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26 Cards in this Set
- Front
- Back
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lecture 5 – urology
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ok
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Hematuria:
> ... RBCs/HPF (seen in U/A) – unspun urine (should undergo evaluation) confirm microscopic hematuria on ... w/ microscope exam |
3
dipstick |
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Detection:
1. Dip Sticks – colorimetric assay 2. False ... for dipsticks -Oxidizing agents (povidione, bacterial, peroxidases) -Myoglobinuria 3. False ... dipsticks -Reducing agents (Vitamin C) -Urine pH <5.1 |
positive
negative |
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Voiding symptoms:
-Dysuria (burning w/ urination), frequency, urgency, nocturia W/ burning and frequency, -in older, think ... -in younger, consider ... or medication |
urinary or prostatic obstruction
STD |
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Physical exam:
HTN, edema, CVAT, trauma, meatal stenosis (caruncule, condyloma), pelvic exam (vaginal bleeding) -edema – think ... -CVAT (costovertebral angle tenderness) - ... etiology -diabetes – think renal ... or parenchymal disease |
renal failure
infectious stenosis |
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Labs:
-U/A -... – impt particularly for those bleeding quite heavily. check to see if they are anemic. -renal function and chemistries |
CBC
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Color:
Bright Red – active bleeding (think ... or ...) Brown – old (..., old clots) |
tumor or stone
glomerular nephritis |
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Proteinuria:
Present - suggest ... parenchymal disease - 3+ or 4 + on dipstick > ... mg/dL Absent – does not eliminate renal parenchymal disease but suggests ... cause or interstitial disease |
renal
150 urologic |
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Casts:
RBC casts -pathognomonic for ... bleeding -crystalluria – suggests ... disease WBC casts -suggests ... |
glomerular
stone pyelonephritis |
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Red cell morphology – phase contrast microscopy (used for microscopic hematuria, not often used for gross hematuria):
dysmorphic cells suggest ... disease normal cells suggest ... disease slide 18 |
glomerular
urologic |
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Urologic evaluation:
... is the most sensitive way to diagnose urolithiasis (but do both w/ and w/o contrast) renal ... is very helpful in differentiating between a cyst or solid. |
CT scan w/o contrast
ultrasonography |
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look at slide 19-20
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It is impt to obtain a ... for a pt who presents w/ kidney stone disease
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CT scan w/o contrast
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start lecture 6 – urolithiasis
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Urolithiasis: SIGNS AND SYMPTOMS
Upper urinary tract calculi — Renal colic is classically associated with ...-onset, severe flank ... over the affected side. —Pain may radiate to the ipsilateral anterior lower abdominal quadrant, groin, or scrotum (labia in females). —Patient unable to find comfortable position; pain not improved by lying still —Associated nausea, vomiting common — Microscopic or gross hematuria almost always present —Fever or elevated white blood cell count if asso¬ciated ... —May be asymptomatic if stone not causing ... -if obstruction + infection, --> ...! |
sudden
pain infection ob¬struction emergency! |
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Lower urinary tract calculi:
—May be asymptomatic —Sudden interruption of urinary ... as stone acutely obstructs bladder neck; may lead to moderate-to-severe pain when ... — Microscopic or gross hematuria |
stream
voiding |
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Causes/risk factors (upper urinary tract calculi):
-... stones most common -... – radiolucent. won’t show up on X-ray. often shows up on CT scan -... stones are infectious in etiology (often pseudomonas) Get a serum calcium level and uric acid level – if high calcium and uric acid, suspect a .... |
calcium oxalate
uric acid struvite (magnesium ammonium phosphate) parathyroid tumor |
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Upper urinary tract calculi cont:
-... stone formation may be due to dietary excess (high protein intake), gout, myetoproliferative disorders, chronic dehydration, Lesch-Nyhan syndrome, in¬gestion of uricosuric drugs (salicylates, thiazides), or idiopathic. —... stones are associated with urinary tract infection with urease-splitting organisms (Proteus, Klebsiella, and others), leading to alkaline urine and magnesium ammonium phosphate crystallization. —... stones are rare and associated with an inherited disorder of renal. tubular reabsorption of cystine. |
Uric acid
Struvite Cystine |
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Lower urinary tract calculi:
—... stones seen in patients with foreign material in bladder (proline mesh, chronic catheterization); inadequate bladder emptying as in neurogenic bladder or chronic bladder outlet obstruction (most often due to ...) |
Bladder
benign prostatic hyperplasia |
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PHYSICAL EXAMINATION:
Fever present if associated infection -Moderate, deep tenderness in flank common greater tenderness suggests possible ... An abdominal mass suggests another cause pain besides urolithiasis. -Elevated heart rate and blood pressure secondary to pain Physical findings tend to generally be ... in terms of aiding w/ the diagnosis of kidney stones. |
pyelonephritis
rare |
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LABORATORY TESTING
Urinalysis - Microscopic hematuria unless stone has caused complete obstruction and no urine from affected , side; pyuria may be present to mild degree, if significant pyuria suggests concomitant ... - ... may provide important information regarding the type of calculus present. Leukocytosis may be present if ... infection Elevated ... may be present if bilateral obstruction or stone in solitary kidney |
urinary tract infection
Crystalluria secondary creatinine |
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What is often the first imaging study used in evaluating those suspect for kidney stone disease?
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CT scan
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GENERAL MEASURES:
Stones < ...-... mm likely to pass; stones > ... cm unlikely to pass spontaneously -Take home message - The ... and ... of the stone is impt Indications for intervention —Fever and/or ... —Intractable ... —Unable to tolerate oral fluid and at risk for dehydration —Progressive renal deterioration; obstruction of ... functioning kidney |
4 to 5
1 size and location infection pain solitary |
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MEDICAL stone tx:
-Patients with evidence of active ... should be treated with broad-spectrum an¬tibiotics. -Hydration and adequate pain control -Drinking excessive amounts of fluids ... increase the likelihood of stone passage. -Patients with a likelihood of spontaneously passing a stone (<4—5 mm in size) may be sent home with analgesics; should be instructed to re¬turn if pain worsens, or severe vomiting or fever -Controversy exists regarding maximum period of observation of partially obstructing stone without development of significant irreversible renal dys¬function; generally should intervene if stone has not passed within ... to ... weeks -drugs that may be beneficial in passing a stone: alpha adrenergic blockers, medrol dose pack, NSAIDS |
urinary tract in¬fection
does not 4 to 6 |
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Surgical stone tx:
Patients with active UTI/sepsis: obstructed kidney drained by placement of ureteral ... or percutaneous nephrostomy tube -Calculi in kidney: ... with or without stent placement -Ureteral calculi: ESWL or ... stone removal; the approach depends on size and location of stone, availability of ESWL, and patient and physician preference. -Stent placement in anticipation of ureteral dilation and subsequent spontaneous stone passage is an option for patients with smaller ureteral calculi. |
stent
ESWL (extracortical shock wave lithotrypsy) ureteroscopic |
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PREVENTION:
... is the single most important measure to avoid recurrent stone formation. |
Increased fluid intake (produce ~2 quarts of urine/day)
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