Week 12

Question 1

What is Urolithiasis?

Answer 1

Development of renal calculi (kidney stones) in the renal system

Question 2

What is the cause of Urolithiasis?

Answer 2

Elevated urinary levels of salts, organic or inorganic acids

Question 3

Who is at higher risk of developing kidney stones?

Answer 3

Genetic predisposition 
Urinary tract infection 
Cystic kidney disease 
Hyperparathyroidism 
Hypercalciuria

Question 4

What are the clinical manifestations of Urolithiasis?

Answer 4

Severe and shooting pain

Lower back pain (CVA)

Question 5

What is the diagnostic criteria of Urolithiasis?

Answer 5

History of pain
CT, renal ultrasonography, IVP (intravenous pyelogram)
Urinalysis
Collecting excreted stones

Question 6

What is the treatment of Urolithiasis?

Answer 6

Pain control (pharmacy)
Calculi removal
Extracorporeal shockwave lithotripsy (ESWL) - ultrasound shock waves that crush the stones to make them easy to pass through urine
Percutnaneous Nephrolithotomy - Stone is too large for EWSL so removed using a nephroscope
Ureteroscopic Stone - stones that are located in the mid or distal portions of the ureters

Question 7

What is urinary incontinence?

Answer 7

Inability to voluntarily prevent the discharge of urine

Question 8

What are the causes of Urinary Incontience?

Answer 8

Impaired muscle contraction
Altered neural transmission
Hormonal stimulation
Mechanical factors

Question 9

What are the clinical manifestations of urinary incontinence?

Answer 9

The urge to pass urine & volumes exceeding bladder capacity

Question 10

What is the diagnostic criteria of urinary Incontinence?

Answer 10

History of patterns and triggers
Post residual volume (determines adequate bladder emptying)
Urodynamic testing - Cystometry & Cystometrogram

Endoscopic tests

Question 11

What is the treatment of Urinary Incontinence?

Answer 11

Bladder training 
Intravaginal support devices 
Pelvic floor strengthening 
Drugs 
Surgical - relief of mechanical obstruction

Question 12

What is polycystic kidney disease? (PKD)

Answer 12

Growth of fluid filled cysts bilaterally in the kidneys. It’s a leading cause of ESRF

Question 13

What is the pathophysiology of PKD?

Answer 13

Pressure on renal blood vessels which obstructs perfusion. It leads to tissue degeneration and obstructed tubular flow.

Question 14

What are the CM of PKD?

Answer 14

Hypertension 
Enlarged kidneys 
Altered fluid/electrolyte balance 
Renal calculi 
Diverticular disease 
Urinary tract infection 
Accumulation of nitrogenous wastes 
Impaired function in organ systems

Question 15

What is the diagnostic criteria of PKD?

Answer 15

Family history
Genetic testing (mutations of PKD1 & 2)
Physical Exam - greater than 3 cysts
Laboratory confirmation of renal failure

Question 16

What is the treatment of PKD?

Answer 16

Pain control - Analgesics
Treatment of urinary infection - Antibiotics

Blood pressure control
Promotion of renal function
Supportive care during end-stage renal disease
Dialysis (hemodialysis & peritoneal)
Renal transplant

Question 17

What is diverticular disease?

Answer 17

Infection of the diverticula due to fecal matter. The intestine may perforate leading to hemorrhage, abscess, sepsis & peritonitis

Question 18

What are the CM of diverticular disease?

Answer 18

Altered stool elimination
Intermittent & unpredictable lower abdominal pain
Nausea
Vomiting

Question 19

What is the diagnostic criteria of diverticular disease?

Answer 19

Physical Exam for abdominal tenderness & distension

Laboratory Analysis - bloody stools, low hemoglobin and hematocrit indicating anemia/complete blood count indicating infection

Imagine studies X-ray, ultrasound, CT for inflamed or ruptured diverticula

Question 20

What can prevent diverticular disease?

Answer 20

Dietary alterations:
Diet high in fiber & low in fat
Avoidance of foods that may lead to constipation
Regular Fluid intake/preferably water

Daily exercise
Pharmacologic Medications - laxatives or antispasmodic for cramping

Question 21

What is the treatment for diverticular disease?

Answer 21

Management of symptoms 
Control of infection 
Bowel rest 
Prevention of complications 
Surgical correction of perforated diverticula

Question 22

What is functional fecal Incontinence (Encopresis)?

Answer 22

Inappropriate fecal soiling frequently in children. Withholding of feces from pain or fear of defecation.

Question 23

What are the CM of Encopresis?

Answer 23

Absence of retentive posturing (purposely avoiding defecation by voluntary contraction of the pelvic floor and buttocks)
Absence of organic disease
Age over 4 years

Question 24

What is the diagnostic criteria of Encopresis?

Answer 24

Stool pattern 
Related factors 
Diet history 
Emotional stress 
Associated urinary symptoms 
Family history of constipation

Question 25

What is the treatment of Encopresis?

Answer 25

Behaviour management
Prevention of constipation
Counselling and mental health

Question 26

What happens when you have Encopresis?

Answer 26

The more stool in the colon the more it stretches, more water is reabsorbed, stool becomes hard, painful defecation which leads to impaired neuromuscular functioning.