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General Surgery EOR > Urology and Renal > Flashcards

Urology and Renal Flashcards

1
Q

What are the average values for acid/base disorders?

A

“24/7 40/40”

-24 (HCO3, base)/7.40 (pH)/40 (CO2, acid)

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2
Q

What is the three-step approach to acid-base disorders?

A

Look at your pH (7.35-7.45 is normal)
-<7.35 -acidosis
->7.45 = alkalosis
Next look at your PCO2 is it normal low or high (35-45 normal)
-Increase CO2 and decrease pH = respiratory acidosis
-decrease CO2 and increase pH = respiratory alkalosis
-If you don’t see a change in the CO2 in relation to the pH then take a look at the HCO3
Finally, look at the HCO3 is it normal, low, or high (20-26 normal)
-decrease HCO3 and decrease pH = metabolic acidosis
-Increase HCO3 and increase pH = metabolic alkalosis

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3
Q

What is bladder carcinoma?

A

A 60-year old white pain with painless hematuria

  • painless hematuria in a smoker, transitional cell carcinoma is the most common type
  • cystoscopy with biopsy is the gold standard for initial diagnosis
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4
Q

What is the treatment of bladder carcinoma?

A

include surgery,k biological therapy and chemotherapy

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5
Q

What is chronic renal failure?

A

a progression ongoing loss of kidney function (GFR) defined as less than 60 mL/min/1.73 m2 or presence of kidney damage (proteinuria - urinary albumin excretion of > 30 mg/day or equivalent, glomerulonephritis or structural damage from polycystic kidney disease) for > 3 months

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6
Q

What are the etiologies of chronic renal failure?

A
  • diabetes is the most common cause (30% of cases)
  • HTN is responsible for 25% of cases
  • Chronic GN accounts for 15% of cases
  • interstitial nephritis, polycystic kidney disease, obstructive uropathy
  • any of the causes of AKI may lead to CKD if prolonged and/or if treatment is delayed
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7
Q

What is stage 1 CKD?

A

normal GFR (>90 L/min/1.73 m2) plus either persistent albuminuria or known strucutral or hereditary renal disease

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8
Q

What is stage 2 CKD?

A

mild GFR 60 to 89 ml/min/1.73 m2

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9
Q

What is stage 3 CKD?

A

moderate GFR 30 to 59 ml/min/1.73 m2

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10
Q

What is stage 4 CKD?

A

severe GFR 15 to 29 ml/min/1.73 m2

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11
Q

What is stage 5 CKD?

A

kidney failure GFR <15 ml/min/1.73 m2

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12
Q

What is a finding in chronic renal failure in the urine?

A

broad waxy casts in urinary sediment are a specific finding in chronic renal failure

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13
Q

What is the treatment for chronic renal disease?

A

treament is aimed at slowing the progression of CKD and treating reversible causes of acute deterioration

  • ACE inhibitors and ARBs: slow progression of renal dysfunction, particularly in proteinuric patients
  • Managing comorbidities: hypertensive control (<130/80), tight glycemic control (A1C 6.5-7.5%), cholesterol control, tobacco cessation
  • maintain hemoglobin at 11-12 g/dl: erythropoietin, iron supplementation and antiplatelet therapy
  • diertary managment: protein restriction, calcium, and vitamin D supplements, limitation of water, sodium, potassium, and phosphorus
  • pneumococcal vaccination
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14
Q

When shoudl the need for hemodialysis or kidney transplant be considered?

A

coordinated with nephrologist

  • when metabolic disarray persists despite the use of restrictions and supplements, worsening acidosis, volume overload, nausea, pericardial friction rub, neuropathy, decreased mental staus, worsening nutritional status, and debilitating fatigue
  • there is no evidence showing a clear benefit of initiating hemodialysis when patients are asymptomatic as opposed to uremic
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15
Q

What are the signs and symptoms of urinary tract infection?

A

pain with urination, foul-smelling urine, frequent urination

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16
Q

What are the signs and symptoms of pyelonephritis?

A

pain with urination, fever, and chills

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17
Q

What are the signs and symptoms of urethritis?

A

pain wtih urination, frequent urge to urinate, pain during intercourse

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18
Q

What are the signs and symptoms of urolithiasis/nephrolithiasis?

A

pain with urination, sharp pain, flank pain

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19
Q

What is edema?

A

a swelling caused by a collection of fluid in the spaces that surround the body’s tissues and organs

  • peripheral edema - the lower legs or hands
  • ascites - abdomen
  • chest - pulmonary edema (lungs) and pleural effusion (space surrounding the lungs)
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20
Q

What are the caues of edema?

