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Surgery M4 part 2 > Urology > Flashcards

Urology Flashcards

1
Q

What is hematuria?

A

presence of blood in urine
MICROSCOPIC: > 5 RBCs/HPF
MACROSCOPIC: hemorrhage into urinary tract will give urine red or brownish volor

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2
Q

What is false hematuria?

A

discoloration of urine from food (beetroot), myoglobin, & some drugs (rifampicin)

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3
Q

What are the classifications of hematuria?

A

1- microscopic of macroscopic (gross)
2- intermittent or persistent
3- initial, total, or terminal
4- painful or silent

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4
Q

What does initial, total, or intermittent hematuria indicate?

A

initial: lower UT cause
total: pre-renal, renal, or ureteric cause
terminal: severe bladder irritation (caused by stone or infection)

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5
Q

Which type of hematuria is more dangerous, silent or painful?

A

SILENT: malignancy
painful: stones probably

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6
Q

What are the causes of hematuria?

A

PRE-RENAL: bleeding disorder

RENAL

  • urinary stones
  • renal tumors
  • renal injury
  • renal infarct
  • glomerulonephritis

POST-RENAL

  • bladder tumor
  • cystitis & UTI
  • Benign Prostatic Hyperplasia
  • carcinoma prostate
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7
Q

What investigations should be done for a patient presenting with hematuria?

A

LAB

  • Urine analysis: to confirm & search for cause of hematuria
  • Blood tests: CBC, bleeding profile, renal function tests (urea, creatinine)

RADIOLOGICAL

  • ultrasound
  • CT abdomen
  • IVU

INSTRUMENTAL
- cystourethroscopy

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8
Q

What are the types of pain that could present in any urological pathology?

A

RENAL PAIN -> dull aching pain in loin
URETERIC COLIC -> acute pain felt in loin radiating to ipsilateral iliac fossa & genitalia
BLADDER PAIN -> suprapubic dull aching pain made worse by bladder filling
PERINEAL PAIN -> penetrating ache in perineum & rectum (associated with inguinal discomfort)
PELVIC PAIN -> chronic prostitis or chronic prostate pain syndrome or prostadynia
URETHRAL PAIN -> burning in vulva or penis (especially during voiding)

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9
Q

What are the causes of renal pain?

A

Stretching of capsule of kidney due to:

  • renal inflammation
  • acute obstruction
  • stones
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10
Q

What is the cause of ureteric pain?

A
  • passage of ureteric stone
  • blood clot or sloughed renal papilla gives identical pain

the site of pain is a guide to the progression of a stone

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11
Q

What is the cause of bladder pain?

A
  • inflammation of the bladder -> extreme discomfort at end of micturition
  • irritation of trigone of the bladder -> sharp pain referred to the tip of the penis
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12
Q

What are the common symptoms in benign prostatic hyperplasia?

A
  • hesitancy: difficulty to start micturition
  • intermittency: interrupted micturition
  • dribbling: slow leak of urine after finishing micturition
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13
Q

What’s the difference between precipitancy & incontinence?

A
  • precipitancy: inability to hold micturition & increase desire
  • incontinence: uncontrolled escape of urine without desire
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14
Q

What are the common LUTS?

A
  • Dysuria: difficulty in starting micturition
  • Urgency: intense desire to micturate due to bladder irritation
  • Strangury: painful desire to micturate
  • frequency: frequent passage of urine without actual increase in the total volume of urine
  • anuria: complete absence of urine production
  • retention: failure of the bladder to evacuate urine
  • polyuria: increase urine output >3L/day
  • oliguria: decrease urine output <400mL/day
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15
Q

What are the urine function tests that should be preformed?

A
  • serum creatinine: 0.5-1.2mg
  • blood urea: 20-40mg
  • creatinine clearance test
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16
Q

What is PSA?

A

tumor marker specific to prostate

17
Q

How should a patient be prepared for a plain x-ray?

A
  • enema, laxative is given the day before

- patient asked to fast in order to reduce bowel gas shadows

18
Q

What are the normal interpretations seen on a plain x-ray?

A
  • boney parts
  • kidney shadows
  • ureteric line
  • psoas shadow
19
Q

What are the causes of an obliterated psoas shadow in an plain x-ray?

A
  • scoliosis
  • TB spine with cold abscess
  • enlarged kidney
  • malignancy
  • splenic injury (in left sided shadow)
  • retroperitoneal tumors
20
Q

What does ultrasonography demonstrate?

A
  • size of kidney
  • thickness of cortex
  • presence & degree of hydronephrosis
  • intrarenal masses
  • stones (bright ultrasonic reflection & acoustic shadow)
  • volume of urine
21
Q

What is the golden tool to visualize prostate & guide biopsy?

A

transrectal ultrasonography

22
Q

What method of investigation is best for detection of ureteric stones?

A

CT

23
Q

What is the significance of CT?

A
  • diagnose ureteric stones
  • in renal carcinoma -> size & site of tumor
    - > degree of invasion
    - > enlarged lymph nodes at renal hilum
    - > invasion of renal vein & vena cava
  • CRUCIAL in initial staging & follow up of men with testicular cancer
24
Q

How is IV urography used?

A
  • renal function must be normal
  • overnight fasting for 8 hours
  • contrast UROGRAFFIN is injected IV
  • x-ray is taken in 1-5 minutes then after 15 minutes then 20-30 mins
25
Q

What interpretations are seen in IV urography?

A
  • horse shoe kidney -> flower vase appearance

- ureterocele -> adder (cobra) head appearance

26
Q

What are the indications for retrograde pyelography?

A
  • failure of showing any secretions in IVU as late as 72 hours film
  • doubt about intraluminal lesion
  • renal function deficient
  • urothelial tumors

better delineation of anatomy due to more concentration of dye

27
Q

What is the indication of antegrade pyelography?

A

nephrostomy tube to drain obstructed infected kidney or provide access to percutaneous nephrolithotomy

28
Q

What are the indications of micturating cystourethrography?

A
  • vesicoureteric reflux

- posterior urethral valve

29
Q

What is the procedure that should be done in micturating cystourethrography?

A
  • catheter is passed into bladder
  • dilute iodine dye is infused
  • x-ray taken during micturition
  • free reflux is looked for
30
Q

What does urethrography demonstrate?

A
  • ascending urethrography -> extent of a urethral stricture & presence of false passages & diverticula
  • assess the extent of urethral trauma AFTER HEALING
  • contraindicated in trauma & active infection due to danger of contrast passing into circulation
31
Q

Which method of investigation is diagnostic & therapeutic?

A

CYSTOSCOPY
- examines urethra, bladder, ureteric orfice

contraindicated in -> acute cystitis & prostatitis
complications -> uretheral injury, bleeding, & water intoxication

Surgery M4 part 2 (36 decks)

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