

A

painful swelling of the foreskin distal to a phimotic ring

43
Q

When does paraphimosis occur?

A

after foreskin retracted and not replaced in natural position

44
Q

What is the treatment for paraphimosis?

A

iced glove; granulated sugar; mulitple punctures in oedematous skin; manual compression of glans with distal traction; dorsal slit

45
Q

What is priapism?

A

prolonged erection (>4hrs)

46
Q

What can cause priapism?

A

intracorporeal injection for ED; trauma; haematologic- sickle cell; neuro; idiopathic

47
Q

What are the 2 types of priapism?

A

ischaemic and non-ischaemic

48
Q

What happens with ischaemic priapism?

A

vascular stasis in penis and decreased venous outflow- compartment syndrome

49
Q

What happens with non-ischaemic priapism?

A

traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora

50
Q

What is the investigation of priapism?

A

aspirate blood from corpus cavernosum and doppler USS

51
Q

What would indicate low-flow priapism on blood aspirate?

A

dark blood, low O2 and high CO2

52
Q

What is seen with low-flow on USS ?

A

minimal or absent flow in cavernosal arteries

53
Q

What is the treatmnet for ischaemic priapism?

A

aspiration +/- irrigation with saline; injection of alpha agonist; surgical shunt

54
Q

After what time period is ischaemic priapism unlikely to respond?

A

> 48-72hrs

55
Q

What is the treatment for non-ischaemic priapism?

A

may resolve spontaneously; selective arterial embolization with non-oermanent materials

56
Q

What is Fournier’s gangrene?

A

a form of necrotisiing fasciitis occuring about the male genitalia

57
Q

What are the risk factors for Fournier’s gangrene?

A

DM; local trauma; peri-urethral extravasation and peri-anal infection

58
Q

What does Fournier’s start as?

A

cellulitis

59
Q

What are the signs of Fournier’s gangrene?

A

swollen; erythematous, tender, marked pain, fever, systemic toxicity, crepitus of scrotum; dark purple areas

60
Q

What is the investigation of Fournier’s gangrene?

A

plain xray or USS- gas in tissues

61
Q

What is the rteatment for Fournier’s?

A

antibiotics and surgical debridement

62
Q

What is emphysematous pyelonephritis?

A

an acute necrotisiing parenchymal and perirenal infection caused by gas-forming uropathogens usually E.coli

63
Q

Who does emphysematous pyelonephritis occur in?

A

DM

64
Q

What are the symptoms of emphysematous pyelonephritis?

A

fever, vomiting, flank pain, often assoc with ureteric obstruction

65
Q

What are the investigations of emphysematous pyelonephritis?

A

gas on xray; CT

66
Q

What is the treatment for emphysematous pyelonephritis?

A

often requires nephrectomy

67
Q

What does a perinephric abscess usually result from?

A

a rupture of an acute cortical abscess into the perinephric space or from haematogenous spread

68
Q

What are the signs of perinephric abscess?

A

flank mass; high WBC; high creat; pyuria

69
Q

What is the investigation of perinephric abscess?

A

CT

70
Q

Waht is the treatmnet for perinephric abscess?

A

antibiotics and percut or surgical drainage

71
Q

What is 1 in classification of kidney trauma?

A

haematoma; subcapsular; non-expanding, no parenchymal laceration

72
Q

What is 2 in classification of kidney trauma?

A

laceration <1cm parenchymal depth without urinary extravasation

73
Q

What is 3 in classification of kidney trauma?

A

> 1cm depth, no collecting system rupture or extravasation

74
Q

What is 4 in classification of kidney trauma?

A

laceration thorugh cortex, medulla nd collecting system, main arterial/venous injury with contained haemorrhage

75
Q

What is 5 on kidney trauma?

A

shattered kidney; avulsion of hilum devascularising kidney

76
Q

What are the indications for imagin with suspected kidney trauma?

A

frank haematuria in adult; frank or occult haematuria in child; occult haematuria and shock in adult; penetrating injury with any haematuria

77
Q

What is the investiagtion for kidney trauma?

A

CT with contrast

78
Q

What are the indications for treatmnet with kidney trauma?

A

persistent renal bleeding; expanding/pulsatile perirenal haematoma; urinary extravasation, non-viable tissue

79
Q

What is the non-surgical tx of kidney trauma?

A

angiography/embolisation

80
Q

What is bladder injury commonly associated with?

A

pelvic fracture

81
Q

Waht are the symptoms of bladder injury?

A

suprapubic/abdo painand tenderness and inability to void, lower abdo bruising, guarding, decreased bowel sounds

82
Q

What is seen on catheterisation with bladder injury?

A

frank haematuria

83
Q

What should be done if there is blood at the external meatus or catheter doesnt pass easily?

A

retrograde urethrogram

84
Q

What is the imaging for bladder injury?

A

CT cystography

85
Q

What is seen on CT cystography with extraperitoneal bladder injury?

A

flame-shaped collection of contrast in pelvis

86
Q

What is the treatment for bladder injuries?

A

large bore catheter; antibiotics; repeat cystogram in 14 dayas

87
Q

What are the indications for immediate repair with bladder injuries?

A

intraperitoneal injury; penetrating injury; inadequte drainage; bladder neck injury; rectal or vaginal injury; open pevlic fracture or fracture requiring ORIF; bone fragments projecting into bladder

88
Q

What is posterior urethral injury often associated with?

A

fracture of pubic rami

89
Q

What is seen on exam with urethral injury?

A

blood at meatus; inability to urinate; palpably full bladder; high riding prostate on PR; butterfly perineal haematoma

90
Q

What is the investigation of urethral injury?

A

retrograde urethrogram

91
Q

What is the treatment of urethral injury?

A

suprapubic catheter; delayed reconstruction after 3 month

92
Q

When does penile fracture occur?

A

during intercourse; buckling injury when penis slips out of vagina and strikes pubis

93
Q

What are the syptoms of penile fracture?

A

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

94
Q

What is the treatmnet of penile fracture?

A

prompt exploration and repair; circumcision incision with degloving of penis to expose all 3 compartments

95
Q

What does testicular injury usually present with?

A

exquisite pain and nausae; swelling and bruising

96
Q

What is the investigation of testicular injury?

A

USS- integrity and vascularitiy

97
Q

What is the treatment for testicular injury?

A

early exploration/repair improves testis salvage, reduces convalescence

Renal (33 decks)

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