229- urinary obstruction Flashcards

1
Q

blood supply direction to ureter

A

proximal to iliac arteries it comes from medial side. Distally it comes from lateral side

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2
Q

what happens in phase 2 of acute obstruction

A

pressure is going up while flow is going down

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3
Q

how long before irreversible damage is done? what does this mean clinically?

A

Full recovery possible up until seven days. After 6 weeks no recovery is possible. Give the patient one week to pass stone on their own

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4
Q

limit for diuretic renography

A

if it takes longer to clear than 20 min there is an obstruction

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5
Q

limit for whitaker test

A

pressure gradient greater than 22 cm means obstruction

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6
Q

What is post-obstructive diuresis? when is ti a problem?

A

polyuria following bilateral obstruction clearance. Start to worry if urine output is >200ml/hr for 2 hrs and urine osmolality is low.

Replace with D5 half NS at .5ml for every 1ml lost

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7
Q

four most common types of stones in order

A

calcium oxalate and calcium phosphate, Ammonium magnesuim phosphate (struvite or infection), uric acid, cysteine

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8
Q

which type of stone is seen in kids? Which is radiolucent? which are associated with infection and with what kind of bacteria? which is associated with crohns disease?

A

cysteine
uric acid
Ammonium magnesium phosphate (struvite); urease+ bacteria such as proteus vulgaris, klebsiella)
calcium oxalate/calcium phosphate

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9
Q

what is the most common cause of calcium stones? treatment?

A

hypercalciuria plus/minus hypercalcemia. Thiazide diuretics. Limit high-oxalate foods like nuts vegetables, etc

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10
Q

What type of stone form staghorn calculi? treatment?

A

in adults: struvite. Tx large and nidus for infection so surgical removal and eradicate pathogen.

In kids: cystein. Tx is hydration and alkalinization of urine with potassium citrate and thiola

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11
Q

Uric acid stones: risk factors? associated conditions?

A

gout, increased purine consumption (red meats). High turnover of nucleic acids as in leukemia or myeloproliferative disorder. Tx is low purine diet and alkalinize urine with potassium bicarb

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