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nephrology & urology > cancers and stones > Flashcards

cancers and stones Flashcards

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1
Q

how are stones caused

A

increased saturation of urine with stone forming salts or

lack of inhibitors(citrate) to prevent crystal formation

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2
Q

radiopaque stones

A

calcium kidney stone(75-85%), struvite (10-15%)

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3
Q

unilateral backpain and renal colicky pain that waxes and wanes; may radiate to testes or uvula. N/V. They shift position frequently trying to get comfortable.

maybe fever, hematura, dysuria, urinary frequency

A

neprolithiasis symptoms

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4
Q

study of choice for nephrolithiasis

A

helical(spiral) CT (no contrast needed)

do ultrasound for children and pregnant patients

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5
Q

what drugs can help facilitate stone passage

A

alpha blocker or CCB

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6
Q

what do u do if pt has a large stone?

A

percutaneous nephrostomy is gold standard

admit to hospital if unable to maintain oral intake/need vigorous hydration

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7
Q

where are stones typically found

A

proximal tract and pass distally;

they lodge at the uteropelvic junction, uterovesicular junction, or ureter at the level of the iliac vessels

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8
Q

nephrolithiasis occurs when

and gender

A

3rd or 4th decade of life.

2 to 3 fold more common in males

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9
Q

most common stone

A

calcium (75-85%); they are radiopaque

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10
Q

uric acid stones

frequency

xray

form in who

assoc with what

urine and pH

tx

A

5-8%; radiolucent

radiolucent on xray but detectable on CT

form in pts with persistantly acidic urine with or w/out hyperuricemia

assoc with gout, xanthine oxidase def, high purine turnover states(chemo)

ACIDIC and decreased pH

tx: hydrate, alkalinize urine with CITRATE, restrict purine and allopurinol

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11
Q

radiolucent stones

A

uric acid and cystine

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12
Q

cystine stones

frequency

caused by what

xray

occur in what

pH

tx

microscope and testing

A

less than 1%

caused by impairment of cystine transport; defect in renal transport of certain amino acids

* radiolucent/radiopaque????

occur in autosomal recessive cystinuria

pH decreased

hydrate, Na restriction, alkalinization of urine, pencillamine

hexagonal crystals and + urinary cyanide nitroprusside test

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13
Q

struvite(made up of what)

frequency

organism

urine

common in who

pH

tx

A

10-15%; formed by combo of calcium, ammonium, magnesium

Proteus: staghorn calculi

ALKALINE urine

common in pts with abnormal urinary tract anatomy and urinary diversions and in those that require catherization

increased pH

tx: hydrate, treat UTI if present, surgical removal of staghorn calculi

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14
Q

frequency of recurrence of stones

A

30-50% in 5 years

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15
Q

+FH, low fluid intake, gout, meds(allopurinol, chemo, loop), postcolectomy/postileostomy, specific enzyme deficiencies, hyperPTH

A

risk factors for stones

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16
Q

location of stone symptoms

upper ureter

lower part of ureter

lodged in UVJ

A

upper ureter: pain radiates to ant abdomen

lower part of ureter: pain radiates to ipsilateral groin, testicle, labia

lodged in UVJ: urinary frequency and urgency noted with lower pelvic pain

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17
Q

neprolithiasis symptoms

A

unilateral backpain and renal colicky pain that waxes and wanes; may radiate to testes or uvula. N/V. They shift position frequently trying to get comfortable.

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18
Q

nephrolithiasis can mimic what other conditions

A

acute cholecystitis, acute appendicitis, acute cystitis, diverticultitis

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19
Q

Signs of neprolithiasis

A

tachycardia, tachypnea, diaphoresis, CVA tenderness, restlessness,

abdominal distention due to ileus

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20
Q

acute cholecystitis, acute appendicitis, acute cystitis, diverticultitis

A

nephrolithiasis can mimic what other conditions

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21
Q

tachycardia, tachypnea, diaphoresis, CVA tenderness, restlessness,

abdominal distention due to ileus

A

Signs of neprolithiasis

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22
Q

neprolithiasis

serum chemistries

UA

urine culture

renal ultrasonography

intravenous pyelogram

A

serum chemistries: nml or leukocytosis

UA: microscopic hematuria(85%), ~leukocytes and/or crystals

Do urine culture to R/O infection

renal ultrasonography: only find stones in kidney, proximal ureter, and UVJ

intravenous pyelogram: rarely indicated. must have nml renal function.

