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Medicine Year 1 > Week 109 Renal Colic & Haematuria > Flashcards

Week 109 Renal Colic & Haematuria Flashcards

0
Q

What is bilirubin?

A

By-Product of red blood cell breakdown.

  • Conjugated in liver - allows excretion with bile in small duodenum
  • Enzymes in terminal ileum deconjugate
  • A small portion is reduced to urobilinogen (in stool) & Kidneys
  • Rest reabsorbed @ terminal ileum
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1
Q

What is Cholethiasis?

A

The presence of gallstones in the gallbladder.

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2
Q

What does bile consist of?

A

Water
Bile Acids - synthesised from cholesterol
Cholesterol
Bilirubin

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3
Q

What is choledocholithiasis?

A

A clinical scenario whereupon the gallstone passes into the cystic or common bile ducts.

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4
Q

What is a cholecystectomy?

A

Gall bladder removal.

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5
Q

What is cholangitis?

A

Of or referring to an infection of the common bile duct.

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6
Q

Name of two major facets of clinical manifestations of gallstone disease.

A

Biliary colic and cholecystitis

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7
Q

What is murphys sign?

A
  • 2 fingers on Right hypochondrium & ask to breathe in
  • Results in pain & arrest of respiration as the gallbladder moves below the costal margin.
  • CHECK BOTH SIDES. Only +ve if NOT ON THE LEFT SIDE.
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8
Q

A patient has recurrent abdo pain, jaundice, pale stools & dark urine.

A

Cholelithiasis
Cholelocholithiasis
Cholecystitis

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9
Q

Investigations for suspected biliary tract infection.

A

FBC - Neutrophilia if acute cholecystitis present
LFT - High bilirubin & alkaline phosphatase (obstructive jaundice)
Amylase –> Mild raise in biliary colic but used to exclude pancreatitis.
Ultrasound/Radioisotope scan/ercp/mri/cholangiography

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10
Q

What is the diameter of the common bile duct?

A

<8mm in a patient following cholecystectomy

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11
Q

What are the complications of cholecystitis?

A
  • Acute pancreatitis
  • Ascending cholangitis
  • Gallstones ileus
  • Carcinoma of gall bladder
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12
Q

What is a cholangiocarcinoma?

A

Adenocarcinoma of bile ducts associated with dense fibrous tissue.
Intra or extra hepatic
Uncommon - 8-10% of primary liver tumours.

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13
Q

Treatment of acute cholecystitis?

A

Asymptomatic - no treatment
Infection suspected: - Analgesia, anti-emetics, IV fluids, Blood cultures and antibiotics

Cholecystectomy, open laparoscopic. ERCP if choledocholithiasis.

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14
Q

A patient presents with jaundice. Which four sites for tumours involving the bile duct may present with jundice?

A

CHOLANGIOCARCINOMA - HILUM OR BELOW
CYSTIC DUCT OR GALL BLADDER
PANCREATIC DUCT
AMPULLARY TUMOUR

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15
Q

What is cholangitis?

A

A common (potentially serious) infection of the bile duct. A complication of bile stasis.

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16
Q

Symptoms of cholangitis?

A

Fever
jaundice
Right upper quadrant pain

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17
Q

What investigations would you conduct for a patient with cholangitis (bile duct infection)?

A

LFT - < Alkaline phosphatase & bilirubin
FBC - < neutrophilia
CRP - < Infection
BLOOD CULTURES - +VE IN OVER 90% - USUALLY G-VE E.COLI

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18
Q

HOW IS BILIRUBIN METABOLISED?

A

MACROPHAGES ENGULF RED BLOOD CELLS = HAEM&GLOBIN

IRON FROM HAEM GROUP –> BILIVERDIN –> BILIRUBIN (BOUND TO ALBUMIN IN BLOOD PLASMA)

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19
Q

HOW IS BILIRUBIN EXCRETED?

A

BILIRUBIN IS CONJUGATED IN THE LIVER
HEADS TO THE SMALL INTESTINE –> UROBILINOGEN
EXCRETED IN FAECES, RECYCLE (LIVER) URINE.

