W3L4 Anuria & Retention

Question 1

Definition anuria

Answer 1

• Fail excrete urine for 12H

- Oiguria=excrete <400ml/24H

Question 2

Types Anuria?

Answer 2

I. Prerenal anuria
II. Renal anuria (Acute Tubular Necrosis, ATN)
III.Postrenal anuria (Obstructive)

Question 3

Causes pre-renal anuria?

Answer 3

1. Dehydration(vomit & diarrhea)
2. Hemorrahge
3. Extensive burns
4. Excessive sweating without compensate for fluid loss
5. Heart failure

Question 4

Ttt pre renal anuria?

Answer 4

1. Treatment of the cause
2. Volume replacement(bl. transfuse in
   hemorrhagic shock)
3. Monitoring fluid & electrolytes
4. Replacement therapy(HD & PD)

Question 5

Causes renal anuria(ATN)?

Answer 5

1- Persistent shock
2- Mismatched blood transfusion
3- Bilateral acute pyelonephritis
4- Endogenous toxins(jaundice)
5- Drugs (NSAID)
6- Iodinated contrast media
7- Septicemic shock

Question 6

Ttt renal anuria(ATN)

Answer 6

1. Oliguric phase
   - Fluid balance (x>1 L/d)
   - Electrolytes(K + >5mEq/L)
   - Nitrogen balance(2 Kcal/Kg/day)
   - Treatment of infection
   - Indications of dialysis
2. Diuretic phase
   - Fluid chart
   - Electrolytes adjustment
   - Compensate water loss

Question 7

Causes Post renal (obstructive) anuria?

Answer 7

1. Stone in ureter solitary kidney
2. Stricture in ureter solitary kidney
3. Bilateral ureteric stones
4. Basal bladder tumor
5. Prostatic adenocarcinoma
6. Crystalluria
7. Iatrogenic

Question 8

Diagnosis Post renal (obstructive) anuria?

Answer 8

1. History & clinical exam:
   - Excludes retention
   - General exam(vital signs)
   - State of hydration
   - Abdominal examination
   - Local examination(excludes bladder/ Prostatic tumors)
2. Lab inv(Scr,serum electrolyte, blood gas)
3. Radiological(KUB, US, spiral CT, static MRU)

Question 9

Ttt Post renal (obstructive) anuria?

Answer 9

1. Fluid chart
2. Manage electrolyte disturbance: Hyperkalaemia (K>5 mEq/L)
3. Correction acid–base disturbance
4. Fluid replacement
5. Drainage obs urinary system( ureteric
   catheter (preferable)/percutaneous nephrostomy tube(PCN))
6. Definitive management(ttt cause)
   -removal stone(URS, PCNL, surgery)

Question 10

Def acute urine retention?

Answer 10

Acute painful swelling of lower abdomen aso with inability void with full bladder

Question 11

Causes AUR?

Answer 11

1. Congenital anomalies in children
2. Acute urethritis(>teenager female)
3. Posterior urethral stone
4. Urethral stricture
5. BPO
6. Prostate adenocarcinoma
7. Hysterical
8. Spinal cord injury
9. Head injury
10. Cerebrovascular accidents

Question 12

Ttt AUR?

Answer 12

1. Sure diagnosis
2. Fixation urethral catheter (sterilization, lubrication,
   catheter fixation)
   -6-12 F. in children
   -16 F. in adult males.
   -18 F. in adult females.
3. Fixation suprapubic percutaneous tube
   -Urethral stricture
   -Catheter long period in child
   -Urethral trauma

Question 13

Def chronic urine retention?

Answer 13

Painless swelling of lower abdomen aso with inability void volitionally, aso by overflow incontinence

Question 14

Causes CUR

Answer 14

1. Neuropathicbladder

2. Causes of acute retention

Question 15

Ttt CUR

Answer 15

1. Fixation catheter

2. Treatment cause