A

most common caues include chronic venous insufficiency, also a common complication of DVT

  • lymphedema surgical removal of lymph nodes for treatmetn of cancer (most commonly breast cancer) can cause swellign of a limb or limbs with thickening of the skin on the side of surgery
  • angioedema - reactions to some medications and some inherited disorders can cause fluid to leak out of the blood vessels into surrounding tissues
  • drugs - edema can be a side effect of a variety of medcations, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens
  • infection - peritonitis
  • hypernatremia
  • kidney disease can cause swelling in the lower legs and around the eyes
  • heart failure can cause swelling in the legs, abdomen, and lungs (pulmonary edema), causing shortness of breath
  • cirrhosis can obstruct blood flow through the live, people can develop pronounced swelling in the abdoment (ascites) or in the lower legs (peripheral edema)
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21
Q

What are the syptoms of edema?

A
  • a sensation of “heavy legs”, itching, and pain
  • hyperpigmenation, stasis dermatis, lipodermatosclerosis (thick, brawny skin), atrophie (ivory-colored stellate scars on the legs)
  • increased size of the abdomen (with ascites)
  • difficulty breathing (with edema in the chest)
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22
Q

What is peaked t waves a sign of?

A

hyperkalemia

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23
Q

What are flattened t waves and u waves a sign of?

A

hypokalemia

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24
Q

What is long QT a sign of?

A

hypocalcemia

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25
Q

What is a short QT a sign of?

A

hypercalcemia

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26
Q

What is tall T waves a sign of?

A

hypomagnesemia

27
Q

What is prolonged PR interval and widened QRS a sign of?

A

hypermagnesemia

28
Q

What is low urine sodium and polyuria a sign of?

A

urine osmolaity of less thean 250 despite hypernatremia

-diabetes insipidus

29
Q

What is deficient sectrion of vasopression a sign of?

A

(ADH- anti-piss hormone) from the posterior pituitary

  • neurogenic (central) diabetes insipidus
  • caused by kidneys that are unresponsive to normal vasopression levels - usually inherited X-linked or from lithium or renal disease - Nephrogenic diabetes insipidus
30
Q

How is hyponatremia defined?

A

plasma sodium concentration less than 135 mEq/L

31
Q

How is hypernatremia defined?

A

plasma sodium concentration greater than 145 mEq/L

32
Q

What is nephrolithiasis?

A

A 31-year old man with right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray

33
Q

What are the signs and symptoms of nephrolithiasis?

A
  • colicky flank pain radiating to the groin, hematuria, CVA tenderness, and nausea and vomiting
  • CT scan (spiral CT) without contrast of the abdomen and pelvis is the gold standard for diagnosis
  • urinalysis will often show microscopic hematuria
  • BUN and Cr levels (for evaluation of renal function) and also calcium, uric acid, and phosphate levels
34
Q

What are the four types of nephrolithiasis?

A
  • Calcium oxalate (80%): most common, excess oxalate, hyperparathyroidism, radiopaque, avoid grapefruit jice (makes calcium oxalate stones worse)
  • struvite (10%): associated with chronic UTI with Klebsiella and Proteus species, radiopaque
  • Uric Acid (7%): form in individuals with persistently acidic urine - excess meat/alcohol, gout, radiolucent
  • Cystine (1%): rare genetic, radiolucent (young boy with kidney stones)
35
Q

What are the general measures for all types of stones?

A
  • Analgesia: IV morphine, parenteral NSAIDs (ketorolac)
  • Vigorous fluid hydration - beneficial in all forms of nephrolithiasis
  • Antibiotics - if UTI is present
  • Alpha-blocker therapy (Flomax) for patients with symptomatic ureteral stones > 5 mm and <10 mm to facilitate ureteral stone passage (usually given to most patients independent of size)
  • outpatient management is appropriate for most patients
  • indications for hospital admission include: pain not controlled with oral medications, anuria (usually in patients with one kidney, renal colic plus UTI and/or fever
36
Q

What is the chance of stones spontaneous passing?

A
  • stones < 5 mm will have an 80% chance of spontaneous passage
  • stones >5 - 10 mm have a 20% chance of passage and may require elective lithotripsy - patients should be considered for early elective intervention
  • stones > 10 mm are not likely to pass spontaneously, ureteral stent or percutaneous nephrostomy (gold standard) should be used if renal function is jeopardized, urgent treatment with extracorporeal shock wave lithotripsy can be used for renal stones of less than 2 cm or for ureteral stones of less than 10 mm
37
Q

What is orthostatic hypertension?

A

drop of > 20 mmHg systolic, 10 mmHg diastolic, 15 BPM increase in pulse 2-5 minutes after a change from supine to standing

  • autonomic dysfunction in DM common cause, medications, tilt table testing if autonomic dysfunction is suspected
  • if associated with heart rate > 15 BPM likely related to low blood volume
38
Q

What is renal cell carcinoma?

