Fang 4 Flashcards
1
Q
clinical presentation of urinary calculi
A
- Acute onset, colicky flank pain radiating to the groin or scrotum due to ureteral obstruction causing renal capsular and ureteral distention
- worst pain the pts have experienced
- Lower quadrant pain, urinary urgency, frequency, and dysuria as the stone approaches the ureterovesical junction
- Distressed patient, often writhing, while trying to find comfortable position
- nausea and vomiting
2
Q
diagnostic evaluation of kdiney stones
A
- gross or microscopic hematuria is present in 90%
-
Gold standard: CT scan of abdomen and pelvis without oral or intravenous contrast
*
3
Q
Indications for urgent intervention with urinary stones
A
- Obstructed upper tract with infection
- impending renal deterioration
- pain refractory to analgesics
- intractable nausea/vomiting
4
Q
Chance of passing ureteral stone
A
- 2/3 of ureteral stones will pass within 4 weeks of the onset of symptoms
- If a stone has not passed within 4 weeks, INTERVENTION is usually needed
5-6mm –> 50% change of passing stone
5
Q
Prevention of stones
A
- ADEQUATE HYDRATION (2.5-3L/day
- Diatary modifications
- low animal protein, low sodium, low oxalate diets
- normal dietary calcium intake
- citrate therapy
- Full metabolic evaluation
6
Q
Angiomyolipoma (AML)
A
- Benign solid renal tumor
- Contains proliferation of blood vessels, smooth muscles, and adipose tissue
- PRESENCE OF EVEN A SMALL AMOUNT OF FAT WITHIN A RENAL LESION ON CT SCAN VIRTUALLY EXCLUDES THE DIAGNOSIS OF RENAL CELL CARCINOMA AND IS CONSIDERED DIAGNOSITC OF AML
- Ass. with tuberous sclerosis
PRESENTATION: typically an incidental finding on imaging study
TX:
- OBSERVATION FOR < 4CM
- Symptomatic, >5cm, or atypical appearance
- selective embolization, partial nephrectomy, radical nephrectomy
7
Q
Renal cell carcinoma (RCC) Tumor histotypes
A
- Clear cell RCC (80%) –> loss of VHL
- Papillary (chromophil) RCC (15%) –> activation of MET
- Chromophobe RCC (5%) –> loss of multiple chromosomes
- prognosis is the best among 3 histotypes
