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2 Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

main complication of BPH

A

acute retention

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2
Q

causes of acute urinary retention

A 
prostate infection
BPH
bladder overdistension
excessive fluid intake
alcohol
prostatic infarction
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3
Q

name the 2 types of acute retention

A

precipitated

spontaneous

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4
Q

what can cause precipitated urinary retention

A

non-prostate related surgery
catheterisation
anaesthesia
anticholinergic medication

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5
Q

Tx of acute retention

A

catheter if >1l in bladder

trial without catheter + tamsulosin if <1l residue in bladder

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6
Q

patient with uraemia, oedema, CCF, hypertension who presents with oliguria?

A

post obstructive diuresis

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7
Q

what is solute diuresis?

A

retained urea, Na and water + inability of kidney to concentrate urine

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8
Q

urine output over __ ml/hr is unusual in a patient who hasnt been drinking

A

200

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9
Q

Tx of post obstructive diuresis?

A

monitor fluids and UO

give IV fluids and Na replacement if not resolved within 2 days

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10
Q

pre surgical Tx of stones?

A

IM diclofenac if no renal failure +/- opiates

give tamsulosin if small stone too

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11
Q

differential for acute loin pain?

A

stones

AAA

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12
Q

if stone hasn’t passed in _ __ it is likely to require intervention

A

1 month

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13
Q

the ureters can be found in line with what bony structures?

A

transverse processes of the spine

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14
Q

if a patient with stones is very sick how should you treat them?

A

ureteric stent/stone fragmentation if no infection

percutaneous nephrostomy if infected hydronephrosis

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15
Q

painless frank haematuria makes you think…

A

bladder cancer

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16
Q

what type of catheter is used for clot retention?

A

3 way irrigating haematuria catheter

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17
Q

Ix for frank haematuria?

A

CT urogram

cystoscopy

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18
Q

causes of frank haematuria?

A 
stones
infection
tumour
BPH
polycystic kidneys
trauma
coagulation deficiency
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19
Q

what 2 structures can be torted in the scrotum?

A

spermatic cord

appendix testis

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20
Q

main infectious conditions of the scrotum?

A

epididymitis

epididymo-orchitis

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21
Q

most common causes of epididymo-orchitis?

A

young men- STI

older men- catheter

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22
Q

of the 2 structures in the scrotum that can be torted, which is the most painful and severe?

A

spermatic cord

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23
Q

most common time for testicular torsion and why?

A

puberty as this is when testicular volume gets bigger

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24
Q

pain in scrotum waking teenage boy up from sleep; has nausea and vomiting…

A

testicular torsion

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25
Q

on examination the testicle is found where in testicular torsion?

A

lies high in the scrotum and is facing sideways

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26
Q

what is the onset of the pain in torsion?

A

sudden

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27
Q

where can pain refer in torsion?

A

lower abdoemn

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28
Q

there is loss of what reflex in torsion?

A

cremasteric reflex

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29
Q

Ix of torsion?

A

doppler USS

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30
Q

Tx of torsion?

A

fix it if get it in time
if dead remove
fix the other side

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31
Q

what sign can be found in early torsion?

A

blue dot sign (appendix testis is engorged with blood)

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32
Q

who gets epididymitis?

A

adults

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33
Q

pyrexial patient with urinary symptoms with increased blood flow on imaging and a swollen scrotum…

A

epididymitis

34
Q

important things to ask in PMH for a suspected epididymitis?

A

UTI
urethritis
catheterisation

35
Q

Ix for epididymitis?

A

doppler- INC blood flow
urine culture
chlamydia PCR

36
Q

Tx of epididymitis?

A

analgesia
scrotal support
bed rest
ofloxacin 400mg/day for 2 weeks

37
Q

antibiotic for epididymitis?

A

ofloxacin for 2 weeks

38
Q

child presents with swollen scrotum without fever or tenderness, slightly itchy..

A

idiopathic scrotal oedema

39
Q

what is paraphimosis?

A

painful swelling of the foreskin distal to a phimotic ring

40
Q

what can cause a paraphimosis?

