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45 Cards in this Set

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GU EMERGENCIES
GU EMERGENCIES
Define Meatus:
A passage or opening.
Lithiasis: 1. The formation of stones. 2. Uric acid diathesis
Define Micturition:
Urination
Define Dysuria:
Painful or difficult urination, symptomatic of numerous conditions
Define Calyx:
Any cuplike organ or cavity. 2. A cuplike extension of the renal pelvis that encloses the papilla of a renal pyramid; urine from the papillary duct is emptied into it.
Define Nocturia:
Excessive or frequent urination after going to bed.
Define Hematuria:
Blood in the urine
Define Oliguria:
Urinary output of less than 400 ml/day.
Define Pyuria:
Pus in the urine
Define Phimosis:
Stenosis or narrowness of the preputial orifice so that the foreskin cannot be pushed back over the glans penis
Define Paraphimosis:
Strangulation of the glans penis due to retraction of a narrowed or inflamed foreskin
What diagnostic is gold standard for evaluating renal colic
Intravenous pyelography (IVP)
What is the potential significance of blood at the meatus.
Blood at the meatus is associated with urethral injuries. Pelvic Fx
How would you evaluate blood at the meatus due to trauma
retrograde urethrogram mandatory in this setting in order to make dx and minimize long-term complications of urethral transection (i.e. urethral strictures and urinary incontinence)
What should be avoided while evaluating blood at meatus in trauma
urinary catheter should not be placed to prevent conversion of partial urethral laceration to complete transection. Eval of GU should be performed in retrograde fashion: RO urethral injury before bladder, then bladder before urethral or renal injury
What imaging technique is mandatory in the trauma setting?
retrograde urethrogram
Explain the meaning of a finding of superiorly displaced prostate.
indicates disruption of posterior urethra. Anterior urethral injuries associated with straddle injuries and instrumentation
Define what initial hematuria is suggestive of:
suggests injury to the distal system (i.e., urethra or prostate).
Define microscopic hematuria
Microscopic hematuria is defined as more than five red blood cells (RBCs) per high-power field.
Define what terminal hematuria is suggestive of:
Terminal hematuria suggests bladder neck injury.
Define what continuous hematuria is suggestive of:
Continuous hematuria suggests upper renal system (bladder, ureter, or kidney) injury
8. Understand why the lack of hematuria does not rule out injury to the renal system in penetrating injuries and how to further for renal injury
10% pts w/renal injury related to stab wounds may not manifest hematuria. CT w/contrast is primary imaging for penetrating trauma to kidneys. usually shows appropriate detail of injury to inform mgt decisions
Explain the significance of renal contusion.
relatively minor injury includes renal parenchymal ecchymosis, minor lacerations & subcapsular hematomas w/intact renal capsule. IVP usually normal. CT may reveal edema w/microextravasation of contrast material within renal parenchyma. Subcapsular hematoma appears as flattened portion of renal cortex compressed by hematoma under renal capsule
Contrast cortical versus corticomedullary lacerations of the kidney.
Renal lacerations classified as minor cortical lacerations not involving medulla or collecting system or major renal lacerations extending deep in corticomedullary junction or collecting system. perirenal hematoma may fill perirenal space before its tamponaded by Gerota fascia. imaging studies show disruption of renal outline, perirenal hematoma, & possibly extravasation of contrast material adjacent to kidney
Expain a grade I renal injury and treatment
Contusion (microscopic or gross hematuria, with normal urologic study results)
Subscapular, nonexpanding hematoma without laceration. Observation, spontoneous resolution
Explain a grade II renal injury and treatment
Parenchymal laceration <1.0 cm depth limited to cortex, no extravasation
Nonexpanding hematoma, confined to retroperitoneum Observation, spontoneous resolution
Explain a grade III renal injury and treatment
Parenchymal laceration >1 cm depth with extravasation or collecting system rupture. Observation or surgery
Explain a grade IV renal injury and treatment
Laceration extending through to collecting system
Vascular pedical injury, hemorrhage contained. Surgery
Explain a grade V renal injury and treatment
Shattered kidney
Avulsed hilum (devascularized kidney). Surgery
Explain the treatment options for a zipper injury to the penis
skin of penis or scrotum can get caught in movable part or between teeth of zipper. (Beans above the Frank) Gentle manipulation after local infiltration with 1% lidocaine is most successful way to release entrapment. Release of skin can be achieved by cutting median bar of movable part of zipper with bone-cutting plier. If all procedures fail, removal under general anesthesia or circumcision by the urologist may be required
