Repro Elisco Hematuria; Kct

Front 1

What is the difference b/w micoscopic & macroscopic hematuria?

Back 1

Microscopic: blood in urine diagnosed by UA.
Macroscopic: 'gross' hematuria, can see blood from urethra during voiding.

Front 2

What are the components of the upper urinary tract vs the lower urinary tract?

Back 2

Upper: kidneys, renal pelvis, ureters;
Lower: bladder, prostate in men, urethra.

Front 3

What are the causes of Hematuria?

Back 3

SHITTT!
S-stones
H-hemoglobinopathies
I-infection
T-trauma
T-tumor
T-Tb

Front 4

Where is microscopic hematuria usually diagnosed?

Back 4

Dx in office setting & need accurate H/P looking @ pain, voiding symptoms, smokers, prior hx of stones or tumors.

Front 5

Once dx of microscopic hematuria is made, what are the next steps in the evaluation?

Back 5

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.

Front 6

What is the most common cause of microscopic hematuria in men?

Back 6

BPH

Front 7

Where is the diagnosis of gross hematuria usually made? What should the H/P include?

Back 7

hospital setting; H/P: length of time, pain, trauma, GU surgery, anticoagulants, chemo, indwelling foley catheter (trauma), terminal or initial hematuria, presence of clots.

Front 8

Once diagnosis of macroscopic hematuria is made, what are the next steps for management?

Back 8

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.

Front 9

What % of patients w/ stones have hematuria?

Back 9

95%

Front 10

What is the most common type of stone?

Back 10

Calcium oxalate, 70%;
-Uric acid & cystine stones comprise the other 20%

Front 11

**What procedure should be done on any patient w/ flank pain & hematuria thats suspected of having a stone?

Back 11

Non-contrast CT scan (good for upper & lower stones, IVP no longer gold standard)

Front 12

What questions should be asked to patients in an office evaluation concerning kidney stones?

Back 12

-Family members who are stone formers;
-Diet
-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.

Front 13

What levels should be measured in office evaluation of kidney stone formers?

Back 13

-24 hr urine: Ca, oxalate, uric acid, Mg, & citrate;
-Serum uric acid, Ca & parathyroid levels.
-Serum electrolytes including BUN & creatinine

Front 14

What is the medical management of stone formers?

Back 14

-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.

Front 15

**What drug is used in tx of hyperuricosuric calcium oxalate nephrolithiasis resulting from uric acid overproduction?

Back 15

Allopurinol (directly reduces production of uric acid & therefore lowers uric acid in urine)

Front 16

If pt w / kidney stone has primary hyperparathyroidism, what do they need to be done?

Back 16

Refer to endocrinologist, most likely need parathyroidectomy.

Front 17

How can kidney stones be managed by a urologist?

Back 17

-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.

Front 18

Whats the best way to manage a renal pelvic & proximal ureteral stone?

Back 18

'Push bang' method: stent followed by ESWL.

Front 19

What is the best way for a urologist to manage a mid & distal ureteral stone?

Back 19

Ureteroscopy & removal;
ESWL can be used put limited by pelvic bones.

Front 20

**Whats the most common cause bladder calculi?

Back 20

BPH! (other causes tumor & foreign bodies--staples, sutures, catheters, stents)

Front 21

What is best way for a urologist to manage a bladder calculus?

Back 21

-Cystoscopy followed by electro-hydrolic lithotropsy or laser lithotripsy.
-Must also remove the source of stone.