A

after foreskin is retracted for catherisation or cystoscopy and it isnt brought back to normal

41
Q

Tx of paraphimosis

A

iced glove for 2hrs
puncture edematous skin
compress glans
dorsal slit

42
Q

what condition is called “compartment syndrome of the penis”?

A

priapism

43
Q

main signs and symptoms of priapism?

A

prolonged erection over 4hrs

painful and NO sexual arousal

44
Q

causes of priapism?

A 
erectile dysfuncton injecton
trauma
sickle cell anaemia
neuro conditions
idiopathic
45
Q

main pathophysiology of priapism?

A

ischaemia of the penis due to vascular stasis and lack of venous outflow OR disrupted penile vasculature (non-ischaemic)

46
Q

Ix of priapism?

A

aspirate blood- if it looks dark it could be ischaemic

colour duplex USS- minimal or absent flow in ischaemic, normal to high flow in non-ischaemic

47
Q

Tx of ischaemic priapism?

A

aspiration +/- irrigation with saline
inject alpha blocker
insert shunt

48
Q

Tx of non-ischaemic priapism?

A

observe, may resolve spontaneously

selective arterial embolisation

49
Q

fournier’s gangrene is the penile form of what condition?

A

necrotising fasciitis

50
Q

Tx of fournier’s gangrene

A

surgical debridement

antibiotics

51
Q

predisposing factors to fournier’s gangrene?

A

infection around this area
diabetes
trauma

52
Q

pathophysiology of fournier’s gangrene?

A

begins as cellulitis, then get swelling and crepitus of scrotum (looks dark purple)

53
Q

Ix of fournier’s gangrene?

A

X ray or USS to confirm gas in tissue

54
Q

causative organism of emphysematous pyelonephritis?

A

gas forming uropathogen eg e coli

55
Q

who gets emphysematous pyelonephritis?

A

diabetics

56
Q

associated symptom of emphysematous pyelo?

A

ureteric obstruction

57
Q

diabetic man presents with obstruction, fever, vomiting and flank pain with gas on KUB imaging…

A

emphysematous pyelo

58
Q

Ix of emphysematous pyelo?

A

KUB for gas

CT for extent of emphysema

59
Q

Tx of emphysematous pyelo?

A

nephrectomy

60
Q

findings on bloods in someone with a pyelonephric abscess?

A

high WCC

high creatinine

61
Q

Ix of pyelonephric abscess?

A

bloods

CT

62
Q

Tx of perinephric abscess?

A

antibiotics

percutaneous or surgical drainage

63
Q

which kidney problem will present with a flank mass?

A

perinephric abscess

64
Q

main test for frank haematuria

A

CT with contrast always

65
Q

bladder injury is commonly associated with what problem?

A

pelvic fracture

66
Q

main symptoms of a bladder injury?

A

subrapubic pain and tenderness
inability to void
guarding
diminished bowel sounds

67
Q

there will be gross haematuria in bladder injury T or F

A

T

68
Q

Ix of bladder injury

A

CT cystography

69
Q

Tx of bladder injury?

A

large bore catheter
antibiotics
repeat cystogram in 14 days

if bad, needs surgery

70
Q

a “flame shaped collection of contrast in the pelvis” is likely to be an intra or extraperitoneal injury?

A

extraperitoneal

71
Q

the prostate is attached to what ligament?

A

puboprostatic ligaement

72
Q

posterior urethral injury is often associated with fracture of what structure?

A

pubic rami

73
Q

signs and symptoms of urethral injury?

A 
blood at meatus
cant urinate
palpable full bladder 
high prostate
haematoma
74
Q

what is the haematoma from a urethral injury said to look like?

A

butterfly perineal haematoma

75
Q

Tx of urethral injury?

A

suprapubic catheter

76
Q

main cause of penile fracture

A

intercourse

77
Q

man experiences popping sound followed by pain whilst having sex…

A

suspected penile fracture

78
Q

main signs and symptoms of penile fracture

A

pain
discolouration
swelling

79
Q

Ix of testicular injury?

A

USS

80
Q

main symptoms of testicular injury?

A

pain and nausea

2 Renal (34 decks)

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