Genitourinary System Disorders Part 1

Question 1

What are some causes for urinary obstruction? (7 things)

Answer 1

Hydronephrosis, hydroureter, ischemia, tubular damage, infection, calculi, renal failure

Question 2

What are the 5 risk factors for renal calculi?

Answer 2

metabolic, dietary, genetic, lifestyle/occupation, climate

Question 3

What are the 2 common sites for complete obstruction?

Answer 3

ureteral pelvic junction, ureteral vesicular junction

Question 4

What is the most common site for complete obstruction? (1 site only)

Answer 4

UVJ (ureteral vesicular junction)

Question 5

What are some common causes for renal calculis?

Answer 5

UTI d/t increased organic matter around which minerals can precipitate and increased alkalinity of urine, long uses of antacids/Vit D/large doses of Vit C/ calcium carbonate.

Question 6

What is the most common type of kidney stones?

Answer 6

Calcium oxalates (from foods high in oxalate such as cabbage)

Question 7

Clinical manifestations: what type of pain is experienced if calculi is in the renal pelvis?

Answer 7

r/t hydronephrosis, dull pain and constant in character primarily in the costovertebral angle.

Question 8

clinical manifestations: what type of pain is experienced if calculi is in ureter?

Answer 8

excruciating pain, intermittent. Pain will follow anterior course of the ureter down to suprapubic area and radiate to external genitalia.

Question 9

What are some clinical manifestations of renal calculis?

Answer 9

gross hematuria (d/t rough edges), S/S of UTI, asymptomatic until large stones appear, small smooth stones pass asymptomatically.

Question 10

Composition, occurrence and contributing factors for calcium oxalate (35-40%) and calcium phosphate (8-10%)?

Answer 10

Hypercalcemia and hypercalciuria from hyperparathyroidism (phosphate), vit D intoxication, multiple myloma, immobilization, severe bone disease, cancer renal tubular acidosis, prolonged intake of steroids, increased intake of calcium.

Question 11

Composition, occurrence and contributing factors for uric acid (5-8%)?

Answer 11

high purine diet gout renal failure, blood disorders, use of thiazide diuretics and alkylating agents (primarily, jewish people have this type of stone)

Question 12

Composition, occurrence and contributing factors for Cystine (1-2%)?

Answer 12

Cystinuria resulting from genetic disorder of amino acid metabolism.

Question 13

Composition, occurrence and contributing factors for Struvite: magnesium-ammonium phosphate, (10-15)?

Answer 13

Infection: urea splitting bacteria; referred to as infected stones.

Question 14

Therapeutic measures for calcium phosphate/oxalate?

Answer 14

alkaline urinary pH. increase fluids, diet low in oxalates, administer thiazide diuretics, cellulose phosphate (chelates Ca in GI) chokestyramine (binds oxalates in GI), calcium lactate (precipitates oxalates in GI), reduce daily sodium intake, treat hyperparathyroidism.

Question 15

Therapeutic measures for Uric Acid?

Answer 15

acidic uriniary pH. reduce uric acid concentration, administer potassium citrate to alkalinize urine, allupurinol (antigout), reduce dietary purines.

Question 16

Therapeutic measures for cystine?

Answer 16

acidic urinary pH. increase hydration, administer alpha-penicilamine and tiopronin to prevent crystallization, potassium citrate to alkalinize urine.

Question 17

Therapeutic measures for struvite?

Answer 17

alkaline urinary pH. administer antimicrobial agents, acetphydroxamic acid to acidify urine, remove stones.

Question 18

What is the golden standard diagnostic test to detect renal calculi?

Answer 18

Non-contrast enhanced CT. CT is 95-98% sensitive, specific, accurate, can also detect secondary signs of UTO.

Question 19

What is the KUB diagnostic test?

Answer 19

kidney, ureter, bladder. identifies radiopaqe stones but misses radiolucent stones (uric acid)

Question 20

What is IVP diagnostic test?

Answer 20

Intravenous pyelograph. Highly sensitive and specific but takes longer than CT

Question 21

What is retrograde pyelography?

Answer 21

dye injected to kidney for x-ray studies

Question 22

What can ultrasounds detect in relation to kidney stones?

Answer 22

detect radiolucent stones, but might miss small stones and urethral stones.

Question 23

What lab diagnostic tests are used to detect kidney stones?

Answer 23

Urinalysis, calcium and uric acid levels(pH), nitroprusside urine test to check for cystine

Question 24

What are 2 non-surgical treatments?

Answer 24

pass spontaneously, fluid 2500/day or more to promote stone passage and prevent UTI, ureteral catheters to dilate ureter to allow passage.

Question 25

What is Percutaneous lithotripsy?

Answer 25

require small incision over kidney region (percutaneous nephrostomy tract), nephroscope passed via opening and a snare basket used to retrieve calculi, if not removable- use lithotripter probe to break up stone. Complications: hemorrhage, urinoma, sepsis, abscess.

Question 26

What is the candela laser therapy?

Answer 26

A pulsed-dye laser system designed to break up calculi when migration to lower ureters. Probe is inserted through ureteroscope. Procedure spares pt discomfort and cost of lithrotripsy or surgery.

Question 27

What is extracorporeal shock wave lithrotripsy?

Answer 27

Shock waves are focused on location of stone (through the skin); 70-120 shock/min released. If stones block the urine flow pt will experience severe pain and stent will be introduced. Procedure takes 1 hour, up to 8000 shocks administered. Works best with stones 4mm-2mm diameter.

Question 28

When is surgical intervention used?

Answer 28

when large stones greater than 1cm produce pain, obstruction, and infection.

Question 29

What is the surgical procedure Ureterolithotomy?

Answer 29

removing stones from ureter

Question 30

what is the surgical procedure pyelolithotomy?

Answer 30

removal of stone from renal pelvis

Question 31

What is the surgical procedure nephrolithotomy?

Answer 31

removal of staghorn calculus fom renal parenchyma (kidney split)

Question 32

What is the surgical procedure litholapaxy?

Answer 32

bladder stones removed via suprapubic incision or crushed with a lithotrite (stone crasher procedure)