Urology and vascular basics Flashcards
Symptoms of renal stones
ureteric colic loin-groin pain sudden onset pain nausea and vomiting can't lie still occasionally get bladder obstruction
Examination findings for renal calculi
tachycardia no fevers unless infection--> emergency BP usually unaffected soft, non-tender abdomen renal angle tenderness
Bedside tests for renal calculi
urine dip- microscopic haematuria
ECG, BM, vitals
Bloods for renal calculi
FBC U&E LFT CRP Calcium amylase/lipase clotting VBG for lactate
Imaging for renal stones
CTKUB
AXR
Tx for renal stones
conservative- analgesia (PR diclofenac), fluids, anti-emetics, catheter if bladder obstruction
Medical- usually no abx, 5-10mm stones may be treated with medical expulsive meds e.g. alpha blockers
Surgical- extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, uterorenoscopy and dormier basket removal
2 things to consider when you see haematuria
how much
is it frank blood
5 causes of haematuria
false blood- beetroot, rifampicin stone tumour clotting disorder infection BPH prostatitis infarct
Ix for haematuria
beside- urine dip, MC&S (microscopy, culture and sensitivity), BM, ECG, vitals
bloods- FBC, CRP, U&E, LFT, VBG
imaging- renal USS, flexible cystoscopy and biopsy, CT/MRI, renal angiography
Sx of bladder ca
painless haematuria
recurrent UTI
renal failure
Risk factors for bladder cancer
smoking amine exposure chronic cystitis schistosomiasis pelvic irradiation
3 types of bladder cancer
transitional cell carcinoma
adenocarcinoma
squamous cell carcinoma
Ix of bladder cancer
2 week referral
urine dip
USS
Flexible cystoscopy
Tx options for bladder cancer
depends on stage
superficial- diathermy via transurethral cystoscopy/ transurethral resection, intravesicular chemo with mitocin C or intervesicular immunotherapy
invasive- radical cystectomy, chemo/rad
Sx of renal cell carcinoma
loin pain, mass, painless haematuria
Risk factors for renal cell carcinoma
smoking
obesity
end stage renal disease
hypertension
Ix for renal cell carcinoma
bloods- FBC, U&E, ALP, Calcium
imaging- CT, MRI, CXR for mets
Tx for renal cell carcinoma
radical nephrectomy
medical for those with advanced disease of who won’t survive surgery
Sx of testicular torsion
sudden onset severe pain
nausea and vomiting
lower abdo pain
examination findings in testicular torison
inflam of 1 testis- hot, swollen, tender
testis rides high and transversely
lack cremasteric reflex
ddx for testicular torsion
epidymo-orchiditis
strangulated hernia
appendicitis
Tx for testicular torsion
emergency surgery
NBM
routine bloods- FBC, CRP, U&E, G&s, clotting
acute px of AAA
sudden onset abdo/back/loin pain
examination of acute AAA
hypoT
tachyC
peripherally shutdown/shocked- hypovolemic
DDx for AAA
perforated viscus
acute abdomen- pancreatitis, diverticulitis, appendicitis
renal colic
management of ruptured AAA
ABCDE
CT aorta when haemodynamically stable
surgery if fit
mx of asymptomatic AAA
surveillance until 5.5cm diameter
lifestyle interventions
antiHT, statins, anti-platelets
surgical mx
define acute limb ischaemia
sudden onset reduction in limb perfusion which threatens the viability of the limb
3 causes of acute limb ischaemia
embolisation
thrombosis in situ
trauma
px of acute limb ischaemia
6 P’s
- pale
- pain
- pulseless
- paraesthesia
- paralysis
- perishingly cold
ddx for acute limb ischaemia
DVT
spinal cord/peripheral nerve compression
Ix for acute limb ischaemia
bedside- ECG to check for AF
bloods- lactate, G&S and routine
imaging- doppler US and CT angio
Mx of acute limb ischaemia
conservative- O2, analgesia, fluids
medical- heparin, thrombolytics
surgical- embolectomy, bypass
define chronic limb ischaemia
peripheral artery disease as a result of reduced blood supply to the limb
2 causes of chronic limb ischaemia
atherosclerosis
vasculitis
px of chronic limb ischaemia
intermittent claudification/rest pain/ gangrene
ddx for chronic limb ischaemia
spinal stenosis
Ix for chronic limb ischaemia
bedside- APBI, ECG, BM
bloods- routine and lipid profile
imaging- doppler US, CT/MRI angio
Tx for chronic limb ischaemia
conservative- lifestyle interventions
medical- antiHT, statins, diabetic control, antiplatelet
surgical- angioplasty and bypass