20
Q

WHAT IS INDICATED BY BROWN OR TEAC COLOURED URINE?

A

HIGH BILIRUBIN

21
Q

WHAT IS INDICATED BY PINK URINE?

A

LAXATIVES

BEETROOT

22
Q

WHAT IS INDICATED BY RED URINE?

A

BLOOD

23
Q

WHAT IS INDICATED BY BLACK URINE?

A

BROKENDOWN HAEMOGLOBIN

24
Q

WHAT INVESTIGATION ASSESSES TISSUE FUNCTION OF RENAL PARENCHYMA

A

DMSA SCAN

25
Q

WHAT DRUG CAUSES SMOOTH MUSCLE RELAXATION IN THE URETER, TO ALLOW TREATMENT FOR RENAL CALCULI?

A

TAMSULOSIN

26
Q

WHAT IS THE MOST COMMON PRECIPITATE THAT FORMS RENAL STONES?

A

CALCIUM OXALATE

27
Q

WHAT IS THE SECOND MOST COMMON PRECIPITATE FORMING RENAL STONES?

A

URIC ACID

28
Q

WHY ARE RENAL CALCULI MOST LIKELY TO FORM?

A

URINARY STASIS

29
Q

WHAT IS THOUGHT TO BE THE MAIN CAUSE OF RENAL STONES?

A

HYPERCALCIURIA

30
Q

WHICH ENDOCRINOLOGICAL DISORDER INCREASES THE RISK OF RENAL CALCULI?

A

HYPERPARATHYROIDISM

31
Q

WHAT IT NOT RECOMMENDED AS A WAY TO REDUCE RISK OF RENAL CALCULI?

A

LOW CALCIUM DIET

32
Q

WHERE DO CAALCULI TEND TO FORM?

A

RENAL PELVIS

33
Q

WHAT SIZE CALCULI WILL GET STUCK EN ROUTE FROM THE KIDNEY TO THE BLADDER?

A

> 5MM

34
Q

NAME TWO COMMON SITES OF URETERIC OBSTRUCTION

A

URETOPELVIC JUNCTION

VESICOURETERIC JUNCTION

35
Q

WHAT CAN MIMIC A RENAL STONE?

A

A PHLEBOLITH (CALCIUM DEPOSIT IN VEIN)

36
Q

WHAT IS THE MOST COMMON SYMPTOM OF RENAL CALCULI?

A

RENAL COLIC (RADIATING BACK PAIN)

37
Q

WHAT INVESTIGATION CAN BE CONDUCTED TO IDENTIFY THE SPECIFIC LOCATION OF A RENAL STONE?

A

INTRAVENOUS UROGRAM

38
Q

NAME A CONTRAINDICATION FOR THE USE OF DICLOFENNAC?

A

ASTHMA

39
Q

NAME A CALCIUM CHANNE BLOCKER USED FOR THE TREATMENT OF RENAL CALCULI?

A

NIFEDIPINE

40
Q

WHICH INVASIVE THERAPY CAN BE UTILISED TO BREAK UP RENAL CALCULI?

A

EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

41
Q

WHAT US STEINSTRASSE?

A

FORMATION OF LARGE CALCULI AFTER BREAKDOWN OF SEVERAL SMALLER CALCULI

42
Q

WHICH DRUG CAN BE USED TO TREAT URIC ACID STONES?

A

ALLOPURINOL

43
Q

IN WHAT CONDITIONS ARE URIC ACID STONES COMMON?

A

GOUT

44
Q

NAME TWO SEVERE SIDE EFFECTS OF RENAL CALCULI?

A

RENAL FAILURE

SEPSIS

45
Q

HOW DO RENAL CALCULI CAUSE RENAL FAILURE?

A

HYDRONEPHROSIS CAUSES A URINARY BACKFLOW

46
Q

MIXED MYELOID PROGINATORS PRODUCE WHAT CELLS?

A 
RED CELLS
PLATELETS
MONOCYTES
NEUTROPHILS
EOSINOPHILS
BASOPHILS
47
Q

LYMPHOID STEM CELLS PRODUCE WHICH:

A

LYMPHOCYTES

NK CELLS

Medicine Year 1 (39 decks)

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