Exam 3 GU Procedures (7/15/24) Flashcards
Symptoms of renal dysfunction begin to be seen when GFR drops to ___ from normal.
50%
Which of the following 3 symptoms begin to appear when there is “Severe” renal insufficiency?
A. Anemia
B. Profound Uremia
C. Decreased energy
D. Decreased BUN/Creatinine
E. Acidemia
F. Hypervolemia
B. Profound Uremia
E. Acidemia
F. Hypervolemia
BUN is not usually elevated in kidney disease until GFR is ___ of normal.
75%
While evaluating a CRF patient pre-operatively, you notice they are acidotic. Why is this issue occuring?
- Decreased production of ammonia
As disease progresses = anion gap becomes elevated
Specific Cardiac/Pulm symptoms that are likely to be present pre-operatively in CRF patients:
- HTN
- Atherosclerosis
- Pulm. Edema
- Vent. Hypertrophy
Which of the following are listed as “abnormal” in regard to the hematologic symptoms present in CRF patients?
A. Platelet Aggregation
B. Color
C. Size
D. Prothrombin Consumption
A. Platelet Aggregation
D. Prothrombin Consumption
Most of our anesthetic drugs are ___ in the ____ state, therefore aren’t very harmful in CRF patients.
Most drugs are lipid soluble in non-ionized state
List some anesthetic drugs of concern that are highly ionized and eliminated unchanged in urine:
- Muscle relaxants (Pancuronium)
- H2 receptor blockers
- Cholinesterase inhibitors
- Thiazide diuretics
- Digoxin
- Antibiotics
- Active Metabolites (morphine/meperidine/ketamine/midazolam)
What can we do to provide renal protection for renal insufficiency patients?
Adequate Hydration
Maintenence of adequate RBF
Maintain a normal MAP
Which of the following drugs has been shown to be most effective in offering renal protection to CRF patient’s after having dye injected?
A. Glucagon
B. Mannitol
C. Fenoldopam
D. N-Acetylcysteine
E. Methylene Blue
D. N-Acetylcysteine
Procedure name for using a scope to look through the bladder?
Cystoscopy
What is the procedure of choice for mid/distal ureter kidney stones?
Ureteroscopy
Lifetime prevalence of kidney stones for men and women?
Recurrence rate?
What are these stones comprised of?
Lifetime prevalence of kidney stones for men and women? (Men: 10%, Women: 5%)
Recurrence rate? (50%)
What are these stones comprised of? (Calcium)
What are some “Medical” therapy options for kidney stones?
- NSAIDs
- Aggressive fluid administration
- Calcium channel Blockers
- Alpha blockers
Surgical treatment options for kidney stones:
- Stone basket vs Laser
- Shock wave Lithotripsy
- Perc Nephrolithotomy
Which surgical treatment option is best suited for small/medium intranephrenic stones?
Shock Wave Lithotripsy
What were some issues seen with the older Shock wave lithotripsy procedures?
- Required Water baths
- High incidence of Hypothermia
- Very Painful surgery
Absolute or Relative C/I to Shock wave lithotripsy:
Untreated UTI:
Morbid Obesity:
Pregnant:
Obstruction distal to renal caliculi:
Bleeding disorders:
Calcified Aorta:
Anti-coagulation therapy:
Pacemaker/ICD:
Untreated UTI: Relative
Morbid Obesity: Relative
Pregnant: Absolute
Obstruction distal to renal caliculi: Relative
Bleeding disorders: Absolute
Calcified Aorta: Relative
Anti-coagulation therapy: Absolute
Pacemaker/ICD: Relative
What is one thing that may be required for all OR personnel to wear during SWL?
Some dope protective eye-wear
Percutaneous Nephrolithotomy is useful for…
Requires initial placement of…
Possibility of…
Useful for large intranephric stones
initial placement of uretal stents
TUR syndrome is possible
Intra-Op considerations for Percutaneous Nephrolithotomy:
- GETA
- Short acting NMBD’s (Vec/Roc)
- Lateral Positioning
True or False:
Orchiectomies are almost always unilateral with the affected side being most commonly the left side.
FALSE:
Orchiectomies are almost always bilateral
Testicular torsion must be resolved within ___ to avoid reversible ischemic damage.
6 hrs
Surgical Emergency!
What is one thing that may also be done if undergoing a penectomy?
May include inguinal lymph node biopsy
(Squamous cell carcinoma)
Patients with these 2 comorbidities are most likely to have a penile prosthesis operation:
Diabetes
Spinal cord Injury
Also can be done for impotence treatment, monitor for infection
For which 2 penile operations is a penile block most commonly done and appreciated?
What dermatomes are blocked?
Prosthesis and Penectomy
S2-S4