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Urinary > Obstructions + Urolithiasis > Flashcards

Obstructions + Urolithiasis Flashcards

1
Q

What does a unitary tract obstruction increase your risk of?

A

UTI
Reflux
Stone formation

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2
Q

Causes of urinary retention

A
  • calculi
  • pregnancy
  • benign prostatic hypertrophy
  • recent surgery
  • drugs
  • urethral strictures
  • constipation
  • pelvic masses or tumours
  • inflammation of lower urinary tract
  • issues with spinal cord
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3
Q

How can pregnancy causes urinary retention?

A
  • high levels of progesterone relax muscle fibres in renal pelvis + ureters
  • causes dysfunctional obstruction
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4
Q

Describe acute urinary retention

A

Painful
Inability to void
Residual volume 300-1500ml

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5
Q

Describe chronic urinary retention

A

Painless
May still be voiding
Residual volume 300-4000ml

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6
Q

Acute vs chronic urinary retention

A
  • Acute: painful + unable to void
  • Chronic: painless + may be able to void
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7
Q

Management of acute urinary retention

A
  • catheterise + record residual volume
  • history
  • abdomen + external genitalia exam
  • urine dipstick + U&Es
  • treat any obvious cause
  • BPH - alpha blocker
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8
Q

Management of chronic urinary retention

A
  • catheterise + record residual volume
  • exam
  • urine dipstick + U&Es
  • long term catheterisation

high pressure:
- abnormal U&Es, hydronephrosis
- repeat episodes can cause permanent renal scaring + CKD
low pressure:
- normal renal function
- no hydronephrosis

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9
Q

What is a staghorn calculus?

A

Renal stone in the renal collecting system

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10
Q

What are the most common locations of stones in the urinary tract?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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11
Q

What is acute on chronic urinary retention?

A

Patient has chronic UR but something else happens + causes acute UR so patient has both

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12
Q

What is hydronephrosis?

A
  • Dilation of the renal pelvis + calyces
  • due to obstruction at any point along urinary tract > increased pressure + blockage > urine accumulates in kidneys
  • unilateral or bilateral
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13
Q

What is unilateral hydronephrosis caused by?

A

Upper urinary tract obstruction
e.g. in ureter

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14
Q

What is bilateral hydronephrosis caused by?

A

Obstruction in lower urinary tract
e.g. enlarged prostate

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15
Q

What is post obstructive diuresis?

A

Kidneys eliminate excess amounts of water after resolution of urinary retention through catheterisation

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16
Q

Management of patients with post obstructed diuresis

A
  • monitor urine output for 24hours post catheterisation
  • support with IV fluids if losing high urine volumes
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17
Q

What type of AKI can hydronephrosis cause?

A

Post renal AKI

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18
Q

Why does GFR decline in hydronephrosis?

A
  • accumulation of urine in kidneys + calyces
  • back pressure from obstruction transmitted to distal parts of nephron
  • increases pressure pushing back against hydrostatic pressure in glomeruli
  • GFR declines
19
Q

What does an obstruction at the ureter cause?

A

Hydroureter
Develops into hydronephrosis

20
Q

What does an obstruction in bladder neck cause?

A

Bladder distension with hypertrophy
Then hydroureter
Then hydronephrosis

21
Q

What pain does acute ureteric obstruction cause?

A

Renal colic

22
Q

What can cause an acute ureteric obstruction?

A

Calculus (mainly)
Blood clots
Sloughed papilla

23
Q

What is pyonephrosis?

A

Infected obstructed kidney
Pus, fluid + inflammation in kidney

24
Q

What may failure of prompt treatment in pyonephrosis cause?

A

Death from sepsis
Permanent loss of renal function

25
Q

Diagnosis of upper urinary tract obstruction

A

CT or US
Diuretic renography

26
Q

What can be used to drainage the upper urinary tract?

A

Nephrostomy
JJ stent

27
Q

What is urolithiasis?

A

Urinary stone

28
Q

What demographic do urinary stones most commonly effect?

A

Men
Caucasians

29
Q

Diagnosis of urinary stones

A

CT scan of kidneys, ureters + bladder

30
Q

What are the types of urinary stones?

A
  • calcium oxalate stone (most common)
  • mixed calcium phosphate + calcium oxalate stone
  • magnesium ammonium phosphate stones
  • uric acid stone
  • cystine stone
31
Q

Types of urinary stones + what is associated with each type

A
  • calcium oxalate: hypercalcaemia, hyperparathyroidism, hyperoxaluria
  • mixed calcium phosphate + calcium oxalate: alkaline urine
  • magnesium ammonium phosphate: urea splitting bacteria
  • uric acid: gout + myoproliferative disorders
  • cystine: inherited cystinuria
32
Q

Clinical presentation of urinary stones (renal, ureteric + bladder)

A
  • renal stones: continuous dull ache in lions
  • ureteric stones: renal colic (radiates from loin to groin), sweaty, restless with N+V
  • bladder stones: strangury
  • recurrent UTI, haematuria or rental failure
33
Q

What is strangury?

A

Urge to pass something that will not pass
(Feeling like they need to pee all the time)

34
Q

Treatment of urinary stones

A
  • analgesia
  • high fluid intake
  • urine sieved for analysis
  • surgery for larger stones
  • thiazide
35
Q

What drug can be used to decrease urinary stones?

A

Thiazide
Increases absorption of Na+

36
Q

Interventional treatment of urinary stones

A
  • extracorporeal shock wave lithotripsy
  • ureteroscopy
  • percutaneous nephrolithotomy
37
Q

What is extracorporeal shock wave lithotripsy?

A
  • non-invasive procedure
  • shock waves break down stones into smaller fragments > easier to pass
  • suitable for smaller stones <2cm
38
Q

What is ureteroscopy?

A
  • for stones in ureter + smaller stone in kidney
  • use of thin, flexible instrument to visualise + access stones
  • can remove or fragment stones
39
Q

What is percutaneous nephrolithotomy?

A
  • for larger stones in kidney >2cm
  • invasive
  • small incision to access + remove or breakdown stones
40
Q

What is the most common composition of ureteric stones?

A

Calcium oxalate stone

41
Q

What factors predispose the development of ureteric stones?

A

Low urine volume
Hypercalcaemia
Hyperoxaluria

(Calcium oxalate is most common)

42
Q

What has high levels of oxalate in?

A

Tea

43
Q

Features of hypercalcaemia

A

‘Bones, stones, thrones, moans, groans’
- bone pain + increased fracture risk
- renal sones
- polyuria
- constipation
- confusion + mood disturbance
- abdominal pain

Urinary (24 decks)

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