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FFP Haematuria and urological conditions > Obstructive uropathies > Flashcards

Obstructive uropathies Flashcards

1
Q

Ureteric colic symptoms

A

Flank to pelvis
Associated N&V
Pain radiates to testis, scrotum, labia or anterior thigh

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2
Q

Haematuria symptoms

A

Microscopic

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3
Q

Concurrent infection symptoms

A

rigours, fever lethargy

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4
Q

Initial management of renal stones

A

80% pass spontaneously
Fluid resus if dehydrated
Analgesis (opiates and NSAIDs per rectum)
-Buscopan for colicky pain

If evidence of infection- IV antibiotics and urology referral

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5
Q

Management of large stones or associated hydronephrosis

A

Extracorporeal Shock Wave lithotripsy (contraindicated with pregnancy and if over a bony landmark like pelvis)

Percutaneous nephrolithotomy. For large renal stones. Treatment of choice for renal calculi and stag horn

Flexible uretero-renoscopy- used in pregnancy or morbidly obese or patients with coagulopathy

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6
Q

Admission criteria for urolithiasis

A

Post renal AKI
Uncontrollable pain from simple analgesics
Evidence of ingection
Stone >5mm

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7
Q

Complications of stones

A

Acute-
Infection
Post renal AKI

Recurrent-
Renal scarring
CKD

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8
Q

What are some temporary measures used in significant infection or obstructive nephropathy to relieve obstruction nd avoid renal damage

A

Retrograde stent insertion- Placeme t of stent within ureter via cystoscopy

Nephrostomy- Tube placed directly through skin on the back into the renal pelvis and collecting system.

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9
Q

How to manage recurrent calcium stones

A

All stones- stay hydrated

Check PTH (rule out hyperparathyroidism)
Avoid excess salt
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10
Q

How to manage recurrent calcium oxalate stones

A

Avoid high purine and oxalate foods like nuts, rhubarb, sesame

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11
Q

How to manage recurrent urate stones

A

Avoid high purine foods (red meat, shellfish)

Urate lowering med (allopurinol)

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12
Q

How to manage recurrent cysteine stones

A

Genetic testing

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13
Q

Gold standard for diagnosing stones

A

non contrast CT KUB scan

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14
Q

Symptoms of renal cell carcinoma

A

Haematruaia

Pain, mass in loins

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15
Q

What does a renal cell carcinoma form

A

Parathyroid hormone related protein so patients may get pathological fractures

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16
Q

Diagnosis of renal cell carcinoma

A

Solid mass on USS. Also seen on CT

Bloods show anaemia and may show raised ALP and ESR

17
Q

Treatment of renal cell carcinoma

A

Radical nephrectomy

No role for chemo or radio. Tyrosine kinase inhibitors can be useful. As can renal artery embolisation

18
Q

Bladder outlet obstruction causes

A 
BPH
Bladder stones
Urethral strictures
Prostate cancer
Tumours of rectum, uterus or cervix
19
Q

Causes of bladder stones

A

Urine stasis such as

  • Chronic retention
  • Infections
  • Passed ureteric stones
  • Foreign bodies such as catheters
20
Q

Presentation of bladder stones

A

Lower urinary tract symptoms such as hesitancy, poor or intermittent stream, straining, prolonged micturition, incomplete bladder emptying, post micturition dribbling, frequency, urgency, urge incontinence, nocturne

Chronic irritation of bladder epithelium increases Transitional Cell Carcinoma risk

21
Q

Investigation for bladder stones and management

A

Same as renal stones

Cystoscopy, stone drainage
Lithotripsy

22
Q

Presentation of bladder cancer

A

Painless haematuria, male, smokers, old age, dyes/rubber, schistomiasis

23
Q

Pathology of bladder cancer

A

Prolonged carcinoma contact

24
Q

Diagnosis of bladder cancer

A

Screening for those in at-risk industries

Visually with biopsies on Flexi-cytoscopy

25
Q

Treatment of bladder cancer

A

Cytoscopic removal of tumour +/- intravesical BCG

Radical cystectomy in extensive cases

26
Q

Recurrence of bladder cancer

A

50% chance of recurrence so follow-up is life-long

27
Q

Symptoms of BPH

A 
Hesitancy
Retention
UTI
Nocturia
Frequency
terminal dribbling 
poor flow
28
Q

Treatment of BPH

A

Alpha blockers if a small prostate

5a reductase inhibitors if larger prostate

If medical management fails, then TURP

29
Q

Most common presentation of prostate cancer

A

Raised PSA

30
Q

Where does prostate cancer metastasise

A

Bone and iliac-para-aortic nodes

31
Q

Diagnosis of prostate cancer

A

Trans-rectal biopsy

Graded with Gleason scoring

32
Q

Staging of prostate cancer

A

T1- incidental
T2- within capsule
T3- Through capsule/seminal vesicle
T4- other

33
Q

Treatment of prostate cancer

A

Small, well differentiated disease volume =active surveillance

Endocrine therapy to reduce testosterone in locally advanced/ bony disease +/- Radiotherapy

surgery- TURP or radical prostatectomy

34
Q

What Is Wilm’s tumour

A

Nephroblastoma - primitive embryonic tumour which spreads via blood.

Peaks at 2yo

35
Q

What is renal cell carcinoma

A

Adenocarcinoma from tubular system. Spreads via blood and invades along renal vein.

risk- smoking, obesity, HTN, renal disease, FH

36
Q

What is transitional cell carcinoma

A

Mosly in bladder but can occur anywhere from renal pelvis to bladder

Risk- male, smoking, dye/pesticide,rubber exposure, schistomiasis

FFP Haematuria and urological conditions (9 decks)

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