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21 Cards in this Set

  • Front
  • Back
What is the difference b/w micoscopic & macroscopic hematuria?
Microscopic: blood in urine diagnosed by UA.
Macroscopic: 'gross' hematuria, can see blood from urethra during voiding.
What are the components of the upper urinary tract vs the lower urinary tract?
Upper: kidneys, renal pelvis, ureters;
Lower: bladder, prostate in men, urethra.
What are the causes of Hematuria?
Where is microscopic hematuria usually diagnosed?
Dx in office setting & need accurate H/P looking @ pain, voiding symptoms, smokers, prior hx of stones or tumors.
Once dx of microscopic hematuria is made, what are the next steps in the evaluation?
1) Check urine culture, if + for infection, tx.
2) If urine C/S is -, get upper tract evaluation. CT scan or US of kidneys depending on pt.
3) If renal US or CT scan is + (ex. stone, tumor, or hydronephrosis)-->refer to urologist.
4) If upper tract eval is (-), pt needs cytoscopy.
5) If cytoscopy is (+) (ex bladder tumor, stone, stricture or BPH) manage accordingly.
6. If cystocopy is (-)-->get urine cytologies.
7. If cytolgies are (-), pt may have idiopathic hematuria, reevaluate in 6 months.
What is the most common cause of microscopic hematuria in men?
Where is the diagnosis of gross hematuria usually made? What should the H/P include?
hospital setting; H/P: length of time, pain, trauma, GU surgery, anticoagulants, chemo, indwelling foley catheter (trauma), terminal or initial hematuria, presence of clots.
Once diagnosis of macroscopic hematuria is made, what are the next steps for management?
1. Put lg 22-24F 3 way foley cathether & start continuous irrigation. (need to get clots out!)
2. Stabilize pt hemodynamically & get appropriate labs, T/C is necessary.
3. Once patient is stable, get upper tract eval CT scan w/ contrast if possible.
4. If CT scan is + (ex.stone or tumor), need urologic eval.
5. If CT scan is (-), & bleeding continues, do immediate cystoscopy. This is diagnostic & therapeutic.
6. If bleeding due to coagulopathy, support pt & correct problem.
What % of patients w/ stones have hematuria?
What is the most common type of stone?
Calcium oxalate, 70%;
-Uric acid & cystine stones comprise the other 20%
**What procedure should be done on any patient w/ flank pain & hematuria thats suspected of having a stone?
Non-contrast CT scan (good for upper & lower stones, IVP no longer gold standard)
What questions should be asked to patients in an office evaluation concerning kidney stones?
-Family members who are stone formers;
-Medications-TUMS especially!
-Surgeries-->gastric bypass always cause stones b/c bones are used to carrying more & with sudden loss of weight, you get bone resorption-->bones don't need to be that dense & forms stones.
What levels should be measured in office evaluation of kidney stone formers?
-24 hr urine: Ca, oxalate, uric acid, Mg, & citrate;
-Serum uric acid, Ca & parathyroid levels.
-Serum electrolytes including BUN & creatinine
What is the medical management of stone formers?
-Management depends on types of stones you form;
-Recs for stone formers: inc fluid intake, want >2L urine/day;
-Thiazide: very good in tx of certain hypercalciuric states-->corrects renal leak of Ca by augmenting Ca reabsorption in distal tubule. take HCTZ daily.
**What drug is used in tx of hyperuricosuric calcium oxalate nephrolithiasis resulting from uric acid overproduction?
Allopurinol (directly reduces production of uric acid & therefore lowers uric acid in urine)
If pt w / kidney stone has primary hyperparathyroidism, what do they need to be done?
Refer to endocrinologist, most likely need parathyroidectomy.
How can kidney stones be managed by a urologist?
-Based on stone location & size
-Pts may have lots of pain & need narcotics;
-If any evidence of hydronephosis, infection or precedure planned-->need Abx.
-All stones can be broken up or removed w/ ESWL (extracorporeal shock wave lithotripsy) & layers.
Whats the best way to manage a renal pelvic & proximal ureteral stone?
'Push bang' method: stent followed by ESWL.
What is the best way for a urologist to manage a mid & distal ureteral stone?
Ureteroscopy & removal;
ESWL can be used put limited by pelvic bones.
**Whats the most common cause bladder calculi?
BPH! (other causes tumor & foreign bodies--staples, sutures, catheters, stents)
What is best way for a urologist to manage a bladder calculus?
-Cystoscopy followed by electro-hydrolic lithotropsy or laser lithotripsy.
-Must also remove the source of stone.