Urinary pathology Flashcards
1
Q
The difference between urological and nephrological problem
A
- Surgicla vs medical intevrention
- Pain, welling, haematuria = urological
- Microsocpuc haematuria with tubular casts in urine and quicker deterioration of renal function = neprhological problem
2
Q
Urolithiasis
A
- Crystalline precipitation due to absoloute or relative increase in solute conc (dehydration), change in pH and stasis
- 4 sites of stone impaction due to physiological narrowing.
- Pelvitureteric junction - PUJ
- Vesicoureteric junction - VUJ
- Ureter entering pelvic brim
- Ureter crossed by iliac vessels
3
Q
Structursal abnormalities in ureters
A
- Often unmasked during protocol investiagtiosn after childhood UTI
- horse-shoe kdiney - lowe rpoles bridged by renal tissue causing ureters to kink
- Bifid ureter, retrocaval ureter (behind VC)
- Duplex ureter - Weigert-Meyer law - upper moiety ectopic (opens mor einfero-medially), lower moiety orthotopic
- Incomplete upper tract duplication - asymptomatic or rarely symptomatic if reflux is into othe rlimb instead towards the bladder (saddle reflux/yo-yo reflux)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/378/819/144/a_image_thumb.png?1648806566)
4
Q
What is a retrocaecal/circumcaval ureter
A
- 50% type I- fish hook sign at L3
- Also called LOW LOOP
- Obstructive uropathy +/- stones
![](https://s3.amazonaws.com/brainscape-prod/system/cm/378/820/092/a_image_thumb.png?1648806682)
5
Q
Common ureteric stone types
A
- Oxalate - red spiky surface (rosary bead/coronaviridae like) causes mucosal injury and haematuria, often associated with acquired cystic disease (even seen in cancer in this group_
- Urate - high uric acid- gout
- Phosphate - struvite - stag horn calculus - cast of calyceal system - usually in infection, hydronephrosis
- Apatite-struvite-brushite (calcium phosphate) - all infection related stones (other metabolic)
- Cystine
Struvite = triple phosphate/infection stone (magnesium ammonium phosphate)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/378/820/110/a_image_thumb.png?1648806815)
6
Q
What is the presentation of an UTI
A
- Shooting pain from loin to groin (fixed loin pain in acute pyelonephritis)
- Fever with chill and rigor
- Burnign sensation on passing urine (micturition)
- SMoky urine due to haematuria
7
Q
What are the commonest abcteria for UTI
A
- Gram negative coliforms- E coli, Klebsiella, Proteus (particularly involved in a condition called malakoplakia due to macrophage phagocytic defect)
- Staph saprophyticus ( gram positive in young sexually active females)
8
Q
Management of a UTI
A
- Dipstix- leucocytes (response) and nitrates (bacterial metabolism) high
- Culture- in male, recurrent, high in dipstix as above, discordance with clinical findings
- Lower tract UTI- Nitrofurantoin, Trimethoprim antibiotics
- Upper tract UTI- Cephalexin
- Non-responding cases- culture sensitivity and consult microbiologist
9
Q
Recurrent UTI vs Reinfection
A
- Recurrent- different bacteria- precipitating clinical factors remain same
- Reinfection- same bacteria- may need culture sensitivity and more treatment
10
Q
Management of urolithiasis (ureteric stones)
A
- <5 mm- manage UTI, plenty of fluids- will pass – graveluria
- Medical expulsive therapy- assisted graveluria- alpha adrenergic blockers- tamsulosin, terazosin, doxazosin
- > 15 mm, symptomatic, infective, obstructive- active management
- For acute presentation may need double J stent to facilitate drainage
11
Q
Invetsiagtions for ureteric stones
A
- Ultrasound
- X ray KUB (kidney-ureter-bladder)
- CT KUB (If X ray contraindicated- pregnancy)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/378/820/337/a_image_thumb.png?1648806971)
12
Q
Active management of ureteric stones
A
- 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)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/378/820/480/a_image_thumb.png?1648807023)
13
Q
Complications of ureteric stones - untreated
A
- Infection/UTI (acute pyelonephritis in upper tract)
- Obstruction
- Chronic pyelonephritis
- Non-functioning kidney
14
Q
Complications of treater ureteric stones
A
- Recurrent metabolic stones
- Stainstrasse- stone street- ureteric obstruction if large stone subjected to ESWL
15
Q
A