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Renal/Urology > Urology Tutorial > Flashcards

Urology Tutorial Flashcards

1
Q

List causes of haematuria

A 
Nephritidies
Cancer
stones
Infection (UTI, pyelonephritis)
Trauma
Endometriosis 
Coagulopathies
AV malformations
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2
Q

What is the one of the biggest urological emergencies that can occur in haematuria?

A

Clot retention - where a clot forms and blocks somewhere along the urinary tract and pt goes into acute retention

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3
Q

What is a typical history of clot retention?

A

Patient has pinkish urine for a few days, which got darker and there were clumps in it
Suddenly unable to pee and in a lot of pain

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4
Q

When might you admit someone for haematuria?

A

Clot retention

Suspected Hb drop

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5
Q

How do you manage haematuria?

A 
ABCDE, resus
Transfuse if req.
Insert 3 way foley catheter + do multiple flushes with sterile saline to rid of clots
If still bleeding - bladder USS 
Massive clots may req. surgical removal
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6
Q

If haematuria settles after ABCDE and resus, what might you do?

A

Trial voiding without catheter, outpatient USS KUB and flexible cystoscopy to look for main causes of haematuria

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7
Q

What investigations might you do for suspected stones?

A

CTKUB
Bloods - FBC, UE, coag
Urine dip +/- MSU

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8
Q

What is a staghorn calculus?

A

Calcification of 2+ calyces

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9
Q

What is the difference between CTKUB and CT abdomen?

A

CTKUB doesn’t involve contrast as contrast and stones both appear white so wouldn’t be able to see stones with normal CT abdomen

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10
Q

What is the gold standard test for diagnosing stones?

A

CT KUB

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11
Q

The ureters run in front of what muscle?

A

Psoas major

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12
Q

What might be a sign that a renal stone is causing significant blockage?

A

Hydronephrosis

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13
Q

What is the management of kidney stones?

A

Analgesia

?admission

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14
Q

When might you admit someone with renal stones?

A

Need opiates/IV analgesia
Deranged UE
Infection

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15
Q

What makes renal stones an emergency?

A

If there is an infection on top of the kidney being obstructed

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16
Q

How do you manage infections + stones?

A

ABCDE + resus
Sepsis 6
Drain kidney - nephrostomy/stent

17
Q

What are options for definitive stone management?

A 
Conservative management, e.g. analgesia or medical therapy
ESWL
Flexible/rigid ureteroscopy 
PCNL
Nephrectomy
18
Q

What does ESWL stand for?

A

External shock wave lithrotripsy

19
Q

When is ESWL CI?

A

In pregnancy

If stones are not radio opague

20
Q

What does PCNL stand for?

A

Percutaneous nephrolithotomy

21
Q

What does PCNL involve?

A

Camera inserted straight into kidney and instrument vibrates very quickly and breaks up bits of stones and picks them up

Needed for bigger stones, e.g. staghorn calculi

22
Q

When might you do a nephrectomy for stones?

A

If you check split renal function and affected kidney is only contributing e.g. 2% to total kidney function

23
Q

What are the categories of causes of urinary retention?

A 
Obstructive
Drugs
Inflammatory
Neurogenic
Post-op
24
Q

What are obstructive causes of urinary retention?

A 
BPE
Urethral stricture
Constipation 
Clot retention
Pelvic mass
25
Q

What drugs can cause urinary retention?

A

Alcohol
Diuretics
Spinal/epidural
Opioids

26
Q

What inflammatory processes can cause urinary retention?

A

UTI

Prostatitis

27
Q

What are neurogenic causes of urinary retention?

A 
Spinal cord injury
CES
MS
PD
Pelvic trauma
Pelvic surgery
28
Q

How should you assess a pt in urinary retention?

A

Screen for sx of CES!!
Screen for red flags, e.g. wt loss, bone pain, haematuria (spinal mets?)
Ex - abdo, DRE, neuro

29
Q

What investigation might you do for someone in urinary retention?

A

UE - USS KUB if abnormal

Bladder scan

30
Q

How do you manage acute urinary retention?

A

Catheterise

31
Q

What is determines as low risk urinary retention?

A

<1000ml
UE normal
Uncomplicated

32
Q

How do you manage low risk urinary retention?

A

Discharge, treat cause (e.g. alpha blocker, laxatives, abx) then trial wo catheter

33
Q

What is deemed high risk urinary retention?

A

> 1000ml
Abnormal UE
Complicated, e.g. UTI

34
Q

How is high risk urinary retention managed?

A

Admit, hourly UO, IV fluids if >200ml/h 2hrs

35
Q

Why do you want to give fluids to someone who is in urinary retention and passing >200ml/h 2hrs?

A

They are at risk of post-obstructive diaresis (where they go beyond the normal fluid balance + become v. dehydrated)

36
Q

What is the normal capacity of the bladder?

A

500-600ml

Renal/Urology (29 decks)

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