Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

12. Year 2: Urinary System COPY > Nephro-Urolithiasis > Flashcards

Nephro-Urolithiasis Flashcards

1
Q

Urolithiasis?

A

Process of forming stones in the kidney, bladder, and/or urethra (urinary tract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the prevalence of nephro-urolithiasis?

what is the lifetime risk in males

A

2-3%

1 in 8 will get it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the M:F of nephro-urolithiasis?

A

3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the peak ages for nephro-urolithiasis?

A
  • 30 in males
  • 35 and 55 years in females
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of urological emergency admission?

A

potential stones causing ‘Colic’ symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different stone types and why is this important?

A
  • Calcium oxalate 45%
  • Calcium oxalate and phosphate 25%
  • Triple phosphate 20%
  • Calcium phosphate 3%
  • Uric acid 5%
  • Cystine 3%

most are calcium containing so followed by x-rays but 5-10% will not appear on plane radiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the presentation of urolithiasis?

A
  • Renal pain (fixed in loin)
  • Ureteric colic (radiating to groin)
  • Dysuria/haematuria/testicular or vulval pain
  • Urinary infection
  • Loin tenderness
  • Pyrexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the renal pain due to urolithiasis?

A
  • Renal pain (fixed in loin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations are done for urolithiasis?

A
  • Blood tests
    • FBC, U&E, creatinine
  • Calcium, albumin, urate
  • Parathoromone excess
  • Urine analysis and culture
  • 24 hour urine collections
  • Radiology
    • KUB (kidney/ureter/bladder)
    • Ultrasound
    • IVU (intravenous urogram)
    • CT KUB (kidney, ureter, bladder)
    • CT KUB/urogram – 3D reconstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are indications for surgical treatment of urolithiasis?

A
  • Obstruction
  • Recurrent gross haematuria
  • Recurrent pain and infection
  • Progressive loss of kidney function
  • Patient occupation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are techniques for surgical removal of urolithiasis?

A
  • Open surgery (developed in 1900’s but now very rare)
  • Endoscopic surgery
  • ESWL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different types of stones?

A
  • Renal stones
  • Ureteric stones
  • Bladder stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are advantages and disadvantages of open surgery for treatment of renal stones?

A
  • Advantage of open surgery is single procedure with the least recurrence rate
  • Disadvantage is large scar, long hospital stay, general wound complications, longer recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are indications for open surgery for treatment of renal stones?

A
  • Non-functioning infected kidney with large stones necessitating nephrectomy
  • Cases which for technical reasons cannot be managed by PCNL or ESWL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is simple pyelolithotomy?

A

Surgical incision of the renal pelvis of a kidney for removal of a kidney stone (pylo=pelvis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is simple radial nephrotomy?

A

Surgical procedure wherein the kidney is incised, typically for removal of kidney stones

17
Q

What are 2 kinds of open surgery for kidney stones?

A

Simple pyelolithotomy

Simple radial nephrotomy

18
Q

What does PCNL stand for?

A

Percutaneous nephrolithotomy

19
Q

What are indications for percutaneous nephrolithotomy (PCNL)?

A
  • Large stone burden (risk of Steinstrasse)
  • Associated PUJ stenosis
  • Infundibular stricture
  • Calyceal diverticulum
  • Morbid obesity or skeletal deformity
  • ESWL resistant stones such as cystine
  • Lack of availability of ESWL
20
Q

What is PCNL guided by?

A

Ultrasound of x-rayu

21
Q

What are contraindications for PCNL?

A
  • Uncorrected coagulopathy
  • Active urinary tract infection
  • Obesity or unsuitable body habitus unsuitable for x-ray tablets
  • Relative contraindications include small kidneys and severe perirenal fibrosis
22
Q

What are some complications of PCNL?

A
  • Serious complications occur 3-8%
  • Local complications include
    • Pseudoaneurysm or AV fistulas 0.5-
    • UT injury
      • Pelvic tear 8-15%
      • Ureteral tear 5%
      • Stricture of PUJ 0.1-0.8%
    • Injury to adjacent organs
      • Bowel injury 0.1%
      • Pneumothorax 0.1-0.3%
      • Liver, spleen (very rare)
    • Systemic complications
      • Fever, sepsis 0.2-0.6%
      • Myocardial infarction 0.1-0.4%
23
Q

What is ESWL?

A

Extracorporeal shock wave lithotripsy

shocks the stones and breaks them up into smaller pieces that can then pass out with urine

24
Q

What are indications for ureteroscopy?

A
  • Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation
25
Q

What is extracorporeal shock wave lithotripsy (ESWL) commonly used as first line treatment for?

A

Renal and ureteric calculi

26
Q

What is calculi?

A

A stone in the kidney

27
Q

why is it used as first line and When is ESWL not used as first line treatment?

A

pt’s prefer it as no general anaesthetic needed, just a pain killer, flexible machines and are widely available around the country

Not used for first line treatment for stones >2cm and less effective for lower pole stones:

  • If not effective after 2 treatments then further treatment not justified
  • Often ineffective for treating cystine stones
28
Q

What are indications for open ureterolithotomy?

A
  • Not suitable for laparoscopic approach
  • Failed ESWL or ureteroscopy
29
Q

What is ureteroscopy?

A
30
Q

What is the standard treatment for treating lower ureteric stones?

A

Rigid ureteroscope is the standard instrument for treating lower ureteric stones with a 90-100% success rate:

  • Success rate for proximal stones is lower at 60-70%
31
Q

What are the different kinds of ureteroscopy?

A
  • Flexible ureteroscopes
  • Flexible lithoclast
  • Holmium laser
32
Q

What are complications of ureteroscopy?

A
  • Minor complications 0-30%
    • Haematuria
    • Fever
    • Small ureteric perforation
    • Minor vesico-ureteric reflux
  • Major complications
    • Major ureteric perforation
    • Ureteric avulsion
    • Ureteral necrosis
    • Stricture formation
33
Q

What is the presentation of bladder stones?

A
  • Suprapubic/groin/penile pain
  • Dysuria, frequency, haematuria
  • Urinary infection (persistent)
  • Sudden interruption of urinary stream
  • Usually secondary to outflow obstruction
34
Q

Describe the pain due to bladder stones?

A
  • Suprapubic/groin/penile pain
35
Q

What is the treatment of bladder stones?

A
  • Most treated endoscopically
  • Larger stones can be treated by open excision

12. Year 2: Urinary System COPY (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions