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DU PA GU Emergency

Duke PA Genito-Urinary Emergencies

Definition of acute renal failure Rapidly deteriorating kidney function (accumulation of nitrogenous waste)
Urine output less than 0.5-1cc/kg/hr (400cc/day in adults) oliguria
Most common cause of acute renal failure Hypovolemia
No urine output Anuria
Prerenal cause of ARF Hypovolemia, ineffective circulating volumes (sepsis, anaphylaxis, third spacing), decreased cardiac output (chf, mi)
What can cause dehydration Vomiting and diarrhea, diuretics, skin losses (burns)
Renal origins of ARF Tubulointerstitial, glomerular, vascular
Postrenal origins of ARF Ureteral or bladder obstruction, urethral obstruction
Causes of ureteral or bladder obstruction Kidney stones, blood clots, malignancies, prostatic hypertrophy
Urethral obstructions Strictures, phimosis, meatal stenosis
What lab are you looking at to determine ARF Creatinine >1.4
Treatment for prerenal ARF Volume replacement, maximize cardiac output
Treatment for renal ARF Low dose dopamine, mannitol in early rhabdomyolysis, dialysis
Treatment for postrenal ARF Relieve obstruction (foley, ureteral stent, nephrostomy)
Signs and symptoms of UTI Dysuria, frequency, urgency, hematuria, urethral discharge, pain (suprapubic, rectal, costovertebral)
Most common UTI pathogen E-coli
Safe UTI treatments during pregnancy Nitrofurantoin
Duration of treatment for uncomplicated UTI’s 3 days
Duration of treatment of pyelonephritis, pregnant patients with UTIs, complicated/frequent UTIs/prior treatment failure 7-14 days
Treatment for GC Ceftriaxone (Rocephin) IM
Treatment for Chlamydia Azithromycin or doxycycline
Treatment for trichomonas Metronidazole (Flagyl)
Presentation of acute prostatitis Fever, malaise, back or rectal pain, rectal exam reveals swollen/firm/painful prostate
Source of acute prostatitis in males<35 yo GC, chlamydia
Source of acute prostatitis in males>35 E-coli, klebsiella, Enterobacter, proteus
Treatments for acute prostatitis Quinolone, Bactrim
Presentation of urolithiasis Flank pain (abrupt onset, severe, colicky, may radiate to scrotum), N/V, previous episodes, CVA tenderness, LQ pain
What are some deadly diseases that can mimic presentation for kidney stones AAA, appendicitis, tuboovarian abscess, ectopic pregnancy
Any female of childbearing age with abdominal pain gets a work up for what Pregnancy
Modality of choice for evaluation of urolithiasis in pregnant females Ultrasound
Presentation of testicular torsion Young men, pain with abrupt onset (after exertion, or during sleep), severe low abdominal/inguinal canal/scrotum, N/V, horizontal lie of testicle, absence of cremasteric reflex
Testicular torsion must be detorsed within __ for salvage 4-6
Blue dot sign on translumination of testes is pathognomonic for what Testicular appendage torsion
What is Prehn’s sign and what is it a sign of Pain relief with elevation of testicle, epididymo-orchitis
Treatment for priapism Subcutaneous terbutaline/phenylephrine, Surgery
Inability to retract the foreskin due to fibrous constriction or scar Phimosis
Inability to reduce retracted foreskin over the glans paraphimosis
Created by: bwyche