Urology Flashcards
Define Urolithiasis
Formation of crystalline solutes anywhere along the urinary tracts Renal Stones (in Kidney) or Ureteric
Name 2 stone inhibitors
Magnesium
Citric Acid
State four different types of Renal Stones
Calcium (80%)
Uric Acid (High levels of Purines)
Struvite/Infective
Cystine
Name two causes of high purine levels
High red meat intake
Myeloproliferative Disorders
What is the one type of radiolucent stone
transparent to x ray
Urate
Name the infective organism that most commonly causes Struvite Stones
Proteus
Name the three most common locations for stones to form
PUJ
VUJ
As ureter passes pelvic brim
Give 5 risk factors for stone formation
Age Family History Anatomical Abnormalities (Horseshoe Kidney, Medullary Sponge) Dehydration Crohns
Describe three clinical features of Renal Tract Calculi
Ureteric Colic (Loin to Groin)
Nausea and Vomiting
Haematuria
What is the main differential for flank pain?
AAA
What is the Gold Standard Investigation for Renal Tract Calculi (except in pregnant or young)?
CTKUB WITHOUT contrast
Contrast has a similar density to stone & contrast nephrotxic
What might be present on a CT of an RTC that would indicate infection?
Fat Stranding (ie haziness)
What are Matrix Stones?
Rare stones related to HIV/Hepatitis treatment
Invisible on CT
How is the patient positioned for a CT KUB?
Prone Position
- prone position, because it allows for better assessment of urinary stones at the vesicoureteral junction
Describe the conservative management of RTC
Fluids
Analgesia (Rectal Diclofenac/Paracetamol)
Anti-Emetic
Medical Expulsion Therapy (eg Tamsulosin)
If under 5mm, 68% of stones will pass spontaneously
Name four indications for surgical management of RTCs
Severe Pain > 48hrs
Renal Dysfunction
Previous Renal Disease
Bilateral Stones
Describe three surgical options for RTC
Extracorporeal Shock Wave Lithotripsy
Uteroscopy and Stone Removal (with laser)
Percutaneous Nephrolithotomy (if in kidney)
Name two contraindications to ESWL in RTCs
AAA
Blood Thinners
How would an RTC present if it was close to/in the bladder?
Frequency
Urgency
What happens if an RTC becomes infected?
an infected obstructed system is a urological emergency and patients can die
Describe a 3 step management plan for an Infected Obstructed System
Sepsis 6
Stent under GA or Percutaneous Nephorstomy under LA
HDU/ITU
Define Pyelonephritis
Inflammation of Kidney Parenchyma and Renal Pelvis, typically due to bacterial infection
Bacteria can reach by ascending urinary tract, haematogenous spread, or lymphatic spread (from retroperitoneal abscess)
Give 3 risk factors of Pyelonephritis
Halted flow of urine (BPH/Spinal Cord) Retrograde Ascent (Female, Indwelling Catheter) Factors Predisposing (DM, Steroids)
Describe the clinical features of Pyelonephritis
Fever
Loin Pain
Nausea and Vomiting
May have corresponding LUTS