A

triad of hematuria, flank pain, and abdominal mass (palpable)

  • renal clear cell = MC(80); transitional cell = second Mc
  • risk factor: smoking
39
Q

How is renal cell carcinoma dx?

A

ultrasound or CT then biopsy

40
Q

What is the tx for renal cell carcinoma?

A

surgery with radical nephrectomy = curative

41
Q

What is renal vascular disease?

A

narrowing of one or both of the renal arteries

42
Q

What is renal artery stenosis?

A

narrowing of one or both renal arteries most often caused by atherosclerosis or fibromuscular dysplasia

  • narrowing of artery = impeded blood flow to kidney = renovascular HTN
  • presentation: age <30 with HTN or HTN with CAD/PVD, or HTN resistant to 3+ drugs
  • patient placed on ACE who develops acute renal failure or sharp rise in BUN/Cr = think renal artery stenosis
43
Q

How is renal artery stenosis dx?

A

ultrasound = first imaging in age <60

  • renal arteriography is gold standard for diagnosis
  • may hear a renal artery bruit on auscultation
44
Q

What is the tx for renal artery stenosis?

A

percutaneous transluminal angioplasty (PTA) plus stent placement or with a surgical bypass of the stenotic segment

45
Q

What is testicular carcinoma?

A

A 22-year old male who develops a right scrotal hydrocele with elevated serum beta-HCG

46
Q

How does a testicular carcinoma present?

A

a firm, painless, non-tender testicular mass and a feeling of heaviness in the scrotum

47
Q

What is the most common type of testicular carcinoma?

A

seminoma is the most common type (60%)

48
Q

What are the risk factors for testicular carcinoma?

A

a history of cryptorchidism

49
Q

How is a testicular carcinoma dx?

A

ultrasound and tumor markers: AFP and beta-HCG

50
Q

What is the tx for testicular carcinoma?

A

surgery, radiation, and chemotherapy

51
Q

What is postoperative urinary retention?

A

a common complication of both spinal and epidural anesthesia is a prolonged blockade or parasympathetic fibers that innervate the bladder with resultant urinary retention and the need for a urinary bladder catheter

52
Q

What are obstructive causes of urinary retention?

A

urethral stricture, bladder calculi or neoplasm, foegin body

53
Q

What are neurogenic causes of urinary retention?

A

multiple sclerosis, parkinson disease, CVA, postoperative retention

54
Q

What are traumatic causes of urinary retention?

A

urethral, bladder or spinal cord injury

55
Q

What are extraurinary causes of urinary retention?

A

fecal impaction, AAA, rectal or retroperitoneal mass

56
Q

What are infectious causes of urinary retention?

A

local abscess, cystitis, genital herpes, zoster

57
Q

What is acute urinary retention?

A
  • inability to void in the presence of a full bladder
  • risk factors: male gender, prostatic enlargement; epidural, spinal or prolonged anesthesia; antihistamine and narcotic use; pelvic and perineal procedures M > F
  • suprapubic discomfort with urgency and inability to void
  • unable to void within 8 h after surgery or 8 h after catheter removal
  • painful
  • vomiting
  • palpable bladder on exam
  • hypotension, bradycardia, cardiac dysrhythmias
  • complication: infection, ischemia, long-term bladder dysfunction
58
Q

What is chronic urinary retention?

A
  • painless
  • develops gradually
  • frequent urination of small amounts or overflow incontinence: sensation of fullness
  • suprapubic dullness
  • rounded midline mass
59
Q

What is detrusor (bladder) sphincter dyssynergia?

A
  • a consequence of neurological pathology: SCI or multiple sclerosis
  • urethral sphincter muscle dyssynergically contracts during voiding causing the flow to be interrupted and bladder pressure to arise
  • obstructive cause
  • daytime and nighttime wetting
  • urinary retention
  • history of UTI/bladder infections
  • associated: constipation and encopresis
60
Q

How is urinary retention dx?

A

physical exam (palpable bladder), bladder residual volume upon placement of a Foley catheter

61
Q

How is acute urinary retention dx?

A
  • bladder ultrasound: 500 mL of urine
  • postvoid residual: 500 mL or greater
  • urine culture
  • CBC is suspected infection
62
Q

How is chronic urinary retention dx?

A
  • postvoid residual bladder volume by catheterization or ultrasound
  • abdominal US or CT indicated to identify suspected masses, stones, or hydronephrosis
63
Q

How is detrusor (bladder) sphincter dyssynergia dx?

A

postvoid residual volume (PVR) >150 mL

64
Q

What is a Wilms tumor?

A

child < 4 years of age with an abdominal tumor that does NOT cross the midline

  • child with painless, unilateral abdominal mass with no other signs or symptoms, also known as nephroblastoma
  • HTN secondary to elevated renin levels and fever from tumor necrosis, hematuria, and anemia
  • mean age is 3.5 years

General Surgery EOR (10 decks)

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