Lesson 4B (Part 4) Flashcards Preview

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Flashcards in Lesson 4B (Part 4) Deck (28)
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1

Nephrolithiasis

Renal calculi

2

Who is more affected by nephrolithiasis?

Caucasian men with increasing age

3

What are nephrolithiasis composed of?

Calcium
- 60-80%

4

What are predisposing conditions of nephrolithiasis? (5)

1. Dehydration
2. Urinary stasis
3. Hyperuricemia
4. Hyperparathyroidism
5. Hypercalciuria

5

What is the cause of nephrolithiasis?

No cause
- if not obstructed its usually asymptomatic

6

Where can migrating calculus cause? (2)

1. Infundibular
2. UPJ obstruction
- stones may pass into the ureter and lodge in three areas of ureteric narrowing

7

What are symptoms of calculi?

Flank pain

8

What percent do stones <5mm pass spontaneously?

80%

9

What percent of patients have flank pain due to calculi?

77-93%

10

What are the 3 areas of ureteric narrowing?

1. UPJ just past the ureteropelvic junction
2. Where the ureter crosses the iliac vessels
3. UVJ at the ureterovesicular junction

11

What accounts of ureteric narrowing?

Small diameter (1-5mm) of UVJ

12

What are the modalities that can identify calculi? (5)

1. Plain x-ray films
2. Tomography
3. Intravenous urography
4. Ultrasound
- high sensitivity ***
5. Unenhanced CT
- used if US is unable to detect size and location of stones in patients with severe pain or cant see due to gas

13

What are the sonographic findings of calculi?

Echogenic foci with sharp distal acoustic shadowing
- twinkle artifact

14

What percent of stones have the twinkling artifact?

83%

15

What are other possibilities that can mimic calculi? (5)

1. Intrarenal gas
2. Renal artery calcification
3. Sloughed papilla
4. Pyelitis
5. Ureteric stent

16

What do you want tin order to see a twinkle artifact?

A high PRF
- high gain

17

What might be hard to see due to bowel gas and deep retroperitoneal position?

Ureteral calculi

18

Hydroureter

A dilated ureter will be seen as a tubular hypoechoic structure entering the bladder obliquely

19

What may be seen on either side of the stone?

Anechoic ureter

20

What does obstructing ureteral calculus cause?

Hydronephrosis of the collecting system

21

What happens with hydronephrosis of collecting system?

Urine is being produced but cannot flow from the kidney to the bladder

22

What can hydronephrosis be confused with?

Multiple parapelvic cysts
- which would not connect to the pelvis
- they need to be connected

23

What are the S/S of hydronephrosis? (4)

1. Flank pain
2. Hematuria
3. Fever
4. Leukocytosis

24

What could potentially cause hydronephrosis? (8)

1. Stasis of urine
2. Infection
3. Tumor extension from the bladder, ureter or kidney
4. Thrombus
5. A kink in the UPJ
6. An enlarged prostate gland in men
- which can be due to BPH or prostatitis
7. Pregnancy
- causes a compression due to a growing fetus
8. A narrowing of the ureter from an injury or birth defect

25

What is grade 1 hydronephrosis?

Small fluid filled separation of renal pelvis

26

What is grade 2 hydronephrosis?

Dilation of some but not all calyces

27

What is grade 3 hydronephrosis?

Marked dilatation of renal pelvis and all calyces
- an echogenic line separates the collecting system from the parenchyma

28

What is grade 4 hydronephrosis?

Prominent dilatation of the collecting system
- cortical thinning
- unable to separate the collecting system and the parenchyma