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Renal > Urological emergencies > Flashcards

Urological emergencies Flashcards

1
Q

What is acute urinary retention a complication of?

A

BPH

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2
Q

What are the symptoms of acute urinary retention?

A

Inability to urinate with increasing pain

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3
Q

What are the different types of acute urinary retention?

A

Spontaneous

Precipitated

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4
Q

What can cause precipitated acute urinary retention?

A

Non-prostate related surgery
Catheterization or urethral instrumentation
Anaesthesia
Medication with sympathomimetic or anticholinergic effects

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5
Q

What is the treatment of acute urinary retention?

A

Catheter

If painful retention <1L residue and normal serum electrolytes then trial without catheter (TWOC) during same admission

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6
Q

What is post-obstructive acute urinary retention?

A

Often present in patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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7
Q

How do you monitor post-obstructive diuresis?

A

Monitor fluid balance and beware if urine output >200 ml/hr

Usually resolves in 24 -48 hrs but in severe cases may require IV fluids and sodium replacement

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8
Q

What are the differentials of acute loin pain?

A

Ureteric colic secondary to calculus

Possibility of diagnosis outwith urinary tract, especially AAA

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9
Q

What is the pain mediated by in renal colic?

A

Prostaglandin release by ureter in response to obstruction

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10
Q

What is the treatment for ureteric colic?

A

PR diclofenac +/- opiate

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11
Q

How likely is a spontaneous passage of a ureteric stone?

A

<4mm 80%
4-6mm 59%
>6mm 21%

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12
Q

What are indications to treat a ureteric obstruction urgently?

A

Pain unrelieved
Pyrexia
Persistent nausea/ vomiting
High-grade obstruction

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13
Q

What is the emergency treatment for a ureteric stone?

A

Ureteric stent
Stone fragmentation if not infection
Percutaneous nephrostomy for infected hydronephrosis

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14
Q

What can cause frank haematuria?

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

What investigation is required for frank haematuria?

A

CT urogram

Cystoscopy

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16
Q

What are the differentials of an acute scrotum?

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

What is the cause of torsion of a spermatic cord?

A

Most common at puberty
Occurs with trauma or athletic activity but usually spontaneous
Adolescent often woken from sleep

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18
Q

What are the symptoms of an acute torsion?

A 
N+V 
Referral of pain to lower abdomen
Testis high in scrotum
Transverse lie
Absence of cremasteric reflex 
Acute hydrocele and oedema may obliterate landmarks
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19
Q

How can an acute torsion be investigated?

A

Doppler USS but do NOT delay exploration with fixation of both testes

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20
Q

What can be seen of a torsion of the appendage?

A

Localised tenderness at upper pole with a blue dot sign

Testis should be moblie and cremasteric reflex present

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21
Q

How will epididymitis present?

A

Dysuria
Pyrexia
UTI
Urethritis

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22
Q

What are the signs of epididymitis?

A

Cremasteric reflex present
Suspect if pyuria
Doppler - swollen epididymis, increased blood dow
Send urine for culture + chlamydia PCR

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23
Q

What is the treatment for epididymitis?

A

Analgesia + scrotal support, bed rest

Ofloxacin 400g/day for 14 days if chlamydia

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24
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to the phimotic ring
Happens after the foreskin is retracted for catheterization or cystoscopy and staff member forgets to replace in its natural position

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25
Q

How is paraphimosis treated?

A

Iced glove
Multiple punctures in oedematous skin
Manual compression of gland with distal retraction on oedematous foreskin
Dosal slit

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26
Q

What is priapism?

A

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

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27
Q

What is the aetiology of priapism?

A 
Intracorporeal injection for ED 
Trauma
Hematological dyscrasias
Neurological conditions
Idiopathic
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28
Q

What is the classification of priapism?

A

Ischaemia (veno-occlusive or low flow)
Vascular stasis in penis and decreased venous outflow
Non-ischaemia

29
Q

What causes non-ischaemic priapism?

A

Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora
Fistula formation between cavernous artery and lacular spaces allows blood to by pass the normal helicine arteriolar bed

30
Q

How is non-ischaemic priapism diagnosed?

A

Aspirate blood from corpus cavernosum - dark blood, low O2, high CO2
Duplex - minimal or absent flow in cavernosal arteries in low-flow normal to high flow in non-ischaemic priapism

31
Q

How is ischaemic priapism treated?

A

Aspiration +/- irrigation with saline
Injection of alpha-agonist (phenylephrine)
Surgical shunt

32
Q

How is non-ischaemic priapism treated?

A

Observe, may resolve spontaneously

Selective arterial embolization with non-permanent materials

33
Q

What is fournier’s gangrene?

