RENAL (SURGERY) Flashcards
What is hydronephrosis?
Dilation of renal pelvis
Is the most common abnormality found on ultrasound
It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction
Main symptom is flank pain
Other symptoms are nausea vomiting and lower urinary tract symtoms
What is pyonephrosis?
Pyonephrosis is a supparative infection of upper urinary tract due tộ obstruction of ureter
Clinical features of pyonephrosis?
Patient present with fever
Chills
Flank pain
Nausea
Vomiting
Bloody or foul smelling urine
Frequent and painful urination
It is associated with supparative damage of renal parenchyma and function loss
Causes of hydronephrosis/pyonephrosis?
Kidney/ureter stones
UTI
Congenital blockage
Blood clot
Scarring of tissue
Tumor or cancer
Pregnancy
What is pelviureteric junction obstruction?
Pelviureteric junction obstruction is a restriction to the flow of urine from renal pelvis to the ureter which if left uncoreected may lead to progressive renal deterioration
As it impedes the flow of urine it also causes hydropnephrosis(dilatation of renal pelvis)
What are the clinical features of pelviureteric junction obstruction?
Pain in their back or side particularly after they have drunk lot of fluid(dietls crisis)
Also UTI & blood in their urine
Some have no symptoms and are diagnosed by US,CT,MRI
Decision regarding treatment is done by MAG-3 scan
Patient planned for treatment undergo Anderson-hynes pyeloplasty
Types of ureteral obstruction
Intraluminal
Intramural
Extraluminal
What is vesicoureteric junction obstruction?
Ureterovesical junction obstruction refers to a blockage of flow of urine down to the bladder,causing urine to back up into and dilate the ureters and kidney (megaureter and hydronephrosis)
Clinical features and diagnosis of vesicoureteric junction obstruction
Back or flank pain
Associated with nausea and vomiting
Other symptoms may be UTI or mild abdominal pain
Diagnosis
U/S
KUB
MAG-3 scan and CT urogram
What is Obstruction secondary to stone?
Obstruction to the flow of urine into the bladder can be caused by impaction of a calculus in the pelvis of the kidney esp at the ureteropelvic junction or anywhere along the course of ureter
It can present with hydronephrosis of pyonephrosis
If bilateral cause renal failure
Obstruction due to stones symptoms
In emergency patient present with severe flank pain,pain radiating to groin,nausea,vomiting,fever and urinary symptoms
How is the patient treated who came with obstruction due to stones?
Managed in emergency with a PCN( percutaneous nephrostomy) or DJ stent followed by definite treatment later
What is ureter ligation?
If complete ligation of ureter occurs,the urine from the ipsilateral kidney is prevented from draining into the bladder,leading to hydronephrosis and progressive deterioration of ipsilateral kidney function
Treatment of ureter ligation
Ureter reimplant
Psoas hitch
Boari flap
Test of choice for diagnosing ureterolithiasis
IVP
Intravenous pyelogram
