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Renal > Urological Emergencies and Outflow Tract Obstruction > Flashcards

Urological Emergencies and Outflow Tract Obstruction Flashcards

1
Q

Define acute urinary retention?

A

Inability to urinate with increasing pain

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2
Q

What is acute urinary retention often a complication of?

A

Benign prostatic hyperplasia

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3
Q

First treatment of acute urinary retention?

A

Need a catheter

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4
Q

With acute loin pain as well as urinary tract what other causes should you consider?

A 
AA
Malignancy
Ovarian/ testicular Torsion
Ectopic pregnancy
GI cause
Lower resp pain
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5
Q

Intense loin to groin pain suggests?

A

Renal colic

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6
Q

Treatment of renal colic?

A

NSAIDS e.g. diclofenac
Small stones < 0.5cm diameter usually pass spontaneously if hydration is maintained
Larger stones may need intervention

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7
Q

Indications to treat renal colic urgently?

A

Pain is unrelieved by medication, pyrexia, persistent nausea/ vomiting, high grade obstruction

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8
Q

Frank haematuria =

A

Bladder cancer until proven otherwise

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9
Q

What must be ruled out in acute scrotum?

A

Testicular torsion

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10
Q

Testicular torsion peaks at what age?

A

13-15yo

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11
Q

Presentation of testicular torsion?

A

sudden, severe unilateral scrotal pain, associated vomiting

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12
Q

Only way to confirm something is testicular torsion or not?

A

Scrotal exploration

If torsion can untwist

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13
Q

What can mimic testicular torsion in slightly younger boys?

A

Torsion of the appendix testes (hydatid of Morgani)

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14
Q

Presentation of torsion of appendix testes?

A

Similar to testicular torsion potentially slightly less severe
There will be the blue dot sign

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15
Q

Blue dot sign?

A

Torsion of the appendix testes

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16
Q

Treatment of torsion of appendix testes?

A

Supportive

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17
Q

Describe benign prostatic hyperplasia?

A

This occurs often in men over 60 yo and aetiology not fully understood. Microscopically hyperplasia affects the glandular and connective tissue elements of the prostate.
Enlargement of the gland stretches and distorts the urethra obstructing bladder flow.

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18
Q

Describe symptoms men with benign prostatic hyperplasia may complain of?

A

When bladder is filling: frequency, urgency, nocturia
When trying to pass urine: hesitancy, poor flow intermittent flow, sensation of incomplete emptying, post micturition dribbling

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19
Q

What suggest high pressure chronic retention in those with BPH?

A

bedwetting

20
Q

Red flag signs in suspected BPH that may actually suggest bladder cancer?

A

Haematuria
Suprapubic pain
Recurrent UTIs

21
Q

With suspected BPH what should you make sure to ask about?

A

Pain in back and neurological symptoms

Need to rule out cauda equina etc

22
Q

Describe exam and investigations for BPH?

A

Abdo exam > enlarged bladder
DRE > Benign prostate characteristically feels smooth
Investigations: urine culture, serum PSA, renal function, US, pressure flow studies of bladder emptying

23
Q

Medical management of BPH?

A

Alpha blockers e.g. tamsulosin act to relax prostate and bladder smooth muscle
5 alpha reductase inhibitors e.g. finasteride which block conversion of testosterone to dihydrotestosterone the androgen primarily responsible for prostatic growth and enlargement
Anticholinergics which inhibit bladder smooth muscle contraction
Beta agonist inhibits bladder smooth muscle contraction

24
Q

Describe surgical treatment of BPH?

A

Transurethral resection of prostate gland or holmium laser enucleation of prostate

25
Q

Priorities in acute retention or retention with overflow in BPH?

A

Relieve pain and catheterise the bladder

26
Q

3 things that can promote stone formation?

A

Urinary stasis, infection and indwelling catheters

27
Q

Stones form if stone forming substances _________

A

reach high enough concentrations to crystallise out of solution

28
Q

Most common stones?

A

Calcium stones

29
Q

Predisposing factors to calcium stones?

A

Low urine volume
high urine calcium and oxalate
Low urine citrate (citrate usually helps inhibit stone formation)

30
Q

Hypercalciuria occurs in _________ of patients with stones and usually idiopathic and due to ________

A

65%

increased intestinal calcium absorption

31
Q

Urate stones form in what type of urine?

A

Acidic urine

32
Q

Why may you get acidic urine and urate stones?

A

May be idiopathic
Due to enzyme defects
Rapid cell turnover/ death e.g. malignancy and chemo
Loss of alkaline bowel contents in diarrhoea, ileostomy, or laxative abuse

33
Q

UTI stones are composed of ________ usually due to infection with __________

A

magnesium, ammonium phosphate with varying amounts of calcium
Proteus

34
Q

Why do cystine stones form?

A

Due to autosomal recessive defect in the dibasic amino acid transporter which reduces cystine reabsorption causing cystinuria

35
Q

What kidney diseases are associated with stones?

A

PKD, Medullary sponge kidney and renal tubular acidosis

36
Q

Drugs associated with kidney stones?

A

Loops, antacids, vit d and c, acetazolamide and theophylline

37
Q

Presentation of renal stones?

A 
asymptomatic often
Pain: renal colic
Haematuria
UTI 
Urinary tract obstruction
38
Q

Calculi get stuck at 3 predictable sites which are ________

A

pelviureteric junction
pelvic brim (where ureter kind of turns as goes over the pelvis)
vesicoureteric junction

39
Q

Investigations for stones?

A 
XR
US
Contrast CT
Check for UTI
Check renal function
40
Q

Stones _____ usually pass spontaneously

A

less than 0.5cm in diameter

41
Q

Long term treatment of calcium stones?

A

Decrease calcium, sodium and animal protein in diet and maintain hydration

42
Q

Long term treatment of urate stones?

A

Investigate if underlying cause, decrease dietary purines (eg. red meats) increase urine alkalisation with sodium bicarbonate or potassium citrate, allopurinol to inhibit rate production

43
Q

Long term treatment of cystine stones?

A

Good fluid intake, alkalisation of urine with sodium bicarbonate

44
Q

Acute pain relief for renal colic?

A

NSAIDS- diclofenac

45
Q

Bladder stones are usually associated with ______ and present with _______

A

Bacteruira

Frequency dysuria and haematuria

46
Q

Presence of renal stones is usually checked for with?

A

USS

Renal (19 decks)

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