Obstructive uropathies Flashcards
Ureteric colic symptoms
Flank to pelvis
Associated N&V
Pain radiates to testis, scrotum, labia or anterior thigh
Haematuria symptoms
Microscopic
Concurrent infection symptoms
rigours, fever lethargy
Initial management of renal stones
80% pass spontaneously
Fluid resus if dehydrated
Analgesis (opiates and NSAIDs per rectum)
-Buscopan for colicky pain
If evidence of infection- IV antibiotics and urology referral
Management of large stones or associated hydronephrosis
Extracorporeal Shock Wave lithotripsy (contraindicated with pregnancy and if over a bony landmark like pelvis)
Percutaneous nephrolithotomy. For large renal stones. Treatment of choice for renal calculi and stag horn
Flexible uretero-renoscopy- used in pregnancy or morbidly obese or patients with coagulopathy
Admission criteria for urolithiasis
Post renal AKI
Uncontrollable pain from simple analgesics
Evidence of ingection
Stone >5mm
Complications of stones
Acute-
Infection
Post renal AKI
Recurrent-
Renal scarring
CKD
What are some temporary measures used in significant infection or obstructive nephropathy to relieve obstruction nd avoid renal damage
Retrograde stent insertion- Placeme t of stent within ureter via cystoscopy
Nephrostomy- Tube placed directly through skin on the back into the renal pelvis and collecting system.
How to manage recurrent calcium stones
All stones- stay hydrated
Check PTH (rule out hyperparathyroidism) Avoid excess salt
How to manage recurrent calcium oxalate stones
Avoid high purine and oxalate foods like nuts, rhubarb, sesame
How to manage recurrent urate stones
Avoid high purine foods (red meat, shellfish)
Urate lowering med (allopurinol)
How to manage recurrent cysteine stones
Genetic testing
Gold standard for diagnosing stones
non contrast CT KUB scan
Symptoms of renal cell carcinoma
Haematruaia
Pain, mass in loins
What does a renal cell carcinoma form
Parathyroid hormone related protein so patients may get pathological fractures
Diagnosis of renal cell carcinoma
Solid mass on USS. Also seen on CT
Bloods show anaemia and may show raised ALP and ESR
Treatment of renal cell carcinoma
Radical nephrectomy
No role for chemo or radio. Tyrosine kinase inhibitors can be useful. As can renal artery embolisation
Bladder outlet obstruction causes
BPH Bladder stones Urethral strictures Prostate cancer Tumours of rectum, uterus or cervix
Causes of bladder stones
Urine stasis such as
- Chronic retention
- Infections
- Passed ureteric stones
- Foreign bodies such as catheters
Presentation of bladder stones
Lower urinary tract symptoms such as hesitancy, poor or intermittent stream, straining, prolonged micturition, incomplete bladder emptying, post micturition dribbling, frequency, urgency, urge incontinence, nocturne
Chronic irritation of bladder epithelium increases Transitional Cell Carcinoma risk
Investigation for bladder stones and management
Same as renal stones
Cystoscopy, stone drainage
Lithotripsy
Presentation of bladder cancer
Painless haematuria, male, smokers, old age, dyes/rubber, schistomiasis
Pathology of bladder cancer
Prolonged carcinoma contact
Diagnosis of bladder cancer
Screening for those in at-risk industries
Visually with biopsies on Flexi-cytoscopy
