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ACC > Urology Core Conditions > Flashcards

Urology Core Conditions Flashcards

1
Q

What are the 3 groups of causes of AKI?

A

Pre-renal
Intrinsic
Post-renal

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2
Q

What are the pre-renal causes of AKI?

A 
HypoV/haemorrhage
Sepsis
Overdiuresis
ACEi
Third spacing of fluids (pancreatitis)
Cardiac failure
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3
Q

What are the intrinsic causes of AKI?

A 
Rapidly progressive glomerulonephritis
Acute interstitial nephritis
Vasculitis (HUS)
Nephrotoxins
ACUTE TUBULAR NECROSIS (hypo perfusion)
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4
Q

What are the post-renal cause of AKI?

A

Ascending UTI
Renal/bladder calculi
Retroperitoneal fibrosis & strictures
Hyperplasia & cancer (lymphoma)

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5
Q

How is AKI investigated?

A 
Urinalysis
Bloods: FBC, U&E, LFTs, Ca, Phosphate, bicarb, U:C, kidney injury molecule
CXR
Renal USS
ECG
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6
Q

In AKI how long does it take for creatinine to raise?

A

48-72hours

Cell damage irreversible by this time

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7
Q

What is the management for pre-renal AKI?

A 
Treat cause
Restore volumes: Bloods, fluids (Saline)
Vasopressors: Dopamine/ Epinephrine
Vol overload: Diuretics- Furosemide
Renal replacement
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8
Q

What is the management for intrinsic AKI?

A

Treat cause
Refer to nephrologist- acid-base status
Same as pre-renal treatment

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9
Q

What is the management for post-renal AKI?

A 
Bladder catheterisation
Relieve obstruction (stenting, lithotripsy, nephrostomy)
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10
Q

What medications should be stopped in AKI?

A 
Statins (Rhabdomyolysis)
ACEi
NSAIDs
Contrast
Gentamicin
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11
Q

What mnemonic can be used for investigations required in a potential AKI?

A 
ROUND UP 26
R- Regular U&Es & creatinine
O- Obstruction excluded
U- Urinalysis
N- Nephrotoxic drugs stopped
D- Dry (0.9% NaCl) wet (Furosemide)
U- Monitor urine output (<0.5ml/kg/hr for 6hours)
P- Prescription review
26- Rise in creatinine within 48hours needed for AKI diagnosis
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12
Q

In the blood results, what differentiates an AKI from CKD?

A

CKD= anaemia, hyperphosphataemia, hyperkalaemia

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13
Q

What are the most common causes of UTI?

A 
E. Coli type 1 &amp; 2
Staph Saprophyticus (honeymoon cystitis)
Enterobacter (Proteus, Klebsiella)
Group B Strep
Psuedomonas
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14
Q

What is the treatment for a UTI?

A

Abx: Nitrofurantoin 3-5days
Resistance: Ciprofloxacin

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15
Q

What are the causes of urinary retention?

A 
Ureteral stones
BPH
Surgery
Tumour
Drugs (Anticholinergics, Opioids, Benzos, NSAIDs, OH-)
Congenital abnormalities
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16
Q

How is urinary retention managed?

A

Immediate decompression by catheterisation
Alpha blocker before catheter
TWOC follow-up

Post op retention: Cholinergics, intravesicle prostaglandin

Calculi: Hydration, 30mg IM Ketorolac, stent/nephrostomy

Abx: Gentamicin 3-5mg/kg IV every 8hours

17
Q

What is testicular torsion?

A

EMERGENCY
Twisting of the testicle on the spermatic cord leading to constriction of the vascular supply & time-sensitive ischaemia/necrosis

18
Q

What are the causes of testicular torsion?

A

Trauma

Anatomical: Bell clapper deformity

19
Q

What are the signs & symptoms of testicular torsion?

A 
Intermittent, acute pain
Pain NOT relieved upon elevation
Scrotal swelling/oedema
Scrotal erythema
Reactive hydrocele
High-riding testicle
Horizontal line
Absent cremasteric reflex
20
Q

How is testicular torsion investigated?

A

Greyscale USS: Fluid & whirlpool sign

Power doppler USS or Colour doppler USS: Absent/dec blood flow in affected testicle

21
Q

How is testicular torsion managed?

A

Neonate: Stabiliazation, urological consultation for emergency scrotal exploration
Non-neonate: Supportive care, scrotal exploration, manual de-torsion

22
Q

What is the prognosis for testicular torsion?

A

4-6hours: Testes most likely viable
10-12hours: Ischaemia & irreversible testicular damage likely
>12hours: Necrosis likely

23
Q

Who is most likely affected by testicular torsion?

A

Neonates

Adolescents

24
Q

What is contained in the spermatic cord?

A 
Vas Deferens
Lymphatics
Testicular artery
Cremasteric artery
Panpiniform plexus (veins)
Testicular nerves
Nerve to cremaster
25
Q

How is urinary retention investigated?

A 
MSU later
Bloods: U&amp;Es
Cystography
IV urography
Cystoscopy
Urodynamics
26
Q

What is the diagnostic criteria for an AKI?

A

One of the following criteria met:

  • Serum creatinine >26 over 48hours
  • Serum creatinine rises >x1.5 from baseline measurement taken that week
  • Urine output <0.5l/kg/hr for >6 consecutive hours
27
Q

What are the risk factors for developing an AKI?

A 
>75
Hx of CKD, peripheral vascular disease, CF, Liver disease, HTN, DM
Hypovolaemia
Sepsis
Taking nephrotoxic drugs
28
Q

What can an untreated AKI lead to?

A

HyperK
Uraemia
Fluid overload
Acidosis

ACC (21 decks)

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