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Clin Med III > kidney stones, bladder ca, RCC > Flashcards

kidney stones, bladder ca, RCC Flashcards

1
Q

types of kidney stones

A
  • calcium stone- most common
  • struvite stones- aka staghorn calculi
  • uric acid stones
  • cystine stones- often recurrent
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2
Q

risk factors for calcium stones

A
  • hx of prior stones
  • family hx
  • diet
  • medications
  • hyperparathyroidism
  • hypercalcemia of malignancy
  • sarcoidosis
  • medullary sponge kidney
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3
Q

dietary risk factors for calcium stones

A
  • dehydration*
  • short gut -> increased enteric absorption of oxalate
  • large consumption of grapefruit juice, tomato juice, apple juice, soda
  • high Na or protein intake
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4
Q

medications at risk for causing calcium stones

A
  • diuretics- esp thiazides
  • antacids in high volumes
  • vit D and C
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5
Q

risk factors for uric acid stones

A
  • gout
  • hyperuricosuria
  • chronic diarrhea
  • HTN, DM, obesity*
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6
Q

other drugs that may cause stones

A
  • indinavir
  • acyclovir
  • triamterene
  • sulfadiazine
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7
Q

clinical presentation of kidney stones

A
  • sudden onset renal colic
  • severe unilateral flank pain, may radiate to groin
  • pacing, rocking, writing, constant movement
  • n/v, diaphroesis
  • tachycardia, HTN
  • normal abd exam
  • testicles non-tender and non-swollen
  • hematuria, dysuria, frequency, urgency
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8
Q

describe the colicky pain of kidney stones

A
  • SUDDEN onset severe pain
  • pain waxes and wanes
  • severe pain usually lasts 20-60 min
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9
Q

where do kidney stones usually get stuck?

A
  • UPJ
  • pelvic brim
  • UVJ
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10
Q

pain from a stone stuck in the kidney

A
  • flank pain

- hematuria

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11
Q

pain from a stone stuck in the proximal ureter

A
  • renal colic and flank pain

- upper abd pain

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12
Q

pain from a stone stuck in middle ureter

A
  • renal colic

- anterior abdominal/groin pain

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13
Q

pain from a stone stuck in distal ureter

A
  • renal colic
  • dysuria/ urgency/ frequency/ hesitancy
  • anterior abd pain
  • groin pain
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14
Q

what should you look for on UA for kidney stone work up

A
  • microhematuria- common but not always present
  • pH, crystals, bacteria
  • signs of infection
  • limited pyuria is common from irritation due to stone
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15
Q

US for kidney stone dx

A
  • look for indirect signs of obstruction
  • hydroureter, no ureteric jet
  • procedure of choice in pregnancy, kids, hx of prev stone
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16
Q

KUB for kidney stone dx

A
  • stone frequently gets obscured by stool, bowel gas, bones
  • does not show all stone types
  • cant see uric acid stones, pure cystine stones, indinavir stones
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17
Q

IV pyelograms for kidney stone dx

A
  • poor visualization of non-GU structures

- need good kidney function- get SCr prior to test

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18
Q

non-contrast CT scan for kidney stone dx

A
  • gold std
  • IDs all stone types in all locations
  • fast and accurate
  • c/i in kids and pregnancy
  • can also see ureteral/ collecting dilation, perinephric/ periureteric stranding, nephromegaly, rim sign
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19
Q

what is the rim sign

A
  • ureter swollen around kidney stone
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20
Q

management for kidney stones

A
  • IV hydration
  • NSAIDs (ketorolac)
  • +/- antiemetics- usu emesis due to pain
  • +/- tamulosin
  • d/c to home if able to take PO meds and fluids
  • strain urine
  • send stone for analysis
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21
Q

when is hospitalization required for kidney stones

A
  • cannot take PO due to intractable vomiting
  • refractory/ severe pain
  • pregnant
  • elderly/ comorbidities
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22
Q

what are emergent situations in the setting of kidney stones

A
  • sepsis + obstruction
  • ARF
  • anuria
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23
Q

what are the procedures used for kidney stones

A
  • extracorporeal shock wave lithotripsy (ESWL)
  • ureteroscopy
  • percutaneous nephrolithostomy (PCNL)
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24
Q

