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General Surgery > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

Bladder Carcinoma

A

MC - Transitional Cell carcinoma; M 3x > F

Sxs

  • Painless hematuria in smoker

Dx

  • Cystoscopy w/ bx** - gold

Tx

  • endoscopic resection w/ cystoscopy q 3 mos
    • ​Recurrent or multiple lesions - intravesical chemo
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2
Q

Metabolic Acidosis (high Anion Gap)

Acid-Base Disorders

A

pH < 7.3 and HCO3 < 20

determine Anion Gap = Na - (Cl- + HCO3)

  • Carbon monoxide, cyanide, Congenital Heart Dz
  • Aminoglycosides
  • Toluene/glue sniffing
  • Methanol
  • Uremia
  • DKA/ETOH/Starvation
  • Paracetamol/Acetaminophen, paradelhyde
  • Iron/Isoniazide
  • Lactic acidosis
  • Ethanol/Ethylene gylcol - Antifreeze
  • Salicylates/ ASA/Aspirin
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3
Q

Metabolic Acidosis (normal Anion Gap)

Acid-Base Disorders

A

pH < 7.3 and HCO3 < 20

Excess production or ingestion of HCO3

Need to determine whether High Anion Gap Met Acidosis or Normal = 8 to 12 mEq/L

Eti:

  • MCC diarrhea
  • Type 2 Renal Tubular Acidosis
  • Spironolactone

Compensation via hyperventilation = decr CO2

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4
Q

Metabolic Alkalosis

A

pH > 7.4 and HCO3 > 26 mEq/L

Eti:

  • Loop diuretics
  • Antacid
  • Vomiting
  • Aldosterone
  • up

Compensation - increase CO2 = hypoventilation/decrease breathing

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5
Q

Nephrolithiasis

dx, tx

A

Dx:

  • UA - microscopic/gross hematuria, leukocytes/crystals
  • non-contrast CT - gold std*
  • Renal US - ID stones in kidney, prox ureter, UVJ

Tx:

  • <5mm - likely to pass on own, lots of fluid - strain urine, adq analgesics
  • 5-10mm - can’t pass spont., incr fluids & analgesics
    • elective lithotripsy/ureteroscopy
    • refer to uro w/ 9mm stone
  • >10mm - incr complications
    • tx as inpatient - maintain PO intake, vigorous h20
    • Ureteral stent - percutaneous nephrostomy = gold std
    • ample analgesia
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6
Q

Nephrolithiasis

eti, sxs

A

50% recurrence w/in 10 yrs of 1s stone

Renal Calculi - occur in urinary tract

Calcium stones MC > uric acid > struvite > cystine

Sxs:

  • Asymptomatic until inflammation or complete/partial ureteral obstruction develops
  • Colicky unilateral back/flank pain radiating to groin
  • CVA tenderness
  • N/V
  • Dysuria, urinary freq, fever, chills, hematuria
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7
Q

Respiratory Acidosis

A

pH < 7.3 and pCO2 > 45

Acute Resp Acid

  • pH - very llow
  • HCO3 - slightly ele or normal

Chronic Resp Acid

  • pH - close to nl
  • HCO3 - very ele > 30

Eti: Hypoventilation

  • Airway obstruction
  • Sedative use
  • Acute lung dz
  • Chronic lung dz
  • Opioid
  • Weakening resp muscle

Compensation - increase HCO3 retention/reabsorption via kidneys = takes 24 hrs

aka decr HCO3 excretion

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8
Q

Respiratory Alkalosis

A

pH > 7.4 and pCO2 < 35

CO2 decr < 36 mmHg = Decr HCO3 & decr H+

Eti: Hyperventilation

  • Panic attacks
  • Anxiety attacks
  • Salicylates
  • Tumor
  • Pulm Embolism
  • Hypoxia

Compensation - decrease HCO3 retention/reabs via kidneys aka incr HCO3 excretion, get rid of more HCO3

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9
Q

Edema ddx

A

Swelling from fluid collection around body’s organs and tissues

MCC Chronic venous insufficiency, or DVT

  • Lymphedema - sx removal of LN => swelling of limb or thickening of skin on side of sx
  • Angioedema - rx to meds, fluid leak of of blood vessels into tissues
  • Drugs - PO dm, htn drugs
  • Infection - SBP
  • HyperNa
  • Kidney dz
  • HF - swelling in legs, abd, lungs
  • Cirrhosis

