RCC, Wilms Tumor, Dehydration, Hypervolemia Flashcards
what is the classic triad of S&S of renal cell carcinoma?
CAB
CVA tenderness (flank pain)
Abdominal mass
Bloody urine
a patient with renal cell carcinoma has blockage of left renal vein or inferior vena cava. what 3 symptoms would be present?
LLE edema
left varicocele
ascites
what is the 1st line to diagnose renal cell carcinoma? (2)
CT or US
2nd line diagnostic for renal cell carcinoma?
MRI
what diagnostics can be used to assess for mets of renal cell carcinoma? (3)
Chest xray
Chest CT
bone scan
stage this RCC: diameter < 7cm
localized
tumor only within kidney
stage 1
stage this RCC: diameter > 7cm
localized
tumor only within kidney
stage 2
stage this RCC: any size
regional
tumor within kidney parenchyma or blood vessels and in surrounding lymph nodes or fatty tissue
stage 3
stage this RCC: any size
metastatic
tumor spread beyond kidney to the adrenal glands or other organs
stage 4
treatment for small RCC < 4cm, advanced disease or not good surgical candidate?
active surveillance
treatment for small RCC 4-7 cm in affected kidney and healthy contralateral kidney, persons with single kidney, or bilateral RCC?
partial nephrectomy
treatment for RCC > 7cm or if partial nephrectomy not feasible?
radical nephrectomy
what does RCC respond to?
immunotherapy (interleukin-2 and interferon-alpha 2b)
what are 2 complications of RCC?
renal vein thrombosis
mets to adrenals, brain, bones, lungs…
what is the most common renal malignancy in children?
wilms tumor / nephroblastoma
what is wilms tumor associated with?
WT1 or WT2 gene deletions
what is the most common presentation of wilms tumor?
painless abdominal mass
patient presents with painless abdominal mass, hypertension, hematuria, fever, N/V, weight loss, and lethargy. Dx?
wilms tumor
what will a patient with wilms tumor show on CBC?
polycythemia
how to diagnose wilms tumor?
renal US
what diagnostic should be ordered for wilms tumor to characterize it, see lung and pulmonary mets, assess for renal extension into inferior vena cava, and staging?
CT chest, abdomen, pelvis
what is a favorable finding in wilms tumor?
triphasic pattern of blastema, epithelial or stromal tissues (differentiated)
what is a unfavorable finding in wilms tumor?
focal/diffuse anaplasia (undifferentiated)
loss of the structural and functional differentiation
treatment for wilms tumor?
nephrectomy
what is the treatment for high stage wilms tumor with mets? (3)
chemo
radiation
renal replacement therapy
what are 3 ways we intake water?
food (800)
oral water (500)
oxidation (300)
what are 4 ways we output water?
urine (500)
skin (500)
respirations (400)
feces (200)
patient presents with thirst and mild discomfort. severity of dehydration?
mild
patient presents with lethargy, postural dizziness, fatigue, thirst, and muscle cramps. severity of dehydration?
moderate
patient presents with confusion, chest/abdominal pain, tachypnea, seizures, and coma. severity of dehydration?
severe
what can extreme dehydration lead to?
death
what suggests volume depletion in dehydration?
low urine Na / Cl
treatment for mild-moderate dehydration?
oral rehydration with free water
what should we do if weight/fluid loss is unknown in dehydration?
administer 1-2 liters of isotonic fluids
what is the maintenance therapy for dehydration?
1-2 liters / day of 1/2 isotonic saline in 5% dextrose
+ 20 mEq KCl per liter
what should be considered if dehydration lasts over 1-2 weeks without eating?
total parenteral nutrition (TPN)
IVFs that contain water, electrolytes, +/- glucose
crystalloids
IVFs that are mainly albumin and blood products
colloids
crystalloid solution that is used to raise ECF quantity
isotonic
crystalloid solution that is used when the cells are dehydrated in a hypertonic environment and fluid needs to be returned into the cells
hypotonic
crystalloid solution that is used in a hypotonic environment and prevents cell edema
hypertonic
colloids are usually ______ solutions that contain albumin and fresh frozen plasma. which patients are they given to?
hypertonic
burn patients
what are the 2 most used crystalloids?
normal saline
lactated ringers
4 advantages of crystalloids?
inexpensive
non-allergenic
half life = 30-60 mins
veggie/vegan
what can large volumes of crystalloids increase the risk of?
hyperchloremic acidosis
what do lactated ringers increase the risk for?
hyperglycemia
what should not be done concurrently with IV fluids?
blood transfusion
what patients are colloids reserved for?
severely hypovolemic patients
3 advantages of colloids?
replaces fluid volume
molecules too large to cross walls
half life = hours to days
4 disadvantages of colloids?
anaphylaxis risk
expensive
bleeding
not veggie/vegan
what can excessive use of colloids lead to?
cardiac or renal failure
what is the most common cause of fluid overload?
CHF
patient presents with weight gain, increased HR, hypertension, crackles, polyuria, edematous skin, and jugular venous distention. Dx?
hypervolemia
how will urinalysis present in hypervolemia?
diluted
2 imaging studies used to diagnose hypervolemia?
CXR
echo
management for hypervolemia? (4)
treatment medication?
treat cause
monitor weight + I&O
restrict fluid
restrict sodium
furosemide
what position would help manage hypervolemia?
high-semi Fowler’s position (elevate head of bed)