A

Necrotizing fasciitis occuring about the male genitalia

Arises from skin, urethra or recatal region

34
Q

What are predisposing factors to fournier’s gangrene?

A

Diabetes
Local trauma
Periurethral extravasation
Perianal infection

35
Q

What will fournier’s gangrene start as?

A

Cellulitis - swollen, erythematous, tender
Marked pain, fever, systemic toxicity
Swelling and crepitus of scrotum, dark purple areas

36
Q

How is fournier’s gangrene investigated?

A

Plain x-ray or USS to look for gas in tissues

37
Q

How is fournier’s gangrene treated?

A

Antibiotics

Surgical debridement

38
Q

What is emphysematous pyelonephritis?

A

Necrotizing parenchymal and perineal infection caused by gas-forming uropathogens, usually e.coli

39
Q

What is emphysematous pyelonephritis associated with?

A

Diabetes

Ureteric obstruction

40
Q

What will emphysematous pyelonephritis present with?

A

Fever, vomiting, flank pain
Gas on KUB
CT to define extent of emphysematous process

41
Q

What is a perinephric abscess?

A

Usually results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
Flank mass in 50%

42
Q

What will a perinephric abscess show clinically?

A

High WCC
High serum creatinine
Pyuria

43
Q

What is the investigation of choice for a perinephric abscess?

44
Q

What is the treatment of choice for a perinephric abscess?

A

Antibiotics + percutaneous or surgical drainage

45
Q

What is stage 1 renal trauma?

A

Haematoma, subcapsular, non-expanding, no parenchymal laceration

46
Q

What is stage 2 renal trauma?

A

Laceration <1cm parenchymal depth without urinary extravasation

47
Q

What is stage 3 renal trauma?

A

> 1cm depth, no collecting system rupture or extravasation

48
Q

What is stage 4 renal trauma?

A

Laceration through cortex, medulla and collecting system

Main arterial/ venous injury with contained haemorrhage

49
Q

What is a stage 5 renal trauma?

A

Shattered kidney

Avulsion of hilum, devascularization kidney

50
Q

What are indications for imaging in renal trauma?

A

Frank haematuria in adult
Frank or occult haematuria in child
Occult haematuria + shock (systolic <90 mmHg at any point)
Penetrating injury with any degree of haematuria

51
Q

What is the investigation of choice in renal trauma?

A

CT with contrast

52
Q

What is the treatment of choice in renal trauma?

A

98% non op

Angiography or embolization

53
Q

When is surgery indicated in renal trauma?

A

Persistent renal bleeding
Expanding perirenal haematoma
Pulsatile perirenal haematoma

54
Q

What injury is a bladder injury associated with?

A

Pelvic injury

55
Q

What are the symptoms of a bladder injury?

A

Suprapubic/ abdo pain + inability to void
Suprapubic tenderness, lower abdo bruising
Guarding/ rigidity
Diminished bowel sounds

56
Q

When should you NOT pass a catheter in suspected bladder injuries?

A

Blood at external meatus suggests urethral injury - pass suprapubic catheter

57
Q

What is the imaging of choice in bladder injuries?

A

CT cystography

58
Q

What is the treatment for a bladder injury?

A

Large bore catheter
Antibiotics
Repeat cystogram in 14 days

59
Q

What is a posterior urethral injury associated with?

A

Fracture of pubic rami

60
Q

What part of the urethra is most vulnerable to injury?

A

Posterior urethra is fixed at the urogenital diaphragm and puboprostatic ligaments so bulbomembranous junction most vulnerable

61
Q

What are the signs of a urethral injury?

A 
Blood at meatus
Inability to urinate
Palpably full bladder
High riding prostate
Butterfly perineal haematoma
62
Q

What is the investigation of choice in a urethral injury?

A

Retrograde urethrogram

63
Q

What is the treatment of choice in a urethral injury?

A

Suprapubic catheter

Delayed reconstruction after at least 3 months

64
Q

How does a penile fracture occur?

A

During intercourse, buckling injury when penis slips out of vagina and strikes pubis
Cracking or popping followed by pain, discoloration and swelling

65
Q

What is the treatment of choice in a penile fracture?

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartment

66
Q

What will testicular injury present with?

A

Exquisite pain and nausea

Swelling and brusing

67
Q

What is the imaging modality of choice in a testicular injury?

A

USS to determine integrity and vascularity

68
Q

What is the treatment of choice in a testicular injury?

A

Early exploration/ repair improves testis salvage, reduced convalescence, better preserves fertility and hormonal function

Renal (22 decks)

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