Pothoven

Question 1

phsyiology of renal obstruction (timeline)

Answer 1

• initial 2 hours
  
  • increased renal pelvic pressures
  • increase renal blood flow
  • as renal pelvic pressure increases, glomular filtration (GFR) decreases
• At 6-24 hours
  
  • renal pelvic pressures remain elevated
  • renal blood flow DECREASES
• After 24 hrs
  
  • Renal pelvic pressure DECREASE
  • REnal blood flow continues to DECREASE
  • can lead to permanent damage typically occurs within 2 weeks

Question 2

best imaging for Kidney stones

Answer 2

CT is best modality

Ultrasound can be used in pregnancy

Question 3

Presentation of kidney stone

Answer 3

• excruciating pain in the right flank and groin radiating into the scrotum
  
  • right costovertebral angle tenderness
• assocaited nausea and vomiting
• no fever or chills
• unable to find comfortable position
• UA –> moderate blood, no sign of UTI

Question 4

management of kidney stones

Answer 4

• 2/3 of stones will pass wtihin 4 weeks of symptom onset
• Strain urine for stone passage
• Medical expulsion therapy
  
  • alpha blockers
  • CCB
  • NSAIDS
• oral stone dissolution
  
  • uric acid stones only

Question 5

INDICATIONS FOR URGEN INTERVENTION OF URINARY STONES

Answer 5

• obstructed upper tract with infection
• impending renal deterioration
• pain refractory to analgesics
• intractable nausea/vomiting
• (patient preference)

Question 6

Stone prevention

Answer 6

• Adequate hydration (2.4-3L/day)
• dietary modifactions
  
  • low animal protein, low sodium, low oxalate diets
  • normal dietary calcium
• full metabolic evaluation for patients with recurrent stones or strong family history

Question 7

Lower Urinary Tract Symptoms

Answer 7

• Irritative (storage)
  
  • frequency
  • urgency
  • nocturia
  • dysuria
• Obstructive (voiding)
  
  • hesitancy
  • intermittency
  • straining
  • weak stream
  • terminal dribbling
  • sensation of invomplete bladder emptyig

Question 8

BPH pathophysiology/complications

Answer 8

• Hyperplasia of glandular and stomal cells in transition zone and periurethral tissue
• imbalance of cell proliferation and programmed cell death
• requires aging and androgens

COMPLICATIONS

• acute urinary retention
• renal insufficiency
• chronic/recurrent UTI
• uncontrolled gross hematuria/clot retention
• bladder calculi

Question 9

management of BPH

Answer 9

• Watchful waiting
• pharmacotherapy
  
  • alpha antagonists –> relaxes smooth muscle
  • 5-alpha reductase inhibitors –> reduces prostate size
• Miimally invasive thermal therapy
• Sugical options

Question 10

Urinary retention symptoms

Answer 10

ACUTE:

• inability to urinate
• painful, urgent need to urinate
• pain or discomfort in the lower abdomen
• bloating of the lower abdomen

CHRONIC:

• urinary frequency
• trouble beginning a urine stream
• weak or an interrupted urine stream
• urgent need to urinate with little success when trying to urinate
  *

Question 11

complications/tx of urinary retention

Answer 11

• Complications
  
  • UTI, bladder decompensation, renal damage
• TX
  
  • initial bladder drainage with catheterization
  • tx of underlying cause

Question 12

Review slides… didn’t make all NC