#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?
In Different Age Groups, what are the most common causes of Urinary Tract Infections?
- LESS than 1 Years = DUE to Anatomic Genitourinary Abnormalities
- Ages 1 - 5 = DUE to Anatomic / Functional Genitourinary Abnormalities
- Ages 6 - 15 = DUE to Functional Genitourinary Abnormalities
- Ages 16 - 35 = Sexual Intercourse / Diaphragm Use
- Ages 36 - 65 = DUE to Surgery / Prostate Obstruction / Catheterisation
- MORE than 65 Years = DUE to Incontinence / Catheterisation
What are the Symptoms of Patients with Cystitis?
- Dysuria
- Frequency / Urgency
- Low Back / Suprapubic Pain
- Haematuria
- Cloudy / Smelly Urine
What is the Treatment for Acute Cystitis?
- 3 Day Course of TRIMETHOPRIM / SULFAMETHOXAZOLE (TMP / SMX)
- 5 Day Course of FOSFOMYCIN as SINGLE Dose
What Recommendations would you make for Patients with Recurrent Cystitis?
- FLUROQUINONES can be used for TMP / SMX Resistance
What are the Symptoms of Acute Pyelonephritis?
Symptoms of LOWER UT
- Frequency of Urination
- Urgency of Urination
- Discomfort in Urethra
- Nausea / Vomiting
How is Chronic Pyelonephritis Diagnosed?
- Intravenous Urography
- CT
SHOWS Small + ATROPHIC Kidney on AFFECTED Side
Which Disease is Considered in Differential Diagnosis of Xanthogranulomatous Pyelonephritis?
- MISTAKEN for RENAL Cell Carcinoma (RCC)
What are the Risk Factors for Emphysematous Pyelonephritis?
- Diabetes Mellitus
- Escherichia Coli, as Microbial Causative Agent
What is the Difference Between Bacteremia and Sepsis?
- Bacteremia = Presence of BACTERIA in BLOODSTREAM
- Sepsis = INFECTION that has SYSTEMIC Manifestation E.g. SIRS
What are the Criteria for Systemic Inflammatory Response Syndrome?
AT LEAST 2 of the Symptoms
- RISE / FALL in Temperature
- Tachycardia MORE than 90bpm
- Tachypnea of 20x per Minute
- Leukocytes MORE than 12,000 or 4,000 / cubic mm
What are the Risk Factors for Urosepsis?
- Foreign Bodies (Catheters / Nephrostomy)
- Instrumental Examinations of Excretory System
- Diabetes
- Immunosuppression
- POST-Chemotherapy
What are the Most Common Lab Abnormalities in Patients with Sepsis?
- CBC = INCREASED / DECREASED N.O of Leukocytes + DECREASED Platelets
- Coagulation Status = INCREASED INR > 1.5 / apTT MORE than 60 sec
- ELEVATED Urea / Electrolytes
- Hourly Urine = LESS than 0.5 ml / kg/ h FOR 2 hours (Organ Dysfunction)
What are the Principles in the Treatment of Sepsis?
1) Antimicrobial Treatment = Cephalosporins / Meropenem / Imipenem / Cilastatin WITHIN 1st Hour
2) Source Control = Nephrectomy / Orchiectomy
3) Supportive Therapy = O2 / Electrolytes / Normoglycemia (Diabetics) / PREVENTING Thrombosis
