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Urinary system > Obstruction and urolithiasis > Flashcards

Obstruction and urolithiasis Flashcards

1
Q

Outline urinary tract obstruction

A
  • Can occur at any level
  • Unilateral or bilateral
  • Complete or incomplete
  • Gradual or acute onset
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2
Q

What conditions are patients with urinary tract obstruction more at risk of?

A
  • UTI - due to obstruction of urine flow and stasis
  • Reflux
  • Stone formation
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3
Q

What is a staghorn calculus?

A
  • Antler-shaped calculus
  • Take on shape/form of urinary tract
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4
Q

What are some causes of urinary retention?

A
  • Calculi
  • Pregnancy
  • Benign prostatic hypertrophy (BPH)
  • Recent surgery
  • Drugs
  • Urethral strictures
  • Pelviureteric junction obstruction
  • Pelvic masses
  • Constipation
  • Inflammation
  • Tumours
  • Neurogenic disorders
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5
Q

How does pregnancy cause urinary retention?

A
  • High levels of progesterone relax muscle fibres in the renal pelvis and ureters
  • Cause dysfunctional obstruction
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6
Q

How do neurogenic disorders that cause urinary retention arise?

A
  • Congenital abnormalities affecting spinal cord
  • External pressure on cord or lumbar nerve roots
  • Trauma to spinal cord
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7
Q

Outline acute urinary retention

A
  • Painful inability to void
  • Residual volume 300-1500ml
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8
Q

Outline chronic urinary retention

A
  • Painless
  • May still be voiding
  • Residual volume 300-4000ml
  • Can get acute on chronic retention
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9
Q

How do we manage acute urinary retention?

A
  • Catheterise and record residual urinary volume
  • History - weight loss, haematuria, urine stream etc.
  • Examination (abdo, ext. genitalia, DRE)
  • Urine dip
  • U&Es
  • Treat any obvious causes e.g. constipation or BPH
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10
Q

How do we treat acute urinary retention caused by BPH?

A
  • Alpha blocker
  • May trial without catheter after 1-2 weeks
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11
Q

How do we manage chronic urinary retention?

A
  • Catheterise and record residual volume
  • History
  • Exam
  • Urine dip, U&Es (K+ needs to be monitored)
  • Plan for long-term catheterisation or intermittent catheterisation
  • Do not attempt to trial without catheter
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12
Q

Outline high pressure chronic urinary retention

A
  • Abnormal U&Es, hydronephrosis
  • Repeat episodes can cause permanent renal scarring and CKD
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13
Q

Outline low pressure chronic urinary retention

A
  • Normal renal function
  • No hydronephrosis
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14
Q

What is post-obstructive diuresis?

A
  • Occurs following resolution of urinary retention through catheterisation
  • Kidneys often over-diurese
  • Can lead to worsening of AKI (pre-renal)
  • Urine output should be monitored for 24 hours post catheterisation
  • Patients with high urine volumes should be supported with IV fluids
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15
Q

What is hydronephrosis?

A
  • Dilation of renal pelvis and calyces due to obstruction at any point in the urinary tract
  • Causes increased pressure and blockage
  • Can be unilateral or bilateral
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16
Q

What causes unilateral hydronephrosis?

A
  • Upper urinary tract obstruction
17
Q

What causes bilateral hydronephrosis?

A
  • Lower urinary tract obstruction
18
Q

How does hydronephrosis affect the kidneys?

A
  • Progressive atrophy of the kidney develop
  • Back pressure from obstruction is transmitted to distal parts of nephron
  • GFR declines
  • If obstruction is bilateral, patient goes into renal failure
19
Q

Where is the obstruction found in hydronephrosis?

A
  • Pelviureteric junction
20
Q

What is hydroureter?

A
  • Obstruction at ureter
  • Eventually develops into hydronephrosis
21
Q

What is bladder distension with hypertrophy?

A
  • Obstruction of bladder neck/urethra
  • Eventually leads to hydroureter and hydronephrosis
22
Q

Outline acute ureteric obstruction

A
  • Results in renal colic
  • Usually caused by calculus but can be due to blot clots or sloughed papilla
  • Usually a unilateral problem
  • Leads to acute renal failure if bilateral
  • Presents as anuria or oliguria
  • Pyonephrosis can develop
23
Q

What is pyonephrosis?

A
  • An infected, obstructed kidney
  • Urological emergency
  • Failure to promptly decompress may lead to death from sepsis and permanent loss of renal function
24
Q

How is upper urinary tract obstruction diagnosed?

A
  • Diagnosis with CT or USS - show structure not function
  • Diuretic renography (MAG3) is a functional test
25
Q

How is the upper urinary tract drained?

A
  • Nephrostomy
  • JJ stent
26
Q

Outline urolithiasis

A
  • Urinary calculi
  • Affects 10% of the population
  • Especially men and Caucasians
  • Dehydration is a predisposing factor (increases conc. of urine)
  • High recurrence rate 860-80%
27
Q

What are the 3 most common sites of urinary calculi?

A
  • Pelviureteric junction
  • Pelvic brim
  • Vesicoureteric junction
28
Q

What is the gold standard for diagnosing urinary calculi?

A
  • CT scan of kidneys, ureters and bladder
29
Q

What are the 5 types of urinary calculi?

A
  1. Calcium oxalate - most common, associated with hypercalcaemia, primary hyperparathyroidism, hyperoxaluria
  2. Mixed calcium phosphate and calcium oxalate stones - associated with alkaline urine
  3. Magnesium ammonium phosphate stones - associated with urea splitting bacteria
  4. Uric acid stones - associated with gout and myeloproliferative disorders
  5. Cystine stones - patients with inherited cystinuria
30
Q

How do patients with urinary calculi present?

A
  • Depends on site of stone
  • Renal stones may cause a continuous dull ache in the loins
  • Ureteric stones cause renal colic radiating from loin to groin. Patient appears sweaty, pale and restless with vomiting and nausea
  • Bladder stones cause strangury
  • Recurrent and untreatable UTIs, haematuria or renal failure
  • May be asymptomatic
31
Q

Why do ureteric stones cause renal colic?

A
  • Due to increased peristalsis in ureters in response to passage of a small stone
32
Q

How do we treat urinary calculi?

A
  • Adequate analgesia
  • High fluid intake
  • Stones of 4-5mm usually pass spontaneously
  • Larger stones might require surgical treatment
33
Q

What do other treatments for urinary calculi involve?

A
  • Extracorporeal shock wave lithotripsy: shock waves are used to fragment calculi into small pieces which will then pass out in urine
  • Ureteroscopic destruction or removal of stones
  • Endoscopic removal of stone (PCNL)
  • Open surgical removal
34
Q

How do we prevent further formation of urinary calculi?

A
  • High fluid intake
  • Correction of any underlying metabolic abnormality

Urinary system (22 decks)

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