Dx

  • Wells Criteria to r/o dvt
  • Duplex US
  • ABI
  • Urine dipstick r/o nephrotic syndrome

Tx

  • underlying dz
  • compression stockings
  • elevating legs above heart 30 mins 3-4x/d
  • Na restriction
  • avoid diuretics
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10
Q

Acute Urinary Retention

A

Postop Urinary Retention - CC spinal and epidural anesthesia

  • Obstructive Causes - stricture, bladder calculi or neoplasm, foreign body
  • Neurogenic causes - MS, parkinson, CVA, postop retention
  • Traumatic
  • Extraurinary - fecal impaction, AAA, retroperitoneal mass
  • Infectious - abscess, cystitis, genital herpes, zoster

Can’t void w/ full bladder

RF - M, large prostate, prolonged anesthesia

  • Unable to void w/in 8 hrs post sx, or 8 h post cath removal
  • Painful, Vomiting
  • Palpable bladder on exam
  • Hypotension, bradycardia, cardiac arrhythmias

Dx

  • Palpable bladder, residual volume upon Foley placement
  • US - 500 mL of urine
  • Postvoid residual - 500 mL or greater
  • Urine culture
  • CBC if infx

Tx

  • Sterile cath
  • place for 24 hr - void trial
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11
Q

Chronic Urinary Retention

A

Sxs

  • Painless, develops gradually
  • Freq urination of small amnts or overflow continence
  • suprapubic dullness
  • rounded midline mass

Dx

  • Postvoid residual bladder volume by cath or US
  • abd US or CT for masses, stones, or hydronephrosis

Tx

  • Sterile cath
  • place for 24 hr - void trial
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12
Q

Detrusor sphincter dyssynergia

Urinary Retention

A

Contracts during voiding = interrupted flow and rise in bladder pressure

Sxs

  • daytime and nighttime wedding
  • Hx of UTI/cystitis
  • obstructive cause
  • a/w constipation and encopresis

Dx

  • postvoid residual urine volume (PVR) > 150mL

Tx

  • Botulinum A toxin injections
  • Surgical incision of bladder neck - can cause incontinence
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13
Q

Dysuria ddx

A

Cystitis

  • tx macrobid and nitrofuratoin

Pyelonephritis

  • flank pain, CVA tenderness, high fever
  • tx with PO Cipro (outpatient) or IV Ceftriaxone (inpatient)

Urethritis

  • Chlamydia and gonorrhea
  • NAAT - dx
  • Tx - ceftriaxone 250 mg IM + Azithromycin 1g x 1 or doxycycline 100 mg PO BID x 7d

Epididymitis

  • +prehn’s sign
  • chlamydia +gonorrhea <35; E coli > 35
  • tx
    • Ceftriaxone 250 mg IM x1 PLUS Doxy 100 mg PO BID
    • Levofloxacin 500 mg/d x 10d

Prostatitis

  • e coli = men >35
    • FQ or bactrim x 1 mo
  • GC = me<35
    • ceftriaxone and azithromycin (or doxy)
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14
Q

Orthostatic Hypotension

eti

A

Excessive fall in BP when upright

drop of > 20mm Hg systolic, 10 mm Hg in diastole, or both 2-5 mins after supine to standing

Eti:

  • autonomic dysfunction (DM, age) = no incr in HR
  • postprandial = insulin response to high carb intake & blood pooling in GI tract
  • Vagal or carotid sensivity
  • adrenal insufficiency
  • hypovolemia
  • meds
    • eoh
    • a-blockers - Terazosin
    • 5-PDI - sildenafil, tadalafil
    • SSRI, trazodone, TCA, MOAI
    • Antiparkinsonism drugs = levodopa, pramipexole, ropinirole
    • olanzapine, risperidone
    • Propanolol
    • HCTz, furosemide
    • vasodilators - hydralazine, nitroglycerin, CCBs
      *
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15
Q

Orthostatic Hypotension

Dx

A

BP and HR measured 5 min supine and at 1 min and 3 min after standing or sitting upright

  • hypotension w/o compensatory incr in HR < 10bpm = autonomic impairment
  • marked incr > 100 bpm or by > 30 bpm = hypovolemia
  • if sxs develops w/o hypotension = POTS

ECG and serum electrolytes

Tilt table testing r/o autonomic dysfunction

Tx

  • reduce venous pooling
  • incr Na intake
  • Fludrocortisone or Midodrine
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16
Q

