#7. Urolithiasis - Complications & Treatment, Inflammatory Diseases of Urinary System, Pyelonephritis, Urosepsis Flashcards
What are the Obstructive Complications of Urolithiasis?
1) HydroCALYCOSIS = Stone in Neck of Calyx preventing Urine Outflow
2) HydroNEPHROSIS = Stone in Pelvis / Pyelo-ureteral Segment
3) URETERIC Hydronephrosis = Stone in DIFFERENT Location of Ureter
4) Urinary Retention = Calculus Obstruction in Bladder Neck / Urethra
5) Oliguria & Anuria = Obstructive Calculus Anuria of Single Kidney / Bilateral Lithiasis
What are the Inflammatory Complications of Urolithiasis?
1) Chronic Pyelonephritis / Cystitis = Chronic Inflammatory Process at the Site of Stone
2) Acute Calculous Pyelonephritis = Aka Obstructive Calculous Pyelonephritis
3) APOSTEMATOUS Pyelonephritis = Multiple Miliary Purulent Foci in Subcapsular Space
4) Kidney Abscess = 1 or More Purulent Cavities in Parenchyma of Kidney
5) CARBUNCLE of Kidney = Area filled with pus with surrounding necrotic tissue
6) PERI-nephritis = Inflammation of Kidney Capsule
7) PARA-nephritis = Inflammation of PERINEAL FAT Capsule
8) Para-NEPHRIC Abscess = Purulent Foci in PERINEAL Space
9) XANTHOGRANULOMATOUS Pyelonephritis = Chronic GRANULOMATOUS Process of Kidney due to Subacute / Chronic Infection inducing Immune Response
What is the Medication for Renal Colic?
- 1st Line = NSAIDs 150mg / Day for 3 - 10 Days E.g. DICLOFENAC
- 2nd Line = Spasmolytics + Analgesics (Orally) E.g. PAPAVERIN
- 3rd Line = NON-Narcotics / Opioid Analgesics (Parenterally)
What is Medical Expulsive Therapy?
- They’re CONSERVATIVE Methods contributing to the ELIMINATION of the Stone (Small Ones)
What is the Principle of Operation of Extracorporeal Lithotripsy Devices?
- Modern Shock Wave Generating Devices use Electromagnetic Generators
- Lithotripter breaks up the stone with focused, high-energy waves impacting the HETEROGENOUS Structure of the Stone
What are the Indications for Extracorporeal Lithotripsy?
- Radiopaque Stones UPTO 15mm
- NO Inflammatory Complications from Kidney Stone Disease
- ABSENCE of URETERAL Strictures / Congenital Anomalies of PYELOURETERAL SEGMENT
What are the Complications Following Extracorporeal Lithotripsy?
- Subcapsular Renal Hematoma
- Rupture of Kidney
What are the Methods of Intracorporeal Lithotripsy?
- Retrograde Ureteroscopy
- Percutaneous Nephrolithotomy
What are the Indications for Percutaneous Nephrolithotomy?
- Minimally Invasive Surgery to REMOVE Kidney Stones
- An ALTERNATIVE to OPEN Kidney Surgery
What Advice would you give to patients with Urolithiasis to reduce Stone Formation?
- Balanced Diet
- RICH in Vegetables / Fibre
- Normal Calcium Content = 1 - 1.2 g / Day
- NaCl Content = 4 - 5g / Day
- Animal Protein Content = 0.8 - 1 g / Day
What are the Most Common Uropathogens?
- E.Coli and Coliforms
- Gram POSITIVE Microorganisms
- Polymicrobial Infections (Adults)
Which Infections are Classified as Uncomplicated and which as Complicated?
1) Uncomplicated Infections
- Cystitis
- Pyelonephritis
- Recurrent UTI
- Urosepsis (LOW Risk)
2) Complicated Infections
- Cystitis
- Pyelonephritis
- Recurrent UTI
- Catheter Associated UTI
- UTI in Men
- Urosepsis (HIGH Risk)
What is the Definition of Recurrent Infection?
- 2 Episodes within 6 Months
- 3 Episodes within 1 Year
In Which Patients does Asymptomatic Bacteriuria NOT benefit from Treatment?
In PREGNANT Women
- Due to INCREASED Progesterone / Residual Urine Volume
- DUE to Delayed Peristalsis / Urinary Retention in Upper UT / Uterine ENLARGEMENT
- EASILY FORM into SYMPTOMATIC Infection with Potential HARMFUL EFFECTS on the FOETUS
In Which Patients is it Recommended to Treat Asymptomatic Bacteriuria?