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nephrology & urology > cancers and stones > Flashcards

cancers and stones Flashcards

1
Q

how are stones caused

A

increased saturation of urine with stone forming salts or

lack of inhibitors(citrate) to prevent crystal formation

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2
Q

radiopaque stones

A

calcium kidney stone(75-85%), struvite (10-15%)

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3
Q

unilateral backpain and renal colicky pain that waxes and wanes; may radiate to testes or uvula. N/V. They shift position frequently trying to get comfortable.

maybe fever, hematura, dysuria, urinary frequency

A

neprolithiasis symptoms

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4
Q

study of choice for nephrolithiasis

A

helical(spiral) CT (no contrast needed)

do ultrasound for children and pregnant patients

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5
Q

what drugs can help facilitate stone passage

A

alpha blocker or CCB

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6
Q

what do u do if pt has a large stone?

A

percutaneous nephrostomy is gold standard

admit to hospital if unable to maintain oral intake/need vigorous hydration

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7
Q

where are stones typically found

A

proximal tract and pass distally;

they lodge at the uteropelvic junction, uterovesicular junction, or ureter at the level of the iliac vessels

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8
Q

nephrolithiasis occurs when

and gender

A

3rd or 4th decade of life.

2 to 3 fold more common in males

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9
Q

most common stone

A

calcium (75-85%); they are radiopaque

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10
Q

uric acid stones

frequency

xray

form in who

assoc with what

urine and pH

tx

A

5-8%; radiolucent

radiolucent on xray but detectable on CT

form in pts with persistantly acidic urine with or w/out hyperuricemia

assoc with gout, xanthine oxidase def, high purine turnover states(chemo)

ACIDIC and decreased pH

tx: hydrate, alkalinize urine with CITRATE, restrict purine and allopurinol

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11
Q

radiolucent stones

A

uric acid and cystine

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12
Q

cystine stones

frequency

caused by what

xray

occur in what

pH

tx

microscope and testing

A

less than 1%

caused by impairment of cystine transport; defect in renal transport of certain amino acids

* radiolucent/radiopaque????

occur in autosomal recessive cystinuria

pH decreased

hydrate, Na restriction, alkalinization of urine, pencillamine

hexagonal crystals and + urinary cyanide nitroprusside test

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13
Q

struvite(made up of what)

frequency

organism

urine

common in who

pH

tx

A

10-15%; formed by combo of calcium, ammonium, magnesium

Proteus: staghorn calculi

ALKALINE urine

common in pts with abnormal urinary tract anatomy and urinary diversions and in those that require catherization

increased pH

tx: hydrate, treat UTI if present, surgical removal of staghorn calculi

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14
Q

frequency of recurrence of stones

A

30-50% in 5 years

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15
Q

+FH, low fluid intake, gout, meds(allopurinol, chemo, loop), postcolectomy/postileostomy, specific enzyme deficiencies, hyperPTH

A

risk factors for stones

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16
Q

location of stone symptoms

upper ureter

lower part of ureter

lodged in UVJ

A

upper ureter: pain radiates to ant abdomen

lower part of ureter: pain radiates to ipsilateral groin, testicle, labia

lodged in UVJ: urinary frequency and urgency noted with lower pelvic pain

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17
Q

neprolithiasis symptoms

A

unilateral backpain and renal colicky pain that waxes and wanes; may radiate to testes or uvula. N/V. They shift position frequently trying to get comfortable.

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18
Q

nephrolithiasis can mimic what other conditions

A

acute cholecystitis, acute appendicitis, acute cystitis, diverticultitis

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19
Q

Signs of neprolithiasis

A

tachycardia, tachypnea, diaphoresis, CVA tenderness, restlessness,

abdominal distention due to ileus

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20
Q

acute cholecystitis, acute appendicitis, acute cystitis, diverticultitis

A

nephrolithiasis can mimic what other conditions

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21
Q

tachycardia, tachypnea, diaphoresis, CVA tenderness, restlessness,

abdominal distention due to ileus

A

Signs of neprolithiasis

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22
Q

neprolithiasis

serum chemistries

UA

urine culture

renal ultrasonography

intravenous pyelogram

A

serum chemistries: nml or leukocytosis

UA: microscopic hematuria(85%), ~leukocytes and/or crystals

Do urine culture to R/O infection

renal ultrasonography: only find stones in kidney, proximal ureter, and UVJ

intravenous pyelogram: rarely indicated. must have nml renal function.