Describe how a simple scrotal abscess of a hair follicle is managed
I&D of abscess or circumferential excision of roof of abscess followed by wound care and sitz baths
Describe Phimosis and how its managed
inability to retract foreskin proximally & posterior to glans. May be due to infection poor hygiene or previous injury w/scarring. Tx: circumcision, topical steroids applied 4-6 wks is effective 70-90% time
Describe Paraphimosis and how its managed
inability to reduce proximal edematous foreskin distally over glans in natural position. Resulting edema can lead to arterial compromise & gangrene. true urologic emergency. Can reduced by compression of glans for several mins allowing reduction of foreskin back. Or several sm puncture wounds w/22-25g needle allows expression of edema fluid
Describe Fournier’s gangrene and how its managed
polymicrobial synergistic necrotizing infection of perineal subQ fascia & male genitalia originating from skin urethra or rectum. Stars benign infection or simple abscess that quickly becomes virulent leading to end-artery thrombosis in subQ tissue promoting widespread necrosis of tissue. TX: Aggressive fluid resuscitation; gram+(-)& anaerobic abx & surgical debridement, hyperbaric O2 therapy
Describe Orchitis and how its managed
inflammation of testicle (rare), usually in conjunction w/systemic infection (mumps, EB, varicella). Usually unilateral followed by contralateral involvement in 1-9d. Almost always associated w/epididymitis. Tx symptomatic & disease specific
Describe Priapism and how its managed
uruologic emergency presenting as persist, px, erection where corpora & cavernosa engorged w/stagnant bl. glans & corpus spongiosum usually soft & uninvolved; may involve urinary retention. May result in impotence. Often rx related to intracavernosal injection of vasoactive substances for impotence, oral agents for HTN or mental disorders. children due to hematologic disorders (sickle cell). Classified high-flow (non-ischemic) & low-flow (ischemic). Tx: analgesia, terbutaline subq. Pseudoephedrine maybe effective w/1st 4 hrs. Corporal aspiration & irrigation if persistent
Describe testicular torsion, the common age group, how it is diagnosed and treatment considerations
fixation between enveloping tunica vaginalis & posterior scrotal wall. Peaks in puberty but may occur any age. Often involve hx of athletic event, strenuous activity, trauma prior to onset px. Can occur during sleep. Px in lower abd, inguinal canal or testis; constant or intermittent but not positional. Involved testis is firm tender often higher in scrotum when standing. Emergent urologic consultation & surgery. If dx uncertain, US & radionuclide scintigraphy maybe used. Consider manual detorsion of testis as emergent or pre-op tx
Explain how the onset of pain differs in epididymitis from that of torsion. Contrast the most common cause in patient under 40 patient versus the patient over 40.
Onset px more gradual because of inflammation in epididymitis vs ischemic in torsion. Most common cause <40 STDs or complications (stricture) young boys due to coliform bacteria, often w/congenital anomalies of lower GU tract causing reflux. >40 common urinary pathogens (e. coli, klebsiella) Px relieved by opioid; scrotal support; tx infection w/abx
Identify possible causes of urinary retention.
chronic systemic medical illnesses or carcinomas w/ sensory or motor neurogenic side effects or complications; medications; inconvenient/infrequent voiding (car trips); meatal stenosis; urethral stricture; bladder neck stricture; benign prostatic hypertrophy; infrequent ejaculation w/prostatic congestion; silent prostatism
IDentify how urinary retention can be relieved in the emergency department and additional treatment and followup
urethral catheter w/lidocaine jelly; leave cath in place & connect portable drainage bag, instruct family in care & how d/c; abx if evidence of UTI. Admit to hospital or arrange follow up w/urologist
Identify Risk factors for kidney and renal stones
male sex; 3-5 decade of life; hereditary; people who in mt, desert, tropical regions; sedentary jobs; warmest 3 mo yr; inadequate H2O intake; certain meds; previous hx stones
Identify Presentation of renal stones
acute onset severe episodic visceral px & little tenderness. Px in flank radiate anteroinferiorly around abd progresing to ipsilateral testicle/labia. NV, diaphoresis, no comfortable position; anxious, pacing, reluctant to lie still (“writhing”)
Identify where renal stones lodge and why
passage may halt in areas of anatomic narrowing or bending. Common areas: renal calyx, renal ureteropelvic jnx, where ureter passes over pelvic brim & iliac vessels, UVJ (smallest diam & common location). women, common location is posterior pelvis
Identify types of renal stones
75% calcium oxalate, phosphate, or both
10% magnesium- ammonium-phosphate (struvite).
10% uric acid- uroliths
5% cystine and other uncommon minerals
What factors determine whether a stone will pass spontaneously or not
size and location—see table 96-2 in book