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45 Cards in this Set
- Front
- Back
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How do you tell the difference between haematuria caused by tumours vs caused by stones or infection
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infection or stones is usually accompanied by pain or dysuria
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What is the most common type of bladder carcinoma?
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transitional cell carcinoma - 90%
Also can get SCC - 5-7% and adenocarcinoma 1% |
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Symptoms of TCC?
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painless haematuria
can be asymptomatic If storage urinary symptoms consider carcinoma in situ palpable mass on exam --> likely mm invasion ohbstruction of ureters --> hydronephrosis and uraemia mets |
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RF for TCC?
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Smoking
Aniline dye, pain, rubber industry exposure to schistosoma haematobium - 70% produce SCC, 30% TCC |
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What is bladder carcinoma in situ?
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flat, non-papillary erythematous lesion characterised by dyspaslia confined to urothelium
more aggressive, poorer prognosis may progress to invasive TCC |
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Where does TCC arise?
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In transitional epithlium anywhere in the urinary tract from pelvicalyceal system to urethra, but most commonly in the bladder
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How do you manage bladder carcinoma?
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Superficial (non mm invasive disease) - transurethral resection of bladder tumour +/- single dose or maintenance of chemo (BCG)
Invasive Radical cystectomy + pelvic lymphadenectomy with urinary diversion or irradiation for small tumours advanced chemo +/- irradiation +/- surgery |
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What are the 3 types of renal carcinoma?
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Wilm's tumour (nephroblastoma) - seen in kids
Adenocarcinoma Carcinoma of the renal pelvis (SCC or TCC) |
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What is the most common malignant kidney tumour?
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Renal adenocarcinoma
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Where does the renal adenocarcinoma originate from?
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proximal convulted tubule epithelial cell
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How does renal adenocarcinoma usually present?
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usually asymptomatic, frequently diagnosed by US or CT incidentally
Classic "too late" triad gross haematuria flank pain palpable mass |
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What are the most common sites of renal adenocarcinoma mets?
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bone, brain, lung, liver
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Management of RCC?
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surgery is the only effective treatment
Chemotherapy is NOT useful |
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How do you manage carcinoma of the renal pelvis and ureter?
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radical uretonephrectomy with cuff of bladder
distal ureterectomy for distal ureteral tumours |
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What is RCC associated with?
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paraneoplastic syndromes
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What is the cause of Wilm's tumour?
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1/3 autosomal dominant
1/3 sporadic |
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How does Wilm's tumour present that is different to adult presentation of renal tumours?
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hypertension
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What is the most common type of kidney stone?
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calcium oxalate
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What types of kidney stones are there?
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Calcium ones (75-85%)
calcium oxalate calcium phosphate Struvite stones (5-10%) Uric acid stones (5-10%) cystine stones (1%) |
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Clinical features of a kidney stone?
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Urinary obstruction - pain
- flank pain (non-colikcy) - severe waxing and waning pain radiating from flank to groin, testis or tip of penis (ureteral colic) writhing, never comfortable, N/V haematuria diaphoresis Tachycardia, tachypnoea occasionaly sx of trigonal irritation (frequency, urgency) |
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What are the clinical features of bladder stones?
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storage and voiding LUTS, terminal haematuria, suprapubic pain
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What are the RF for kidney stone formation?
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hereditary: RTA, G6Pd, cysteinuria, xanthiunira
Dietary excess: vit C, oxalate, purines, calcium dehydration sedentary lifestyle thiazides UTI (with urea splitting organisms) myeloproliferative disorders GI disorders: IBD hypercalcaemia |
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Which kidney stones will be radioopaque on KUB?
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caclium
struvite cysteine |
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which kidney stones are radiolucent on KUB?
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uric acid
indinavir |
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Which type of kidney stone will be radiolucent on KUB but radioopaque on CT?
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uric acid
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Why is decreasing dietary calcium NOT advisable to prevent calcium stone formation?
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Low dietary calcium leads to increased bile and fat --which bind calcium in the gut leading to decreased calcium oxalate formation --> increased oxalate absorption and higher urine levels of calcium oxalate
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What are struvite stones componsed of?
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magnesium ammonium phosphate
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what is a RF for struvite stones?
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alkaline urinary pH due to infection with urea-splitting organisms --> ppts MAP
NB: Not E. Coli |
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What are RF for uric acid stones
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hyperuricosuria
(low urinary pH, low urine volume, drugs (ASA, thiazides), diet (purine rich - red meats) hyperuricosuria with hyperuricaemia gout high cell turnover (leukaemias, neoplasms) |
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RF for cysteine stones?
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autosomal recessive defect in renal tubular absorption of dibasic amino acids --> COLA in urine (cysteine, ornithine, lysine, arginie)
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Management of acute renal stones?
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alanglesic +/- antiemetic
fluids (if vomiting, do NOT promote stone passage) NSAIDs Alpha blockers - increase rate of spontaneous passage in distal ureteral stones +/- anitbiotics for UTI Septic = emergency - temproary drainage - put in ureteric stent (via cystoscopy, percutaneous nephrostomy - inserts needle into calylx to drain kidney) Can also do this if acute renal failure, anuria, unyeilding pain, N/V |
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When is extracorporeal shockwave lithotripsy warranted in the treatment of kidney stones?
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if stone < 2.5cm
NB: if stone > 2,5cm do percutaneous nephrolithotomy |
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What are the indications for percutaneous nephrolithotomy in treatment of kidney stones?
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if stone > 2.5cm
staghorn UPJ obstruction Calcyceal diverticulum cysteine stones (poorly fragmented with ESWL) |
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What is the interventional management of ureter stones?
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ESWL
Ureteroscopy (extraction or fragmentation) if: failed ESWL, ureteric stricture, |
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How do you manage bladder stones interventionally?
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transurtherhral cystolitholapaxy
camera into bladder, stones broken up by shock |
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When is conservative therapy warranted for kidney stones?
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if stone < 5mm and no complications
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Which type of calcium stones favour acidic or alkaline urine?
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oxalate - acidic urine
phosphate - alkaline |
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Which stones favour low pH
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caclium oxalate
uric acid |
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Which stones favour higher pH
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struvite - favours alkaline environment
phosphate favours pH > 7.5 |
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What are the 3 most common sites of kidney stone obstruction?
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ureteropelvic junction
ureterovesicular junction intersection of the ureter and the iliac vessels |
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What antibiotics are used to treat UTIs?
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trimethoprim or cephalexin or amoxycillin + calvulanate or nitrofurantoin
if resistance to above can use norfloxacin |
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What is the most common cause of acute cystitis?
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Klebsiella
E. Coli (90%) Enterococcus Psueodomonas or proteius mirabilis Staph saphrophyticus, or staph fecalis |
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What investigations should be performed if a patient has haematuria?
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urine cytology, US, cystoscopy
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Source of bacteria for UTIs?
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ascending GI organisms (Most common)
haematogenous (TB, perinephric abscess) lymphatic Direct (IBD, diverticulitis) |
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How do you distinguish pyleonephritis from UTI?
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Pyelonephritis will have more severe symptoms including constitutional sx and CVA tenderness
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