Surgical Recall: Ch. 76 Urology / DVS / Pre-Test Flashcards
- Cystogram
- Ureteral stents
- Cystoscope
- Perc nephrostomy
- Retrograde pyelogram
- Cystogram
- Contrast study of the bladder
- Ureteral stens
- Plastic tubes placed via cystoscope into ureters for stenting, ID, etc…
- Cystoscope
- Scope placed into urethra and into bladder to visualize bladder
- Perc nephrostomy
- Catheter placed through skin into kidney pelvis to drain urine with distal obstruction, etc…
- Retrograde pyelogram
- Dye injected into ureter up into kidney and films taken…
A. non-contrast CT of abdomen and pelvis.
The presentation is consistent with nephrolithiasis. Initial mgmt should focus on IV fluid hydration and analgesia.
Recommended imaging includes a KUB (supine X-ray of abdomen) and non-contrast CT of abdomen and pelvis.
C. Bladder Dome
Injuries to the GU tract are commonly seen following blunt trauma. Bladder injuries typically occur when teh bladder is full (such as following a drinking binge).
The bladder dome is the only region covered by the peritoneum and is considered the weakest portion; thus, it is prone to rupture.
Urethral injury is associated with blood at the urethral meatus and would not be expected to cause free fluid in the peritoneum.
D. Impaired venous drainage
Varicoceles develop as a result of tortuous dilation of the pampiniform plexus of the veins surrounding the spermatic cord and testis. About 80% occur on the L side.
A.
Ureteral obstruction in association with sepsis requires emergent urinary decompression. This is most expeditiously achieved via a percutaneous nephrostomy tube.
Shock wave lithotripsy is unlikely to relieve the obstruction caused by a stone of this size.
D.
- The testes receive blood from three sources:
- testicular a. (aorta),
- cremasteric a. (branch of inferior epigastric a.),
- deferential a. (artery to the ductus deferens which is a branch of the superior vesical a.)
As such, the testicular a. can be divided in most pts without testicular ischemia developing.
The most common cause of testicular ischemia after inguinal hernia repair is injury to the pampiniform plexus –> causes severe testicular congestion and subsequent ischemia
CT of the abdomen
D. B/l orchipexy
Testicular torsion = age (adholescent), sudden onset of pain, testicular swelling, superior displacement of testicle, absent cremasteric reflex
C. Increased absorption of oxalate
Pts with Crohn’s disease that present with flank pain and hematuria should raise suspicion for nephrolithiasis 2/2 hyperoxaluria.
Her laparotomy scar suggests that she had an ileocolic resection, which would predispose her to fat malabsorption as the terminal ileum is the principal site for fat absorption.
In healthy pts, calcium binds to oxalate to prevent its absorption from the GI tract. In pts with increased amounts of fat in GI lumen (e.g., Crohn’s s/p ileocolic resection), the calcium preferentially binds to fat leaving the unbound oxalate available for reabsorption and, thus, increases risk of developing calcium oxalate renal stones.
Hypercalciuria would have been the most likely etiology had she not had Crohn’s
A.
The pt’s hx and U/S findings are suggestive of Henoch-Schonlein purpura (HSP).
Classically develops after URI or drug exposure (vanco) in young children
- Nonthrombocytopenic purpura
- Arthralgia
- Abdominal pain
- Intussusception
- Scrotal pain (less frequent)
U/S findings of an enlarged, rounded epididymis = sufficiently characteristic to allow distinction from torsion in most cases
No sexual activity so not likely epididymitis or UTI
B.
Urothelial carcinoma (TCC) = most common type of bladder cancer in U.S. and well known to be associated with environmental carcinogens (smoking, polycyclic aromatic hydrocarbons)
However, in parts of the world that are endemic for schistosomiasis, such as Sudan, Egypt, Tanzania, the most common variant is SCC.
A. Leydig cell tumors
Benign sex cord-stromal tumors that are associated with high levels of androgen production –> precocious puberty in young boys
Characteristic rod-shaped Reinke crystals = histology
D.
Npehrolithiasis 2/2 uric acid renal stones
Radiolucent and will not show up on x-ray
Sodium bicarbonate, will alkalinize the urine to achieve a urinary pH of 6-6.5
Shock wave lithotripsy may be added as an adjunct to urine alkalinization to further improve the stone-free rate
A.
The demonstration on U/S of a solid mass (e.g., homogenous) within the testicle makes the likelihood of cancer very high. Any painless mass within the testicle is cancer until proven otherwise.
In pts with a testicular mass that is highly suspicious for malignancy (based on physical exam and U/S), radical inguinal orchiectomy is performed.
A 28 y/o man is brought to the hospital after a high-speed, single MVC. The patient has pain in the R pelvis and lower abdomen. BP 120/80, pulse 104/min. Cardiopulm exam is normal. Abdominal palpation shows fullness and mild tenderness in the suprapubic region wtihout rigidity or rebound tenderness. No blood noted at urethral meatus and DRE normal. Pelvic x-rays reveal a R pubic ramus fracture. A foley catheter is placed without resistance and there is immediate return of frank blood. Pt is taken for emergency CT scan of the abdomen and pelvis. Which of the following injuries is most likely seen on CT scan?
a. Extraperitoneal bladder injury
b. Intraperitoneal bladder rupture
c. R ureteral injury
d. Urethral injury
A. Extraperitoneal bladder injury
Contusion or rupture of the neck, anterior wall, or anterolateral wall of bladder. In the case of rupture, extravasation of urine into adjacent tissues causes localized pain in lower abdomen and pelvis. Pelvic fracture is almost always present in EPBI and sometimes a bony fragment can directly puncture and rupture the bladder. Gross hematuria is also usually present and urinary retention (suprapubic fullness) may occur in the case of injury to the bladder neck.
Intraperitoneal bladder rupture describes rupture of the dome of the bladder (walls abut peritoneal space)… therefore, you’d see signs of chemical peritonitis (DIFFUSE abdominal tenderness, guarding rebound).