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23
Q

treatment for stones less than 5 mm

A

FLUIDS!, strain urine, analgesics, follow up weekly or biweekly

alpha blocker or CCB to facilitate passage

most stones pass within 2-4 weeks

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24
Q

treatment of stones 5-10 mm

A

less likely to pass spontaneously

increase fluids and analgesics

elective lithotripsy or ureteroscopy with a stone basket extraction

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25
Q

ESWL(extracorporal shockwave lithotripsy),

percutaneous nephrolithotomy, or

retrograde ureteroscopy

A

treat kidney stones 0.5-3 cm in diameter

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26
Q

ESWL for what size

A

renal stones less than 2 cm or

for ureteral stones less than 10 mm

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27
Q

ureteroscopy for who

A

more effective than ESWL for ureteral calculi

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28
Q

percutaneous nephrolithotomy

A

for stones greater than 2cm

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29
Q

pains meds for nephrolithiasis

A

combo of morphine and ketorolac

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30
Q

calcium stones

common causes

urinary pH

tx

A

common causes: idiopathic hypercalcuria and primary hyperPTH, fat malabsorption, ALKALINE urine

urinary pH: increase for calcium phosphate and decreased in calcium oxalate

tx: hydrate, Na and protein restriction, thiazide,

*do not decrease calcium intake because it can lead to hyperoxaluria and increase risk for osteoporosis

31
Q

staghorn calculi

A

proteus organisum in struvite neprolithiasis

32
Q

hexagonal crystals and + urinary cyanide nitroprusside test

A

cystine neprolithiasis

33
Q

exposure to tobacco;

occupational carcinogens from rubber, dye, printing, chemical industries;

schistosomiasis

cyclophosphamide or aniline dye exposure

chronic infections

diets rich in meat and fat

A

causal factors in bladder cancer

34
Q

2nd most common urologic cancer and

most frequent malignant tumor of urinary tract

A

usually transitional cell carcinoma/ bladder

they are uroepithelial tumors

35
Q

1 risk factor

bladder cancer

gender

age

A

3 times as likely in men

40-70 years of age

smoking

36
Q

bladder cancer presenting symptoms

A

painless gross hematuria

also bladder irritablility and infection

37
Q

definitive diagnostic procedure for bladder cancer

A

cystoscopy then biopsy to confirm

38
Q

bladder cancer treatment

1) carcinoma in situ
2) superficial lesions
3) large, high grade, recurrent or multiple lesions

A

1) intravesicular chemotherapy
2) endoscopic resection and fulgaration; then cystoscopy every 3 months
3) intravesical instillation of thiotepa, mitcomycin-C, or BCG

39
Q

bladder cancer treatment

1) invasive cancers without mets; diffuse TCC in situ
2) invasive cancers with distant mets

A

1) radical cystectomy or radiation therapy for poor candidates for the radical cystectomy or those with unresectable local disease
2) chemo with or w/out radiation

40
Q

RCC common in who

A

men,

older than 55

incidence is higher in american indian/alaskan native men

smoking

41
Q

common symptom of RCC

A

gross or microscopic hematuria(usually), flank pain, palpable mass

fever common

maybe left sided varicocele

42
Q

primary procedure for diagnosing RCC

A

CT scanning

43
Q

3% of all adult cancers

A

RCC

44
Q

RCC mets

A

spread along renal vein to IVC and can mets to lung and bone

45
Q

von hippel-lindau disease and

hereditary papillary renal carcinoma

A

forms of hereditary RCC

46
Q

internists’ tumor

A

RCC

47
Q

RCC Tx

1) localized disease
2) advanced disease
3) avoid what
4) meds: interferon a and interleukin

A

1) radical nephrectomy(no benefit to add radiation)
2) radiation (little benefit of radical nephrectomy)
3) little benefit of chemo or hormonal therapy
4) interferon a and interleukin not successful

48
Q

hypercalcemia, HTN, erythrocytosis, hepatic dysfunction in absence of hepatic mets

A

RCC assoc with paraneoplastic syndromes

49
Q

primary study for RCC

CBC

A

CT with or w/out contrast.

confirm with histology or nephrectomy speciman

do an ultrasonography to rule out a stone in hematuria

CBC: polycythemia and anemia due to increased erythopoietin production in 5-10% of pts