Renal Cell Carcinoma

A

Renal Clear Cell carcinoma MCC, transitional 2nd MCC

RF - smoking**

Sxs

  • TRIAD - advance disease
    • flank pain, hematuria, palpable abd/renal mass
  • Can also have L sided Varicocele and development polycythemia

Dx

  • Abd CT
  • then biopsy

Tx

  • Surgery w/ radical nephrectomy - curative
17
Q

Renal Vascular Disease

A

Narrowing of one or both renal arteries => MCC atherosclerosis or fibromuscular dysplasia

2/2 high blood pressure

Sxs

  • Renal artery bruit on ausc
  • htn before 30yo
  • HTN w/ CAD or PVD
  • HTN resistant to 3 or more drugs
  • if placed on ACE-I but develops acute renal failure or sharp rise in BUN/Cr = renal artery stenosis

Dx

  • US - initial imaging < 60yo w/ suspected RAS
  • Renal arteriography - gold**

Tx

  • Percutaneous transluminal angioplasty + Stenting of renal arteries
  • surgical bypass for revascularization
18
Q

Testicular Carcinoma

A

MC solid tumor in young men 15-40yo (avg 32yo); 5 year survival 90%

Seminoma is MC type

Sxs

  • RF - hx of cryptorchidism
  • firm, painless, nontender testicular mass

Dx

  • B-HCG+ and a-fetoprotein in non seminoma germ cell tumors
  • Scrotal US
  • radio to look for mets

Tx

  • Orchiectomy +/- chemo
  • seminomatous tumors = radiosensitive XRT
  • nonseminomatous are radioresistant
19
Q

Chronic Renal Failure

Stages

A

Stage 1

  • GFR > 90mL/min/1.73m2 + persistent albuminuria or known structural/hereditary renal disease

Stage 2

  • mild GFR 60-89 mL/min/1.73m2

Stage 3

  • moderate GFR 30-59 mL/min/1.73 m2

Stage 4

  • Severe GFR 15-29

Stage 5

  • kidney failure GFR < 16
20
Q

Chronic Renal Failure

sxs, dx

A

Sxs

  • abn elevated serum Cr for 3+mos
  • abn GFR < 60 mL/min for 3+ mos
  • presistent proteinuria or abn on renal imaging even though GFR is normal

Dx

  • UA - spot urine for albumin or protein; Cr ratio, SCr
  • broad waxy casts
  • GFR < 60
  • Anemia, hyponatremia, hyperK, hyperPhos, hypoCa, hyperMg
  • Met acidosis w/ high AG
  • Renal US - small echogenic kidneys
21
Q

Chronic Renal Failure

Prevention, Diet and Meds

A

Prevention

  • glucose and BP control, low Na diet
  • BP < 130/80
  • avoid nephrotoxic agents
  • Refer for stage 3+
  • ACE/ARBS

Diet and Meds

  • protein restriction 0.6-0.8g/kg/day
  • Na 2g/d
  • Phos 800-1000mg/d
  • kidney transplate w/ dialysis CKD stage 5
22
Q

Chronic Renal Failure

Dialysis

A

Indication

  • Uremic symptoms - pericarditis, encephalopathy, GI comps, azotemia
  • GFR < 10 ml/min/1.73 m2
  • Fluid overload unresponsive to diuresis
  • Refractory hyperkalemia

Hemodialysis

  • acq’d through AV fisula (preferred) or prosthetic graft
    • high risk of infection, thrombosis and aneurysm
  • Tx 3x/wk, lasting 3-5 h each session

Periotoneal dialysis

  • Peritoneal membrane is dialyzer - dialysate instilled into peritoneal cavity through indwelling cath
  • complications - peritonitis (N,V, abd pain, D, Constipation, fever)
23
Q

Wilms Tumor

A

Nephroblastoma, MC solid renal tumor of childhood; seen in otherwise healthy children <4yo

RF - fam hx, horsehorse kidney

Sxs

  • asymptomatic abd mass - DO NOT palpate abd of child w/ Wilm’s tumor -> can rupture encapsulated tumor
  • increasing abd size
  • mass smooth, firm, well defined but doesn’t cross midline

Dx

  • US and CT of abd
  • Biopsy and resection

Tx

  • surgical resection and chemo

General Surgery (9 decks)

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