#7. Urolithiasis - Complications & Treatment, Inflammatory Diseases of Urinary System, Pyelonephritis, Urosepsis Flashcards

1
Q

What are the Obstructive Complications of Urolithiasis?

A

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

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2
Q

What are the Inflammatory Complications of Urolithiasis?

A

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

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3
Q

What is the Medication for Renal Colic?

A
  • 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)
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4
Q

What is Medical Expulsive Therapy?

A
  • They’re CONSERVATIVE Methods contributing to the ELIMINATION of the Stone (Small Ones)
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5
Q

What is the Principle of Operation of Extracorporeal Lithotripsy Devices?

A
  • 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
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6
Q

What are the Indications for Extracorporeal Lithotripsy?

A
  • Radiopaque Stones UPTO 15mm
  • NO Inflammatory Complications from Kidney Stone Disease
  • ABSENCE of URETERAL Strictures / Congenital Anomalies of PYELOURETERAL SEGMENT
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7
Q

What are the Complications Following Extracorporeal Lithotripsy?

A
  • Subcapsular Renal Hematoma
  • Rupture of Kidney
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8
Q

What are the Methods of Intracorporeal Lithotripsy?

A
  • Retrograde Ureteroscopy
  • Percutaneous Nephrolithotomy
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9
Q

What are the Indications for Percutaneous Nephrolithotomy?

A
  • Minimally Invasive Surgery to REMOVE Kidney Stones
  • An ALTERNATIVE to OPEN Kidney Surgery
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10
Q

What Advice would you give to patients with Urolithiasis to reduce Stone Formation?

A
  • 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
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11
Q

What are the Most Common Uropathogens?

A
  • E.Coli and Coliforms
  • Gram POSITIVE Microorganisms
  • Polymicrobial Infections (Adults)
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12
Q

Which Infections are Classified as Uncomplicated and which as Complicated?

A

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)

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13
Q

What is the Definition of Recurrent Infection?

A
  • 2 Episodes within 6 Months
  • 3 Episodes within 1 Year
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14
Q

In Which Patients does Asymptomatic Bacteriuria NOT benefit from Treatment?

A

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
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15
Q

In Which Patients is it Recommended to Treat Asymptomatic Bacteriuria?

A
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16
Q

In Different Age Groups, what are the most common causes of Urinary Tract Infections?

A
  • 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
17
Q

What are the Symptoms of Patients with Cystitis?

A
  • Dysuria
  • Frequency / Urgency
  • Low Back / Suprapubic Pain
  • Haematuria
  • Cloudy / Smelly Urine
18
Q

What is the Treatment for Acute Cystitis?

A
  • 3 Day Course of TRIMETHOPRIM / SULFAMETHOXAZOLE (TMP / SMX)
  • 5 Day Course of FOSFOMYCIN as SINGLE Dose
19
Q

What Recommendations would you make for Patients with Recurrent Cystitis?

A
  • FLUROQUINONES can be used for TMP / SMX Resistance
20
Q

What are the Symptoms of Acute Pyelonephritis?

A

Symptoms of LOWER UT
- Frequency of Urination
- Urgency of Urination
- Discomfort in Urethra
- Nausea / Vomiting

21
Q

How is Chronic Pyelonephritis Diagnosed?

A
  • Intravenous Urography
  • CT

SHOWS Small + ATROPHIC Kidney on AFFECTED Side

22
Q

Which Disease is Considered in Differential Diagnosis of Xanthogranulomatous Pyelonephritis?

A
  • MISTAKEN for RENAL Cell Carcinoma (RCC)
23
Q

What are the Risk Factors for Emphysematous Pyelonephritis?

A
  • Diabetes Mellitus
  • Escherichia Coli, as Microbial Causative Agent
24
Q

What is the Difference Between Bacteremia and Sepsis?

A
  • Bacteremia = Presence of BACTERIA in BLOODSTREAM
  • Sepsis = INFECTION that has SYSTEMIC Manifestation E.g. SIRS
25
Q

What are the Criteria for Systemic Inflammatory Response Syndrome?

A

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
26
Q

What are the Risk Factors for Urosepsis?

A
  • Foreign Bodies (Catheters / Nephrostomy)
  • Instrumental Examinations of Excretory System
  • Diabetes
  • Immunosuppression
  • POST-Chemotherapy
27
Q

What are the Most Common Lab Abnormalities in Patients with Sepsis?

A
  • 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)
28
Q

What are the Principles in the Treatment of Sepsis?

A

1) Antimicrobial Treatment = Cephalosporins / Meropenem / Imipenem / Cilastatin WITHIN 1st Hour

2) Source Control = Nephrectomy / Orchiectomy

3) Supportive Therapy = O2 / Electrolytes / Normoglycemia (Diabetics) / PREVENTING Thrombosis