Hernias and Testicular torsion – Drs. Franxman and Buechler

• Reviewed types of hernias.
• Discussed Twist score 
• Manual detorsion – open the book 

R2 Small Groups – Drs. Drury and Hudson

• Reviewed 4 great cases on GU/Renal Emergencies
• Case 1: Paraphimosis
  • Treatment = reduction (emergent)
  • Glans compression, osmotic agent (sugar/mannitol), reduction 
  • Last resort option: band incision (use lido w/o epi)
• Discussed penile nerve block
• Discussed paraphimosis (can’t pull foreskin forward) vs phimosis (can’t pull foreskin back)
• Case 2: Epididymitis
  • Pain improves with testicular elevation 
  • Treat as complicated UTI (levofloxacin), add ceftriaxone + doxycycline if c/f STI
• Case 3: Lithium OD
  • Timeline: Acute (GI symptoms) vs. Acute on Chronic (CNS depression)
  • Discussed complications including lithium induced thyroid dysfunction and EKG findings (nonspecific T wave inversion)
  • Management:
    • When do they need HD?
      • https://www.extrip-workgroup.org/recommendations
      • AEIOU
      • ISTUMBLED drugs 
    • IHD vs CRRT vs SLEDD
      • CRRT and SLEDD easier on BP, better for ICU patients 
• Case 4: Pyelonephritis
  • < 5 mm will pass 
  • > 10 mm = surgery (and consideration of stent placement)
  • Complications:
    • Emphysematous pyelonephritis = gas in bladder wall, kidneys, pelvis 
    • Renal abscess 

Dialysis Fistula Complications – Dr. McGowan

• Fistula = artery to vein 
• Maturation
  • At least 1 month, usually 6-12 months (for revisions)
• Physical Exam
  • Thrill = good, continuous buzz
  • Pulse = bad, generally downstream stenosis 
  • One part has entirely different thrill than rest = c/f focal stenotic lesion 
  • No thrill/ pulse = thrombosis 
• Stop the bleed!
  • Bottle cap method (open side to fistula)
  • Hold pressure 
  • Figure of 8 (not over entire vessel)
  • Purse string 
  • Tourniquet 
• Pseudoaneurysm vs aneurysm
  • Both look like bulging enlargement of fistula 
  • **atraumatic bleed is huge red flag** = Call vascular 
• Distal ischemia
  • Ex: HAIDI or DASS 
  • Is one hand cold compared to other?
• Infection 

Pediatric UTI and Renal Pathology 

• Kids under 24 months diagnosed with UTI require OP renal/ bladder US 
• Discussed UTIcalc.pitt.edu/
• First line treatment for UTI = Keflex 
• Discussed how to treat PSGN – treat underlying infection and treat nephritic syndrome with diuretics, antihypertensives and RRT 
• Discussed Acute Nephritic Syndrome findings (hematuria, HTN, Edema – eyes, scrotum/labia, Oliguria)
• Discussed HUS – Supportive