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MBBS 3: Surgery > Urological Pathologies > Flashcards

Urological Pathologies Flashcards

1
Q

What is a kidney obstuction?

A

a ureteral obstruction is a blockage in one or both of the ureters that carry urine from the kidneys to the bladder
Note: Infected obstructed kidney = emergency

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2
Q

Differential diagnosis for ureteral obstruction?

A
  1. calculi (stones)
  2. Pelviureteric junction obstruction
  3. extrinsic obstruction (when organs press against the ureter causing blockage)
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3
Q

Investigations done in an ureteral obstruction?

A
  1. urinalysis
  2. infection
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4
Q

What are kidney stones?

A

hard deposits of minerals and acid salts that stick together in concentrated urine and are painful when passed
Note: also called nephrolithiasis

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5
Q

What causes kidney stones?

A

when your urine contains more crystal forming substances such as calcium, oxalate and uric acid than the fluid in your urine can dilute
1. dehydration
2. excess calcium in urine
3. excess protein in diet
4. certain medications
e.g. diuretics
5. conditions of the GIT
e.g. ulcerative colitis, Crohns disease
6. Hyperthyroidism

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6
Q

Symptoms of kidney calculi?

A
  1. Renal colic
  2. hematuria
  3. infection
  4. nausea and vomitting
  5. dysuria (pain when urinating)
  6. urinary retention (being unable to urinate)
  7. urgency (feeling the need to urinate more often)
  8. fever or chills
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7
Q

What is renal colic?

A

wavs of sharp, intense pain caused by kidney dysfunction

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8
Q

What causes renal colic?

A
  1. urinary stones
    - if the stone restricts your flow of urine it can cause increased pressure and inflammation
  2. ureteral or bladder spasms
    - when the ureter and bladder muscles contract suddenly resulting in burning and cramping pain
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9
Q

Symptoms of renal colic?

A
  1. flank pain
    - pain on the sides and back of the abdomen between your lower ribs and your hips
    - this pain can radiate to your back, groin or lower abdomen
  2. nausea and vomitting
  3. painful urination
  4. blood in pee
  5. cloudy urine
  6. urine changes
    - foul smelling urine
    - peeing more or less
  7. crystals in your urine
  8. fever
  9. chills
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10
Q

How to exam for kidney stones?

A
  1. abdomen
    - hypoactive bowel sounds as seen in ileus due to severe pain
  2. back
    - costovertebral angle tenderness
    (place left hand pam down at site and bang down on it with your right fist - intense pain is felt)
  3. flank pain
    - palpating to find pain on either side of the lower back between pelvis and ribs
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11
Q

Investigations to diagnose kidney calculi?

A
  1. urinalysis
    - looks for signs of infection and examines the levels of the substances that form kidney stones
  2. imaging
    e.g. CT, X-ray and ultrasound
    - see the size, shape, location and number of kidney stones
  3. blood test
    - check how well the kidneys are functioning, check for infection, look for biochemical problems that may lead to kidney stones
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12
Q

Non-operative management of kidney calculi?

A

Medications
1. analgesia
2. manage nausea and vomiting
3. relax your ureter so the stone passes
e.g. tamsulosin, nifedipine
Note: ibuprofen can increase the risk of kidney failure if taken while having an acute attack of kidney stones

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13
Q

Name operative managements of kidney calculi?

A
  1. ureteroscopy
  2. shockwave lithotripsy
  3. percutaneous nephrolithotomy
  4. open stone surgery
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14
Q

Prevention of kidney calculi?

A
  1. drink water
  2. limit salt
  3. lose weight
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15
Q

Differential diagnosis of kidney calculi?

A
  1. pyelonephritis
  2. ovarian cyst torsion
  3. ectopic pregnancies
  4. large bowel obstruction
  5. appendicitis
  6. diverticulitis
  7. UTIs and cystitis in females
  8. cholelithiasis (gallstones)
  9. inflammatory bowel disease
  10. testicular torsion and UTI in males
  11. urinary tract obstruction
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16
Q

Symptoms of kidney tumours?

A
  1. Visible hematuria
  2. pain
  3. loin mass
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17
Q

Benign kidney tumors?

A
  1. Oncocytoma
  2. angiomyolipoma
  3. cysts
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18
Q

Malignant kidney tumors?

A

Renal cell carcinoma

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19
Q

DDx for renal cell carcinoma?

