Urinary Tract Obstructions Flashcards
Suggest 3 things people are at increased risk of, if there is a urinary tract obstruction
- UTI
- Reflux
- Stone formation
Suggest 10 causes of Urinary retention due to obstruction
- Calculi
- Pregnancy (Progesterone causes muscle relaxation)
- Drugs
- Recent surgery
- Urethral strictures
- Benign Prostatic Hypertrophy (BPH)
- Neurogenic disorders
- Tumours
- Inflammation
- Constipation
Compare Acute and Chronic urinary retention in presentation
Acute;
- Painful
- Inability to void
- Residual volume 300-1500ml
Chronic;
- Painless
- May be able to void
- Residual volume 300-4000ml
What can untreated Acute Urinary Obstruction lead to?
Hydronephrosis and renal failure
What is Post-obstructive Diuresis?
How can we prevent this?
After resolving urinary retention using a catheter, kidneys can over-diurese-> AKI
- Monitored for 24hrs after catheterisation
- IV fluids if high urine volumes
Compare causes of Uni and Bilateral Hydronephrosis
Dilation of Renal pelvis and calyces due to obstruction
Uni: Upper Urinary tract obstructed
Bi: Lower Urinary Tract obstructed (e.g BPH)
How can Hydronephrosis lead to renal failure
- Progressive atrophy of kidney
- Back pressure from obstruction transmitted to distal parts of nephron
- GFR declines and if Bilateral, patient goes into renal failure
Describe Acute Ureteric Obstructions
What can develop?
- Results in Renal Colic
- Usually caused by Calculus
- Usually Unilateral
Pyonephrosis
What is Pyonephrosis? (This is an emergency)
What can it lead to if untreated?
An infected, obstructed kidney
Sepsis, Loss of renal function and Death (50% chance of death)
State 3 features and 1 risk factor of Urolithiasis (Urinary Calculi)
- Affects 10%
- More common in Men and White people
- Dehydration as urine is more concentrated
Urinary Calculi can form anywhere in the urinary tract. What are the 3 most common sites they can form?
How can they be diagnosed?
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction
CT of kidneys, ureters, bladder
What are the 5 types of Calculi?
- Calcium Oxalate (most common)
- Mixed CaPO4 and Calcium Oxalate
- MgNH4PO4: Urea splitting bacteria
- Uric acid: Gout, Myeloproliferative disorders
- Cystine: Inherited cystinuria
What types of Calculi are associated with Hypercalcaemia and Primary Hyperthyroidism?
Calcium Oxalate stones
What types of Calculi are associated with Alkaline urine?
Mixed CaPO4and Calcium Oxalate stones
Describe the clinical presentation of Calculi/ stones
May be asymptomatic, depends on site of stone
- Renal stones: Continuous dull ache in loins
- Ureteric stones: Renal colic (Increased peristalsis), radiates from loins to groin. Patient: Pale, Sweaty, Restless, Nausea + Vomiting
- Bladder stones: Strangury (Urge to pass something but can’t)
- Recurrent untreatable UTIs, Haematuria or Renal failure