50
Q

most common malignancy in young men

highest cure rates of all cancers

related to what

A

testicular ca

cryptorchidism or previous cancer

51
Q

testicular cancer symptoms

A

90% have PAINLESS, solid testicular swelling. maybe heaviness in arch

para-aortic lymphnode involvement or ureteral obstruction

maybe abdominal complaints or pulm symptoms from multiple nodules

52
Q

painless scrotal swelling

A

look for testicular cancer

53
Q

klinefelter syndrome

A

risk factor for testicular ca

54
Q

what kind of tumor is a testicular cancer

A

90-95% are germ cell tumors and malignant

so LOOK FOR METS in lungs, pelvis, and abdomen

include seminomas and non-seminomas

55
Q

diagnostic for non-seminomas

and seminomas

how common are these

A

alpha fetoprotein and beta HCG are elevated in non-seminomas

they are nml in seminomas

65% non seminoma

35% seminoma

56
Q

mixed cell type(40%)

embryonal carcinoma(20%)

teratoma(5%)

choriocarcinoma(under 1%)

A

subtypes of non-seminomas in testicular cancers

57
Q

testicular cancer dx

A

complete orchiectomy for dx; simple bx increases the risk of spreading cancer into scrotum

58
Q

testicular cancer

which is radiosensitive and radioresistant

A

seminomatous tumors are radiosensitive

nonseminomatous tumors are radioresistant

59
Q

non seminomatous tumors tx

stage 1, 2, and 3

A

1) limited to testis, nerve sparing retroperitoneal lymph node dissection or rigorous surveillance without surgery or chemo
2) can be treated with surgery or chemo
3) should be treated with surgery or chemo

60
Q

seminomatous tumors tx for stage 1, 2, 3

A

stage 1 isolated to testis: do radiation of para-aortic and ipsilateral iliac nodal areas

stage IIa and IIb adds increased radiation to affected nodes

stage IIc and III is chemo

61
Q

most common cancer in men

A

prostate

62
Q

prostate cancer

1) pace of growth
2) kind of cell
3) can lead to what

A

1) slow growing
2) adenomatous cells
3) urinary obstruction and metastatic disease

63
Q

prostate cancer

cause

risks

PSA level

A

cause unknown

risks: black, FH, high fat diet

PSA over 4.0

64
Q

prostate cancer

initial test then what to confirm

A

transrectal ultrasonography reveals hypoechoic lesions in peripheral zone

bx confirms and allows histologic grading(gleason system)

6-12 biopsy samples are taken

65
Q

prostate cancer tx

1) stage A and B
2) stage C
3) stage D

A

1) stage A and B(confined to the prostate): radical retropubic prostatectomy, [brachytherapy, or external beam radiation] radiation
2) stage C (tumor with local invasion): similar to above with reduced effectiveness.
3) stage D(distant mets): hormonal manipulation using orchiectomy, antiandrogens, LH releasing hormone agonists, androgen ablation, or estrogens. chemo for advanced disease

66
Q

disadvantages of

radical prostatectomy and

radiation for prostate cancer

A

1) increased risk of incontinence and ED
2) radiation proctitis and GI symptoms

67
Q

screening for prostate cancer

A

DRE and/or PSA at age 50;

begin earlier in blacks and FH

68
Q

nephroblastoma

occur in who

mortality

A

wilms tumor

most often healthy kids; 10% in kids with recognized malformations

most curable; 5% have anaplasia and poor prognosis

incidence of anaplasia increases with age

69
Q

painless abdominal mass in kids

A

wilms tumor

70
Q

wilms presentation

A

anorexia, N/V, fever, abd pain, hematuria

HTN can occur with elevated renin levels

71
Q

study of choice for a wilm’s tumor

A

ultrasonography

can order an MRI and CT to look at tumor extension and regional lymph nodes

CXR to look for pulm mets

72
Q

wilms tx

A

multimodal approach:

surgery

chemo

in some: radiation

73
Q

wilms

resectable vs unresectable tumor tx

A

radical nephrectomy with lymph node sampling for resectable tumors

preop biopsy then chemo for unresectable tumors

*the tumor is chemosensitive

74
Q

wilms tumor

chemo vs radiation

A

the tumor is chemosensitive and responsive to

dactinomycin, vincristine, and doxorubicin

radiation is for higher stage tumors and for tumors with focal anaplasia

nephrology & urology (7 decks)

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