A
  1. acute pyelonephritis
  2. bladder cancer
  3. chronic pyelonephritis
  4. non-hodgkin lymphoma
  5. Wilms tumor
20
Q

Treatment for kidney tumors?

A

surgery

21
Q

Symptoms of bladder outflow obstruction?

A

FUN WISE
Frequency
Urgency
Nocturia
- to do with the bladder
Weak stream
Intermittency/hesitancy
Straining
Emptying incomplete
- to do with the urethra

21
Q

Differential diagnoses of bladder outflow obstruction?

A
  1. Prostatic enlargement,
  2. Urethral stricture,
  3. stones
  4. neurogenic bladder
22
Q

Treatments for bladder outflow obstruction?

A
  1. Acute retention
    - Catheterization, Urethral Vs SPC
  2. Prostatic enlargement:
    - Medical vs surgery
  3. Urethral stricture
    - Open Vs Endoscopic
23
Q

What is a urethral stricture?

A

Spongio-fibrosis of urethra causing narrowing

24
Q

Causes of urethral stricture?

A

Infection,
Inflammation,
Trauma,
Iatrogenic

25
Q

Can you pass a urethral catheter in the presence of a stricture?

A

no

26
Q

What is phymosis?

A

a condition in which tight foreskin cant be pulled back over the head of the penis
- muzzling of foreskin

27
Q

Physiological phymosis?

A

Kids, resolves at puberty
Circumcision not indicated

28
Q

Pathologcial phymosis?

A

Lichen sclerosis, BXO
Needs circumcision

29
Q

Cause of penis fracture?

A

forceful bending of an erect penis

30
Q

History of penis fracture?

A
  • pop felt during intercourse, immediate detumescense (subsiding from a state I’d tension, swelling or sexual arousal)
  • +/- blood in urine
  • Woman on top position
31
Q

Treatment of penis fracture?

A

Emergency
Needs repair to maintain future erection

32
Q

What is a hydrocele?

A

a fluid filled sac around the testicle
- often first noticed as swelling of the scrotum

33
Q

Types of hydroceles?

A
  1. communicating
  2. non-communicating
34
Q

What is a communicating hydrocele?

A

a collection of fluid in the scrotum from an opening in the abdominal cavity
- a failure in the membrane between the abdominal cavity and scrotum causes the scrotum to swell
- a patent processus vaginalis permits flow of peritoneal fluid into the scrotum
Note: associated with inguinal hernias

35
Q

What is a non communicating hydrocele?

A

no communication between the abdominal cavity and the sac around the testicle in the scrotum
- most common type

36
Q

Symptoms of a hydrocele?

A

painless swelling of one or both testicles

37
Q

Risk factors for developing a hydrocele?

A
  1. babies
    - premature birth (>3 weeks)
  2. older people
    - injury or inflammation within the scrotum
    - infection including a sexually transmitted infection
38
Q

How to differentiate between an inguinal hernia and a hydrocele?

A
  1. apply pressure to the abdomen and scrotum to check for tenderness and an inguinal hernia
  2. ask the patient to cough to see how the bulge changes in your groin or abdomen with pressure
  3. shine a light through the scrotum (transillumination) to look for fluid
    - in a hydrocele this test will sow the presence of clear fluid surrounding the testicle
  4. conduct an ultrasound/x-ray to see whether or not there is a hernia, testicular tumor or other cause of scrotal swelling
39
Q

Management of congenital hydrocele?

A

wait until 2 yrs for spontaneous resolution

40
Q

Management of acquired hydrocele?

A

surgery NOT ASPIRATION

41
Q

What is a torsion?

A

Twisting of testicle on its pedicle

42
Q

Symptoms of a torsion?

A

Pain, acute onset, severe, no urinary symptoms, peak age 12-14

43
Q

Presentation of a torsion?

A

swollen, elevated, transverse lie, tender, cremasteric reflex ?absent

44
Q

Differential diagnosis for torsion?

A

orchitis
- inflammation of one or both testicles

45
Q

What is scrotum testicular cancer?

A

Most curable urological cancer

Age, puberty to 35, painless lump,

Risks: FH, Undescended testis, HIV

Tx : orchidectomy and chemo if appropriate

46
Q

Common paediatric urology pathologies?

A

Undescended testis
Phymosis
hydroceles

MBBS 3: Surgery (42 decks)

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