Pathology urogenital

Question 1

How do you determine whether an issue is urological or nephrological?

Answer 1

pain, swelling, haematuria- urological problem

microscopic haematuria with tubular casts in urine and quicker deterioration of renal function- neprhological problem

Question 2

What is urolithiasis?

what are the 4 sites of stone impaction due to physiological narrowing?

Answer 2

crystalline precipitation due to absolute or relative increase in solute concentration (dehydration), change in pH and stasis

1. • Pelviureteric junction- PUJ
2. • Vesicoureteric junction- VUJ
3. • Ureter entering pelvic brim
4. • Ureter crossed by iliac vessels

Question 3

name 4 somewhat common structural abnormalities found during protocol investigations following childhood UTI

Answer 3

1. Horseshoe kidney- lower poles bridged by renal tissue cause ureters to kink
2. bifid ureter, retrocaval ureter (behind vena cava)
3. duplex ureter
4. incomplete upper tract duplication

Question 4

What kind of uropathy is a retrocaval circumcaval ureter?

Answer 4

obstructive +/- stones

Question 5

name and describe 5 types of stone in the urinary system

Answer 5

1. oxalate- red spiky surface which cause mucosal injury and haematuria, which is often associated with acquired cystic disease
2. urate- high uric acid- gout
3. phosphate- stuvite- cast of the clyceal system usually in infection, hydronephrosis
4. apatite-struvite-brushite (calcium phsophate)- all infection related stones
5. cystine

Question 6

what is the rpesentation of a UTI?

Answer 6

• shooting pain from loin to groin (fixed loin pain in acute pyelonephritis)
• fever with chilll and rigor
• burning sensation on passing urine
• smoky urine due to haematuria

Question 7

commonest bacteria for UTI

Answer 7

gram negative coliforms e.g.,

• E.coli
• klebsiella
• proteus

staph saprophyticus (gram +ve in young sexually active females)

Question 8

scenarios where a UTI is likley

Answer 8

• young sexually active females (often new partners)
• elderly bed ridden
• difficulties in maintaing hygiene
• long term indwelling catheters

Question 9

management of UTI with no stones

Answer 9

• investigate- dipstick looking for leukocytes (immune response) and nitrates (bacterial metabolsim) high
• investigate- culture
• lower tract UTI treatment- nitrofurantoin, trimethoprim antibiotics
• upper tract UTI- cephalexin
• non-responding cases- culture sensitivity and consult microbiologist

Question 10

how to mamage urolithiasis

<5mm

6-15mm

>15mm

Answer 10

<5mm- manage UTI, plenty of lfuids, wil pass on its own

6-15mm- medical expulsive therapy- assisted alpha-adrenergic blockers: tamsulosin, terazosin, doxazosin

>15mm- active management, surgery?

Question 11

investigations for uroliths

Answer 11

ultrasound

Xray KUB (kidney-urerter-nladder)

CT KUB

Question 12

active manegement of stones (6)

Answer 12

ESWL- Extra corporeal shock wave lithotripsy
• Dormia basketing (retrograde approach)
• PCNL- Percutaneous nephrolithotomy (antegrade approach)
• May combine with ISWL (intra corporeal) for large stone during
PCNL
• Open surgery- rare, historical
• Nephrectomy- rare, historical unless seriously non function with
calculus pyonephrosis, xanthogranulomatous pyelonephritis
and malakoplakia (both can masquerade as cancer)

Question 13

complications of untreated stones

Answer 13

• Infection/UTI (acute pyelonephritis in upper tract)
• Obstruction
• Chronic pyelonephritis
• Non-functioning kidney

Question 14

caomplications of treated kidney stones

Answer 14

• Recurrent metabolic stones
• Stainstrasse- stone street- ureteric
obstruction if large stone subjected to
ESWL

Question 15

certain metabolic states predispose you to developing different kinds of stones what are they

Answer 15

• Hypercalciuria- hyperparathyroidism
• Hyperoxaluria- usually due to diet ( may be dietary
fads) (ethylene glycol poisoning/anti freeze causes
oxaluria- fatal- not relevant)
• Hyperuricosuria- typically gout
• Cystinuria- genetic
• Renal tubular acidosis
• Nephrocalcinosis- deposition of calcium in kidney-
dystrophic- in damaged tissue, metastatic in
healthy tissue

Question 16

which foods are high in oxalates and whihc are high in purines

Answer 16

oxalate rich food

beans, beer, celery, chocolate, figs, lemon

purine rich food

beef, chicke, lamb, fish, asparagus, beans

Question 17

what is obstructive uropathy?

split into 3 by location what are they

causes of unilateral and bilateral

Answer 17

what is obstructive uropathy?

Flow problem

split into 3 by location what are they

• Luminal- stone, tumour, acute papillary necrosis. (diabetes, historically phenacetin)
• Mural (wall)- tumour, stricture, PUJO (pelvi-ureteric junctional obstruction)
• Extrinsic- compression by tumour

causes of unilateral and bilateral

Unilateral- cause is at or above vesicoureteric
junction
• Bilatral- lower obstruction at or below bladder neck
- BPH, hypertrophic bladder neck

Question 18

which part of the urethra is obstructed by the prostate in benign prostativ hyperplasia (BPH)

in prostate cancer, which part of urethra is affected

Answer 18

benign- transitional zone

cancer- peripehral zone

Question 19

effects of obstructive uropathy on body

Answer 19

• reflux/ back pressure
• hydroureter- dilated
• hydropelvis- swelling and dilation of the pelvis
• hydronephrosis
• chronic pyelonephritis

Question 20

histological chanegs seen in chronic pyelonephritis

Answer 20

• Tubular cystic atrophy, dilation with pink colloid like material
• (thyroidisation)
• Chronic inflammatory infiltrate (not to be referred to as
• interstitial nephritis)
• Variable globally sclerosed glomeruli ( but no
• glomerulonephritides)