extracorporeal shock wave lithotripsy

A
  • usu for proximal stones < 2 CM renally or < 1 cm ureterally
  • stone broken up into pieces
  • fragments passed
  • consider stent
  • less effective if morbidly obese or very hard/ cystine stones
25
when is extracorporeal shock wave lithotripsy c/i
- pregnancy - tightly impacted stones - bleeding disorders
26
ureteroscopy
- used for mid- distal ureteral stones - endoscope through bladder - if stone < 5 mm retrieve it with basket - larger stones get broken up with lithotripsy - usu requires stent
27
percutaneous nephrolithostomy
- stones > 2 cm and proximal collecting system - percutaneous insertion of needle into kidney through CVA - usu done if failed other modalities or large/ complex renal stone
28
staghorn calculi
- upper urinary tract stones - involve renal pelvis and at least two calyces - usu struvite stones - assoc with recurrent UTIs- proteus* or klebsiella - rarely colicy pain - tx of choice= percutaneous nephrolithotomy
29
who requires metabolic work ups for kidney stones
- recurrent stones - strong family hx - usu uric acid or cystine stones
30
what is included in a metabolic work up for kidney stones
- serum PTH and Ca - 24 hour urinalysis**- urine volume, Ca, oxalate, phosphate, citrate, uric acid, pH, Na - BMP
31
treatment for recurrent stones
- depends on 24 hour urine findings - thiazides for hypercalciuria - tx hyperparathyroidism - dietary restriction of purines, give allopurinol or oxalate - k citrate for citrate in urine
32
treatment for uric acid stones
- k citrate- alkalinize urine - allopurinol as prevention - restrict dietary purines
33
treatment for cystine stones
- high fluid intake- 3-4 L of urine output per day
34
treatment for struvite stones
- PNL | - prophylactic abx
35
what type of cancer are most bladder cancers?
- transitional cell carcinoma | - can arise anywhere in GU tract
36
risk factors for bladder cancer
- age > 55 - men > women - cigarette smoking** - occupational exposure - chronic urinary inflammation - family hx - previous pelvic xrt
37
si/sx of bladder cancer
- painless hematuria** - urinary voiding sx less common - advanced disease: LE swelling, bone/ pelvic/ flank pain, palpable mass
38
work up for bladder cancer
- UA- get microscopy and culture, cytology* - cystoscopy*- gold std - CT with contrast or MRI - bone scan and CXR for mets
39
staging of bladder cancer
- T1- superficial tumor - T2- tumor in muscle - T3- tumor in adipose - T4- tumor beyond adipose and into nearby organs/ structures
40
prognosis of bladder cancer
- 70% 10 year survival | - best prognosis if caught early
41
treatment for bladder cancer
- tumor depth determines treatment - endoscopic TURBT for T1 tumors - T2 or larger get neoadjuvant chemo then radical cystectomy
42
what is the chemo used for bladder cancer
- BCG intravesicular for 6-12 weeks
43
renal cell carcinoma (RCC)
- majority of all renal cancer - most commonly in proximal renal tubular epithelium - sporadic or hereditary
44
risk factors for RCC
- males> female - smoking* - obesity - HTN - s/p renal transplant/ dialysis if dev cystic renal disease
45
si/sx of RCC
- painless hematuria* - weight loss, night sweats, malaise - L sided varicocele - classic triad: flank pain, hematuria, flank mass (only seen in 10%) - frequently occur with paraneoplastic syndromes
46
paraneoplastic syndromes assoc with RCC
- hyperCa - non-metastatic liver dysfunction - malignant HTN - erythrocytosis
47
advanced sx of RCC
- spreads to lungs, soft tissue, bones, liver, cuteanous sites, CNS - cough, SOB - HA, seizure - bone pain
48
diagnosis of RCC
- often incidental finding - cytology not as helpful - CT gold std - US good for simple cysts - MRI to det IVC involvement - bone scan and pet scan for mets
49
stage I RCC
- confined to kidneys - IA < 4 cm - IB 4-7 cm
50
stage II RCC
- confined to kidneys (gerota's fascia) | - > 7 cm
51
stage III RCC
- vascular or regional LN involvement | - IVC or renal v
52
stage IV RCC
- adjacent organ involvement and/or distant mets
53
RCC treatment if localized to kidney
- TIA- partial nephrectomy - TIB- T2- radical nephrectomy - low rate of recurrence - good prognosis
54
treatment for locally advanced RCC
- radical nephrectomy | - LN dissection and IVC thrombectomy
55
venous tumor thrombus
- RCC tumor grows into venous circulation | - does not invade wall
56
venous tumor thrombus sx
- LE edema - isolated R varicocele or one that does not reduce - dilated superficial abd veins - PE - RA mass - nonfunction of involved kidney
57
treatment for locally invasive RCC
- en block resection of adjacent organs
58
treatment for disseminated RCC
- palliative radical nephrectomy to help relieve sx - nephrectomy and metastatic excision - IL 2 drugs in minima tumor burden, lung or nodal mets only - interferon- alpha - multikinase inhibitors and VEGF prevent tumor growth - radioresistant and chemoresistant

Clin Med III (26 decks)

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