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23
Q

treatment for stones less than 5 mm

A

FLUIDS!, strain urine, analgesics, follow up weekly or biweekly

alpha blocker or CCB to facilitate passage

most stones pass within 2-4 weeks

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24
Q

treatment of stones 5-10 mm

A

less likely to pass spontaneously

increase fluids and analgesics

elective lithotripsy or ureteroscopy with a stone basket extraction

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25
ESWL(extracorporal shockwave lithotripsy), percutaneous nephrolithotomy, or retrograde ureteroscopy
treat kidney stones 0.5-3 cm in diameter
26
ESWL for what size
renal stones less than 2 cm or for ureteral stones less than 10 mm
27
ureteroscopy for who
more effective than ESWL for ureteral calculi
28
percutaneous nephrolithotomy
for stones greater than 2cm
29
pains meds for nephrolithiasis
combo of morphine and ketorolac
30
calcium stones common causes urinary pH tx
common causes: idiopathic hypercalcuria and primary hyperPTH, fat malabsorption, ALKALINE urine urinary pH: increase for calcium phosphate and decreased in calcium oxalate tx: hydrate, Na and protein restriction, thiazide, \*do not decrease calcium intake because it can lead to hyperoxaluria and increase risk for osteoporosis
31
staghorn calculi
proteus organisum in struvite neprolithiasis
32
hexagonal crystals and + urinary cyanide nitroprusside test
cystine neprolithiasis
33
exposure to tobacco; occupational carcinogens from rubber, dye, printing, chemical industries; schistosomiasis cyclophosphamide or aniline dye exposure chronic infections diets rich in meat and fat
causal factors in bladder cancer
34
2nd most common urologic cancer and most frequent malignant tumor of urinary tract
usually transitional cell carcinoma/ bladder they are uroepithelial tumors
35
bladder cancer gender age #1 risk factor
3 times as likely in men 40-70 years of age smoking
36
bladder cancer presenting symptoms
painless gross hematuria also bladder irritablility and infection
37
definitive diagnostic procedure for bladder cancer
**_cystoscopy_** then biopsy to confirm
38
bladder cancer treatment 1) carcinoma in situ 2) superficial lesions 3) large, high grade, recurrent or multiple lesions
1) intravesicular chemotherapy 2) endoscopic resection and fulgaration; then cystoscopy every 3 months 3) intravesical instillation of thiotepa, mitcomycin-C, or BCG
39
bladder cancer treatment 1) invasive cancers without mets; diffuse TCC in situ 2) invasive cancers with distant mets
1) radical cystectomy or radiation therapy for poor candidates for the radical cystectomy or those with unresectable local disease 2) chemo with or w/out radiation
40
RCC common in who
men, older than 55 incidence is higher in american indian/alaskan native men smoking
41
common symptom of RCC
gross or microscopic hematuria(usually), flank pain, palpable mass fever common maybe left sided varicocele
42
primary procedure for diagnosing RCC
CT scanning
43
3% of all adult cancers
RCC
44
RCC mets
spread along renal vein to IVC and can mets to lung and bone
45
von hippel-lindau disease and hereditary papillary renal carcinoma
forms of hereditary RCC
46
internists' tumor
RCC
47
RCC Tx 1) localized disease 2) advanced disease 3) avoid what 4) meds: interferon a and interleukin
1) radical nephrectomy(no benefit to add radiation) 2) radiation (little benefit of radical nephrectomy) 3) little benefit of chemo or hormonal therapy 4) interferon a and interleukin not successful
48
hypercalcemia, HTN, erythrocytosis, hepatic dysfunction in absence of hepatic mets
RCC assoc with paraneoplastic syndromes
49
primary study for RCC CBC
CT with or w/out contrast. confirm with histology or nephrectomy speciman do an ultrasonography to rule out a stone in hematuria CBC: polycythemia and anemia due to increased erythopoietin production in 5-10% of pts
50
