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Renal > Urological Emergency > Flashcards

Urological Emergency Flashcards

1
Q

What can cause acute urinary retention

A

BPH
Tumours
Anything that obstructs outflow

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2
Q

How do you treat acute urinary retention

A

Catheterisation
Give a uroselective alpha-blocker like alfuzosin
If less than 1L residue and normal electrolytes then trial off the catheter to see if normal function returns

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3
Q

What can cause acute loin pain

A

Ureteric colic secondary to calculus

Must consider non-urinary causes like AAA

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4
Q

How do you treat ureteric calculi

A

NSAID’s +/- opiate
Give alpha-blocker (Tamsulosin) for small stones that expected to pass
If stone is too large to pass then will need surgical intervention - pass scope up and laser the stone to fragment or PC nephrostomy if infected

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5
Q

What is the definitive test for calculi

A

Non contrast CT

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6
Q

What symptoms suggest that a calculi needs urgent treatment

A

Unrelieved pain
Pyrexia - infection
Persistent nausea/vomiting
High grade obstruction

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7
Q

List causes of frank haematuria

A 
Infection
Stones
Tumours
Benign prostatic hyperplasia (BPH)
Polycystic kidneys
Trauma
Coagulation/platelet deficiencies
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8
Q

What investigations should you do for a patient with frank haematuria

A

CT urogram + cystoscopy

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9
Q

How do you manage haematuria

A

Use a 3 way irrigating catheter
Washout of bladder - prevents clots forming
Monitor output and haemoglobin
Remove once settled

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10
Q

What can cause an acute scrotum

A 
Torsion of spermatic cord
Torsion of appendix testis
Epididymitis / epididymo-orchitis
Inguinal hernia
Hydrocoele
Trauma / insect bite
Dermatological lesions
Inflammatory vasculitis
Tumour
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11
Q

Testicular torsion is most common in which group

A

Teenagers – due to growth of testes

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12
Q

How does torsion of the spermatic cord present

A

Sudden onset of pain - severe and unilateral
May be woken from sleep
Nausea and vomiting
Lower abdominal pain

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13
Q

How do you diagnose torsion of the spermatic cord

A

Doppler can be used to rule it out – will show if there is blood flow to the testes
Mostly a clinical diagnosis - don’t delay treatment

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14
Q

How do you treat torsion of the spermatic cord

A

Urgent investigation - take them to theatre
Fix the teste and cord with non-absorbable suture
Remove any dead tissue
Fix both sides to prevent recurrence

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15
Q

What is the bell clapper deformity

A

When the teste sits transversely and is very mobile

High risk of torsion so should be fixed

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16
Q

What pathology gives the blue dot sign

A

Torsion of hydatid of Morgagni
Presents similarly to torsion
Seen in pre-pubescent children
Supportive treatment

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17
Q

What can cause epididymitis

A

STI
UTI
Urethritis
Catheterisation

18
Q

How does epididymitis present

A

Similar to torsion - pain etc
Dysuria
Pyrexia
Generally unwell

19
Q

What tests should you do if epididymitis is suspected

A

Doppler - will show swollen epididymis and increased blood flow
Urine culture
STI test

20
Q

How do you treat epididymitis

A

Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

21
Q

What is paraphimosis

A

Painful swelling of the foreskin distal to a phimotic ring
Foreskin is retracted but cannot come forward again
Gradually it pinches off blood supply – become more and more oedematous

22
Q

How do you treat paraphimosis

A

Ice to reduce swelling
Puncture oedmatous skin
Manual compression of glands and try and move the foreskin back to place
May need a dorsal slit in tissue

23
Q

What is priapism

A

Prolonged erection (>4hrs)
Painful
Not due to sexual arousal

Caused by lack of venous outflow from the penis or unregulated arterial flow that makes it rigid and painful

24
Q

What can cause priapism

A 
Intracorporeal injection for ED, e.g. papaverine
Trauma (penile / perineal)
Haematologic dyscrasias e.g. sickle cell
Neurological conditions
Idiopathic
25
Q

How do you treat ischaemic priapism

A

Aspiration and irrigation with saline
Inject an alpha agonist - phenylephrine - every 5-10 mins
Surgical shunt

26
Q

How do you treat non-ischaemic priapism

A

Observe - may resolve itself

May need selective arterial embolization

27
Q

What is Fournier’s gangrene

A

A form of necrotizing fasciitis occurring about the male genitalia
Can be caused by diabetes, immunocompromise, trauma, infection

28
Q

How does Fournier’s gangrene present

A

Starts as cellulitis - swelling, erythema, tenderness
Pain, fever
Crepitus in scrotum - some bacteria produce gas
Marked toxicity

29
Q

How do you treat Fournier’s gangrene

A

Antibiotics

Surgical debridement

30
Q

What is emphysematous pyelonephritis

A

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
Associated with ureteric obstruction and diabetes

31
Q

How does emphysematous pyelonephritis present

A

Fever, vomiting, flank pain

Gas pockets seen on US

32
Q

List indications for kidney imaging

A

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

33
Q

how do you treat kidney trauma

A

Most can be managed non-operatively by angiography/embolization
If persistent bleeding then do surgery

34
Q

What can cause a bladder injury

A

Pelvic fractures

35
Q

How does bladder injury present

A

Suprapubic pain
Inability to void
Bruising
Haematuria

36
Q

How would you diagnose a extraperitoneal bladder injury

A

Contrast CT

Would show a flame-shaped collection of contrast in pelvis

37
Q

Urethral injury is associated with what

A

Fracture of the pubic rami

38
Q

How does a urethral injury present

A 
Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate
Butterfly perineal haematoma
39
Q

How do you treat urethral injury

A

Suprapubic catheter

Delayed reconstruction after at least 3 months - need to wait for haematoma to resolve

40
Q

How does a penile fracture occur and present

A

Usually due to intercourse - buckling injury when penis strikes the pubis
Cracking/popping sound with pain, discolouration and swelling

41
Q

How do you treat a penile fracture

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

42
Q

What is hydrocele

A

Excess fluid around the testes

Renal (18 decks)

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