MedBugs: SAQ #99

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Case: Urinary retention

A 70-year-old man presents with suprapubic abdominal pain and an inability to pass urine for 12 hours. There is no history of trauma or recent urological instrumentation or procedures. His only known comorbidities are chronic lower back pain, hypertension and BPH. He takes amitriptyline, gabapentin, paracetamol and amlodipine. On exam he has normal external genitalia, bladder is palpable consistent with acute urinary retention. Bedside USS reveals bilateral hydronephrosis. Vitals are as follows : T 37.4 HR 110 BP 190/100 RR 20 Sats 98%RA. Bloods are within normal limits except Cr 140.

1. Complete the table below listing (6) potential causes (other than BPH) and the historical information you will seek in relation to each cause. 6 marks

Bladder scan shows 1.1L in the bladder and the patient undergoes IDC insertion. UA shows moderate blood only.

2. List (3) potential complications of urinary catheterisation 3 marks

The nursing staff have educated the patient with respect to routine catheter care and the patient has an appointment with his GP in 2 days.

3. List (3) key pieces of medical discharge advice you will provide to this patient, assuming BPH is the most likely cause 3 marks

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Case: Urinary retention

1. Complete the table below listing (6) potential causes (other than BPH) and the historical information you will seek in relation to each cause. 6 marks

2. List (3) potential complications of urinary catheterisation 3 marks

3. List (3) key pieces of medical discharge advice you will provide to this patient, assuming BPH is the most likely cause 3 marks

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