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Abdominal Pathology > Lesson 4B (Part 4) > Flashcards

Lesson 4B (Part 4) Flashcards

1
Q

Nephrolithiasis

A

Renal calculi

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2
Q

Who is more affected by nephrolithiasis?

A

Caucasian men with increasing age

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3
Q

What are nephrolithiasis composed of?

A

Calcium

- 60-80%

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4
Q

What are predisposing conditions of nephrolithiasis? (5)

A
  1. Dehydration
  2. Urinary stasis
  3. Hyperuricemia
  4. Hyperparathyroidism
  5. Hypercalciuria
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5
Q

What is the cause of nephrolithiasis?

A

No cause

- if not obstructed its usually asymptomatic

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6
Q

Where can migrating calculus cause? (2)

A
  1. Infundibular
  2. UPJ obstruction
    - stones may pass into the ureter and lodge in three areas of ureteric narrowing
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7
Q

What are symptoms of calculi?

A

Flank pain

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8
Q

What percent do stones <5mm pass spontaneously?

A

80%

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9
Q

What percent of patients have flank pain due to calculi?

A

77-93%

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10
Q

What are the 3 areas of ureteric narrowing?

A
  1. UPJ just past the ureteropelvic junction
  2. Where the ureter crosses the iliac vessels
  3. UVJ at the ureterovesicular junction
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11
Q

What accounts of ureteric narrowing?

A

Small diameter (1-5mm) of UVJ

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12
Q

What are the modalities that can identify calculi? (5)

A
  1. Plain x-ray films
  2. Tomography
  3. Intravenous urography
  4. Ultrasound
    - high sensitivity ***
  5. Unenhanced CT
    - used if US is unable to detect size and location of stones in patients with severe pain or cant see due to gas
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13
Q

What are the sonographic findings of calculi?

A

Echogenic foci with sharp distal acoustic shadowing

- twinkle artifact

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14
Q

What percent of stones have the twinkling artifact?

A

83%

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15
Q

What are other possibilities that can mimic calculi? (5)

A
  1. Intrarenal gas
  2. Renal artery calcification
  3. Sloughed papilla
  4. Pyelitis
  5. Ureteric stent
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16
Q

What do you want tin order to see a twinkle artifact?

A

A high PRF

- high gain

17
Q

What might be hard to see due to bowel gas and deep retroperitoneal position?

A

Ureteral calculi

18
Q

Hydroureter

A

A dilated ureter will be seen as a tubular hypoechoic structure entering the bladder obliquely

19
Q

What may be seen on either side of the stone?

A

Anechoic ureter

20
Q

What does obstructing ureteral calculus cause?

A

Hydronephrosis of the collecting system

21
Q

What happens with hydronephrosis of collecting system?

A

Urine is being produced but cannot flow from the kidney to the bladder

22
Q

What can hydronephrosis be confused with?

A

Multiple parapelvic cysts

  • which would not connect to the pelvis
  • they need to be connected
23
Q

What are the S/S of hydronephrosis? (4)

A
  1. Flank pain
  2. Hematuria
  3. Fever
  4. Leukocytosis
24
Q

What could potentially cause hydronephrosis? (8)

A
  1. Stasis of urine
  2. Infection
  3. Tumor extension from the bladder, ureter or kidney
  4. Thrombus
  5. A kink in the UPJ
  6. An enlarged prostate gland in men
    - which can be due to BPH or prostatitis
  7. Pregnancy
    - causes a compression due to a growing fetus
  8. A narrowing of the ureter from an injury or birth defect
25
Q

What is grade 1 hydronephrosis?

A

Small fluid filled separation of renal pelvis

26
Q

What is grade 2 hydronephrosis?

A

Dilation of some but not all calyces

27
Q

What is grade 3 hydronephrosis?

A

Marked dilatation of renal pelvis and all calyces

- an echogenic line separates the collecting system from the parenchyma

28
Q

What is grade 4 hydronephrosis?

A

Prominent dilatation of the collecting system

  • cortical thinning
  • unable to separate the collecting system and the parenchyma

Abdominal Pathology (49 decks)

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