Urinary Tract Obstruction and Hydronephrosis

Study Notes

Urinary Tract Obstruction

Can happen anywhere in the urinary tract, from the kidney to the urethra.
Causes urine to back up, leading to:
- Hydronephrosis (swelling of the kidneys)
- Increased risk of infection
Slow obstruction may have few or no symptoms.
Sudden obstruction can lead to severe symptoms and even kidney failure.

Hydronephrosis

Occurs when urine flow is blocked, leading to buildup in the kidneys.
Increased pressure stretches the urinary tract.
If pressure isn't relieved:
- Damage to kidney filtering parts
- Gradual loss of kidney function

Clinical Manifestations and Treatments

Acute Hydronephrosis

Symptoms:
- Sudden, intense pain in the side or back
- Pain that can spread to the groin
- Blood in the urine
- Pus in the urine (sign of infection)
- Fever, nausea, vomiting, abdominal pain
Treatments:
- Fluids given by IV
- Medications based on the stone's composition
- Breaking up the stone (lithotripsy) or surgery
- Changing diet
- Monitoring kidney function
- Patient education to reduce risk factors

Chronic Hydronephrosis

Symptoms:
- May have no symptoms until the obstruction is complete
- Dull, aching pain in the side or back
- Blood in the urine
- Signs of urinary tract infection (UTI): pus in the urine, fever, discomfort
- A mass that can be felt in the side (in severe cases)
Treatments:
- Checking kidney function
- Changing diet
- Fluids given by IV
- Breaking up the stone (lithotripsy) or surgery
- Patient education to reduce risk of recurrence

Kidney Stones

Symptoms:
- Often no symptoms
- Dull, aching pain in the side or back
- Microscopic blood in the urine
- Signs of UTI

Ureteral Stones

Symptoms:
- Severe, sudden pain in the side or back (renal colic)
- Pain that can spread to the lower abdomen, groin, and genitals
- Nausea and vomiting
- Pale skin
- Cold, clammy skin
Treatments:
- Drinking plenty of fluids
- Changing diet
- Medications based on the stone's composition
  - Pain relievers (like morphine)
  - NSAIDs (like indomethacin)

Bladder Stones

Symptoms:
- May have no symptoms
- Dull pain in the lower abdomen, especially with exercise or urination
- Blood in the urine (visible or microscopic)
- Signs of UTI

Hydronephrosis Summary

Acute

Causes sudden, intense pain that can spread to the groin.

Chronic

Develops slowly and often has few symptoms, possibly dull back or side pain.
A palpable mass may indicate significant hydronephrosis.
Other symptoms can include nausea, vomiting, abdominal pain, blood in the urine, and signs of UTI (pus in the urine, fever).

Infection Risk

Increased risk of UTIs (upper and lower) due to urine buildup caused by obstruction.

Collaborative Care for Urinary Calculi (Stones)

Goal:
- Relieve acute symptoms
- Remove or break down stones
- Prevent new stones from forming

Asymptomatic Stones

Managed conservatively as an outpatient.

Urgent Treatment

Based on:
- Location of the stone
- Severity of blockage
- Pain level
- Bleeding
- Kidney function
- Presence of UTI

Description

This quiz covers urinary tract obstruction and hydronephrosis, exploring their causes, symptoms, and treatment options. Learn about the implications of slow versus sudden obstruction and the clinical manifestations associated with acute hydronephrosis. Test your knowledge on this critical area of urology.