most common malignancy in young men highest cure rates of all cancers related to what
testicular ca cryptorchidism or previous cancer
51
testicular cancer symptoms
90% have PAINLESS, solid testicular swelling. maybe heaviness in arch para-aortic lymphnode involvement or ureteral obstruction maybe abdominal complaints or pulm symptoms from multiple nodules
52
painless scrotal swelling
look for testicular cancer
53
klinefelter syndrome
risk factor for testicular ca
54
what kind of tumor is a testicular cancer
90-95% are germ cell tumors and malignant so LOOK FOR METS in lungs, pelvis, and abdomen include seminomas and non-seminomas
55
diagnostic for non-seminomas and seminomas how common are these
alpha fetoprotein and beta HCG are elevated in non-seminomas they are nml in seminomas 65% non seminoma 35% seminoma
56
mixed cell type(40%) embryonal carcinoma(20%) teratoma(5%) choriocarcinoma(under 1%)
subtypes of non-seminomas in testicular cancers
57
testicular cancer dx
complete orchiectomy for dx; simple bx increases the risk of spreading cancer into scrotum
58
testicular cancer which is radiosensitive and radioresistant
seminomatous tumors are radiosensitive nonseminomatous tumors are radioresistant
59
non seminomatous tumors tx stage 1, 2, and 3
1) limited to testis, nerve sparing retroperitoneal lymph node dissection or rigorous surveillance without surgery or chemo 2) can be treated with surgery or chemo 3) should be treated with surgery or chemo
60
seminomatous tumors tx for stage 1, 2, 3
stage 1 isolated to testis: do radiation of para-aortic and ipsilateral iliac nodal areas stage IIa and IIb adds increased radiation to affected nodes stage IIc and III is chemo
61
most common cancer in men
prostate
62
prostate cancer 1) pace of growth 2) kind of cell 3) can lead to what
1) slow growing 2) adenomatous cells 3) urinary obstruction and metastatic disease
63
prostate cancer cause risks PSA level
cause unknown risks: black, FH, high fat diet PSA over 4.0
64
prostate cancer initial test then what to confirm
transrectal ultrasonography reveals hypoechoic lesions in peripheral zone bx confirms and allows histologic grading(gleason system) 6-12 biopsy samples are taken
65
prostate cancer tx 1) stage A and B 2) stage C 3) stage D
1) stage A and B(confined to the prostate): radical retropubic prostatectomy, [brachytherapy, or external beam radiation] radiation 2) stage C (tumor with local invasion): similar to above with reduced effectiveness. 3) stage D(distant mets): hormonal manipulation using orchiectomy, antiandrogens, LH releasing hormone agonists, **_androgen ablation_**, or estrogens. chemo for advanced disease
66
disadvantages of radical prostatectomy and radiation for prostate cancer
1) increased risk of incontinence and ED 2) radiation proctitis and GI symptoms
67
screening for prostate cancer
DRE and/or PSA at age 50; begin earlier in blacks and FH
68
nephroblastoma occur in who mortality
wilms tumor most often healthy kids; 10% in kids with recognized malformations most curable; 5% have anaplasia and poor prognosis incidence of anaplasia increases with age
69
painless abdominal mass in kids
wilms tumor
70
wilms presentation
anorexia, N/V, fever, abd pain, hematuria HTN can occur with elevated renin levels
71
study of choice for a wilm's tumor
ultrasonography can order an MRI and CT to look at tumor extension and regional lymph nodes CXR to look for pulm mets
72
wilms tx
multimodal approach: surgery chemo in some: radiation
73
wilms resectable vs unresectable tumor tx
radical nephrectomy with lymph node sampling for resectable tumors preop biopsy then chemo for unresectable tumors \*the tumor is chemosensitive
74
wilms tumor chemo vs radiation
the tumor is chemosensitive and responsive to dactinomycin, vincristine, and doxorubicin radiation is for higher stage tumors and for tumors with focal anaplasia

nephrology & urology (7 decks)

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