Pathology urogenital Flashcards
How do you determine whether an issue is urological or nephrological?
pain, swelling, haematuria- urological problem
microscopic haematuria with tubular casts in urine and quicker deterioration of renal function- neprhological problem
What is urolithiasis?
what are the 4 sites of stone impaction due to physiological narrowing?
crystalline precipitation due to absolute or relative increase in solute concentration (dehydration), change in pH and stasis
- • Pelviureteric junction- PUJ
- • Vesicoureteric junction- VUJ
- • Ureter entering pelvic brim
- • Ureter crossed by iliac vessels
name 4 somewhat common structural abnormalities found during protocol investigations following childhood UTI
- Horseshoe kidney- lower poles bridged by renal tissue cause ureters to kink
- bifid ureter, retrocaval ureter (behind vena cava)
- duplex ureter
- incomplete upper tract duplication
What kind of uropathy is a retrocaval circumcaval ureter?
obstructive +/- stones
name and describe 5 types of stone in the urinary system
- oxalate- red spiky surface which cause mucosal injury and haematuria, which is often associated with acquired cystic disease
- urate- high uric acid- gout
- phosphate- stuvite- cast of the clyceal system usually in infection, hydronephrosis
- apatite-struvite-brushite (calcium phsophate)- all infection related stones
- cystine
what is the rpesentation of a UTI?
- 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
commonest bacteria for UTI
gram negative coliforms e.g.,
- E.coli
- klebsiella
- proteus
staph saprophyticus (gram +ve in young sexually active females)
scenarios where a UTI is likley
- young sexually active females (often new partners)
- elderly bed ridden
- difficulties in maintaing hygiene
- long term indwelling catheters
management of UTI with no stones
- 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
how to mamage urolithiasis
<5mm
6-15mm
>15mm
<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?
investigations for uroliths
ultrasound
Xray KUB (kidney-urerter-nladder)
CT KUB
active manegement of stones (6)
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)
complications of untreated stones
- Infection/UTI (acute pyelonephritis in upper tract)
- Obstruction
- Chronic pyelonephritis
- Non-functioning kidney
caomplications of treated kidney stones
• Recurrent metabolic stones
• Stainstrasse- stone street- ureteric
obstruction if large stone subjected to
ESWL
certain metabolic states predispose you to developing different kinds of stones what are they
• 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
which foods are high in oxalates and whihc are high in purines
oxalate rich food
beans, beer, celery, chocolate, figs, lemon
purine rich food
beef, chicke, lamb, fish, asparagus, beans
what is obstructive uropathy?
split into 3 by location what are they
causes of unilateral and bilateral
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
which part of the urethra is obstructed by the prostate in benign prostativ hyperplasia (BPH)
in prostate cancer, which part of urethra is affected
benign- transitional zone
cancer- peripehral zone
effects of obstructive uropathy on body
- reflux/ back pressure
- hydroureter- dilated
- hydropelvis- swelling and dilation of the pelvis
- hydronephrosis
- chronic pyelonephritis
histological chanegs seen in chronic pyelonephritis
- 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)
