Urinary Tract Obstruction Flashcards
principal causes of uto in < 10 yo
- ureteral/urethral stricture
2. Neurologic abn
most common ultrasonographic abn found in fetal urinary tract
hydronephrosis
most common cause of hydronephrosis in fetuses and young children
upj obstruction
lipophilic antiretroviral therapy
sulfadiazine
most common cause of ureteral obstruction in younger men
nephrolithiasis
most common nephrolithiasis
calcium oxalate
forms staghorn calculit
struvite (ammonium-magnesium-sulfate) + cysteine stones
from sickle cell disease, amyloidosis, analgesic abuse, acute pyeloneph; intrinsic, intralluminal, intraureteral acquired cause of obstruction
papillary necrosis
causes of ureteral strictures
schistosomiasis, TB, nsaid, instrumentation
most common duration of temporary obstruction in pregnancy
third trimester
predisposition to severe obstruction
mutliple fetuses, polyhydramnios, gravid uterus, solitary kidney
management for severe obstruction in pregnancy
ureteral stent
second most common cause of extrinsic obstruction in women
pelvic malignancies
most common cause of UTO in men
BPH
most common cause of malignant genitourinary tumors
cervical ca
second most common malignant GU tumors
bladder cancer
most common cause of urinary obstruction of vascular cause
abdominal aortic aneurysm
pain in obstruction is a result of
abrupt stretching of the renal capsule or the wall of the collecting system (C-type sensory fibers)
microscopic hematuria wihtout proteinuria
calculus or tumor
pyuria and bacteriuria
pyelonephritis
bacteriuria
stasis
refers to the excretion of urine show sp.g is neither greather nor less than that of protein free plasma (1.008-1.012); reflects damage to kidney’s tubules or medulla
isosthenuria
high urine pH, isosthenuric urine, UNa >20, FeNa >1, UOsm < 350
distal tubular dysfunction
diagnostic study of choice for evaluation of patient with acute flank pain
helical CT
diagnostic required for nephrolithiasis sec to HIV protease inhibitors (indinavir)
contrast enhanced CT
diagnosing upper urinary tract obstruction and information on the differential renal function of both kidneys
renal scintigraphy or isotopic renography
functional effect of upper urinary tract dilation by measuring hydrostatic pressures in the renal pelvis and bladder during infusion of saline and contrast mixture via catheter
whitaker test
whitaker test result that is obstructed
> 22 cmH20
< 15 cm H20, nonobstructed
2 phases of obstruction
early hyperemic phase (2-3 hours)
late vasoconstrictive phase (2-3 hours)
dilation of the renal pelvis and calyces proximal to the point of obstruction
hydronephrosis
blockage of urine flow due to a functional or structural derangement from tip of urethra back to renal pelvis
obstructive uropathy
functional or pathologic parenchymal damage secondary to blockade of urine flow
obstructive nephropathy
distinguish between hydronephrosis or pelvic dilation with obstruction and dilation without obstruction
diuretic renography
noninvasive information about differential renal function of both kidneys
isotopic renography
decrease in SNgFR due to afferent arteriolar vasoconstriction and a decrease in Pgc
Late vasoconstrictive phase
mediated by vasodilator prostaglandins; inc in hydraulic pressure along Pgc, maintauned sngfr, afferent arteriolar vasodilation
Early hyperemic phase
Neurogenic bladder tx
intermittent catheterization
