Week 109 Renal Colic & Haematuria Flashcards
What is bilirubin?
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
What is Cholethiasis?
The presence of gallstones in the gallbladder.
What does bile consist of?
Water
Bile Acids - synthesised from cholesterol
Cholesterol
Bilirubin
What is choledocholithiasis?
A clinical scenario whereupon the gallstone passes into the cystic or common bile ducts.
What is a cholecystectomy?
Gall bladder removal.
What is cholangitis?
Of or referring to an infection of the common bile duct.
Name of two major facets of clinical manifestations of gallstone disease.
Biliary colic and cholecystitis
What is murphys sign?
- 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.
A patient has recurrent abdo pain, jaundice, pale stools & dark urine.
Cholelithiasis
Cholelocholithiasis
Cholecystitis
Investigations for suspected biliary tract infection.
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
What is the diameter of the common bile duct?
<8mm in a patient following cholecystectomy
What are the complications of cholecystitis?
- Acute pancreatitis
- Ascending cholangitis
- Gallstones ileus
- Carcinoma of gall bladder
What is a cholangiocarcinoma?
Adenocarcinoma of bile ducts associated with dense fibrous tissue.
Intra or extra hepatic
Uncommon - 8-10% of primary liver tumours.
Treatment of acute cholecystitis?
Asymptomatic - no treatment
Infection suspected: - Analgesia, anti-emetics, IV fluids, Blood cultures and antibiotics
Cholecystectomy, open laparoscopic. ERCP if choledocholithiasis.
A patient presents with jaundice. Which four sites for tumours involving the bile duct may present with jundice?
CHOLANGIOCARCINOMA - HILUM OR BELOW
CYSTIC DUCT OR GALL BLADDER
PANCREATIC DUCT
AMPULLARY TUMOUR
What is cholangitis?
A common (potentially serious) infection of the bile duct. A complication of bile stasis.
Symptoms of cholangitis?
Fever
jaundice
Right upper quadrant pain
What investigations would you conduct for a patient with cholangitis (bile duct infection)?
LFT - < Alkaline phosphatase & bilirubin
FBC - < neutrophilia
CRP - < Infection
BLOOD CULTURES - +VE IN OVER 90% - USUALLY G-VE E.COLI
HOW IS BILIRUBIN METABOLISED?
MACROPHAGES ENGULF RED BLOOD CELLS = HAEM&GLOBIN
IRON FROM HAEM GROUP –> BILIVERDIN –> BILIRUBIN (BOUND TO ALBUMIN IN BLOOD PLASMA)
HOW IS BILIRUBIN EXCRETED?
BILIRUBIN IS CONJUGATED IN THE LIVER
HEADS TO THE SMALL INTESTINE –> UROBILINOGEN
EXCRETED IN FAECES, RECYCLE (LIVER) URINE.
WHAT IS INDICATED BY BROWN OR TEAC COLOURED URINE?
HIGH BILIRUBIN
WHAT IS INDICATED BY PINK URINE?
LAXATIVES
BEETROOT
WHAT IS INDICATED BY RED URINE?
BLOOD
WHAT IS INDICATED BY BLACK URINE?
BROKENDOWN HAEMOGLOBIN
WHAT INVESTIGATION ASSESSES TISSUE FUNCTION OF RENAL PARENCHYMA
DMSA SCAN
WHAT DRUG CAUSES SMOOTH MUSCLE RELAXATION IN THE URETER, TO ALLOW TREATMENT FOR RENAL CALCULI?
TAMSULOSIN
WHAT IS THE MOST COMMON PRECIPITATE THAT FORMS RENAL STONES?
CALCIUM OXALATE
WHAT IS THE SECOND MOST COMMON PRECIPITATE FORMING RENAL STONES?
URIC ACID
WHY ARE RENAL CALCULI MOST LIKELY TO FORM?
URINARY STASIS
WHAT IS THOUGHT TO BE THE MAIN CAUSE OF RENAL STONES?
HYPERCALCIURIA
WHICH ENDOCRINOLOGICAL DISORDER INCREASES THE RISK OF RENAL CALCULI?
HYPERPARATHYROIDISM
WHAT IT NOT RECOMMENDED AS A WAY TO REDUCE RISK OF RENAL CALCULI?
LOW CALCIUM DIET
WHERE DO CAALCULI TEND TO FORM?
RENAL PELVIS
WHAT SIZE CALCULI WILL GET STUCK EN ROUTE FROM THE KIDNEY TO THE BLADDER?
> 5MM
NAME TWO COMMON SITES OF URETERIC OBSTRUCTION
URETOPELVIC JUNCTION
VESICOURETERIC JUNCTION
WHAT CAN MIMIC A RENAL STONE?
A PHLEBOLITH (CALCIUM DEPOSIT IN VEIN)
WHAT IS THE MOST COMMON SYMPTOM OF RENAL CALCULI?
RENAL COLIC (RADIATING BACK PAIN)
WHAT INVESTIGATION CAN BE CONDUCTED TO IDENTIFY THE SPECIFIC LOCATION OF A RENAL STONE?
INTRAVENOUS UROGRAM
NAME A CONTRAINDICATION FOR THE USE OF DICLOFENNAC?
ASTHMA
NAME A CALCIUM CHANNE BLOCKER USED FOR THE TREATMENT OF RENAL CALCULI?
NIFEDIPINE
WHICH INVASIVE THERAPY CAN BE UTILISED TO BREAK UP RENAL CALCULI?
EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY
WHAT US STEINSTRASSE?
FORMATION OF LARGE CALCULI AFTER BREAKDOWN OF SEVERAL SMALLER CALCULI
WHICH DRUG CAN BE USED TO TREAT URIC ACID STONES?
ALLOPURINOL
IN WHAT CONDITIONS ARE URIC ACID STONES COMMON?
GOUT
NAME TWO SEVERE SIDE EFFECTS OF RENAL CALCULI?
RENAL FAILURE
SEPSIS
HOW DO RENAL CALCULI CAUSE RENAL FAILURE?
HYDRONEPHROSIS CAUSES A URINARY BACKFLOW
MIXED MYELOID PROGINATORS PRODUCE WHAT CELLS?
RED CELLS PLATELETS MONOCYTES NEUTROPHILS EOSINOPHILS BASOPHILS
LYMPHOID STEM CELLS PRODUCE WHICH:
LYMPHOCYTES
NK CELLS
