Surgery Marrow Pg 337-346 (Urology)
50 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the management strategy for Grade 4 kidney injury with an infected urinoma?

  • DJ stent implantation
  • Partial nephrectomy
  • Pigtail catheter drainage (correct)
  • Conservative management

    • Grade 1-3 kidney injuries require surgical intervention.

    False

    What feature is associated with Grade 5 kidney injuries?

    Expanding hematoma

    Grade 5 kidney injuries may necessitate ________ for management.

    <p>partial or total nephrectomy</p> Signup and view all the answers

    Match the following grades of kidney injury with their corresponding management strategies:

    <p>Grade 1-3 = Conservative management Grade 4 Sterile = DJ stent implantation Grade 4 Infected = Pigtail catheter drainage Grade 5 = Partial/total nephrectomy</p> Signup and view all the answers

    Which zone of retroperitoneal trauma involves major vessels such as the aorta and IVC?

    <p>Zone 1</p> Signup and view all the answers

    A CT scan (CECT) is the preferred investigation for an unstable patient with renal injury.

    <p>False</p> Signup and view all the answers

    What investigation is not useful in a stable patient with suspected renal injury?

    <p>FAST (focused assessment with sonography for trauma)</p> Signup and view all the answers

    A laceration less than 1 cm with no urinary extravasation is classified as a Grade ______ kidney injury.

    <p>1</p> Signup and view all the answers

    Match the following renal injury grades with their descriptions:

    <p>Grade 1 = Laceration less than 1 cm, no urinary extravasation Grade 2 = Detail not provided</p> Signup and view all the answers

    Which of the following is NOT typically considered a clinical feature of urological issues?

    <p>Diarrhea</p> Signup and view all the answers

    The gold standard for confirming a urological infection is a urine culture.

    <p>False</p> Signup and view all the answers

    What is the causative organism most commonly associated with pyelonephritis?

    <p>E. coli</p> Signup and view all the answers

    In the management of a perinephric abscess, _____ therapy is administered a few weeks before any intervention.

    <p>Anti tubercular</p> Signup and view all the answers

    Match the following terms with their respective descriptions:

    <p>DJ stenting = Used for kinking of ureter Augmentation cystoplasty = Uses ileum for bladder enhancement Pigtail catheter = Drainage in perinephric abscess VUR = Mechanism of ascending infection</p> Signup and view all the answers

    What is an early finding in renal tuberculosis?

    <p>Papillary ulcer</p> Signup and view all the answers

    A 'ghost calyx' refers to a normal calyx in healthy kidneys.

    <p>False</p> Signup and view all the answers

    What term describes the bladder capacity decrease due to renal tuberculosis?

    <p>Thimble bladder</p> Signup and view all the answers

    In renal tuberculosis, the condition known as ______ affects the ureter due to the infection.

    <p>ureteral stricture</p> Signup and view all the answers

    Match the renal tuberculosis findings with their respective descriptions:

    <p>Cement kidney = Severe calcifications within the kidney Kerr's kink = Stricture at the ureteropelvic junction Beaded ureter = Irregularities along the ureter Putty kidney = Kidney filled with caseous necrosis</p> Signup and view all the answers

    Which of the following is NOT a complication of ureteric injury?

    <p>Pneumothorax</p> Signup and view all the answers

    Complete transection of the ureter with segment loss can be repaired using an anastomosis over a DJ stent.

    <p>False</p> Signup and view all the answers

    Name one of the diagnosis methods used to identify ureteric injury.

    <p>CT urography</p> Signup and view all the answers

    A common complication after ureteric injury is the formation of a __________.

    <p>urinoma</p> Signup and view all the answers

    Match the type of ureteric injury with its corresponding management:

    <p>Partial Injury = Repair with absorbable suture Complete Tear (without segment loss) = Anastomose over DJ stent Complete Transection (with segment loss) = Boari Flap repair, Psoas hitch</p> Signup and view all the answers

    What is the primary purpose of URS (Ureteroscopic Removal of Stones)?

    <p>To visualize and remove stones via ureter</p> Signup and view all the answers

    What is the first line management for bladder stones?

    <p>Perurethral cystolithotomy</p> Signup and view all the answers

    PCNL is indicated for stones larger than 7 mm.

    <p>True</p> Signup and view all the answers

    Bladder stones can be caused by infection or obstruction.

    <p>True</p> Signup and view all the answers

    What is one expected complication of PCNL?

    <p>Bruising</p> Signup and view all the answers

    The laser used in URS procedures is the _______-YAG laser.

    <p>Holmium</p> Signup and view all the answers

    Which type of stone is most commonly found in children with bladder stones?

    <p>mixed urate stones</p> Signup and view all the answers

    Match the following procedures with their indications:

    <p>URS = Visualizes and removes stones via the ureter PCNL = Indicated for stones greater than 7 mm ESWL = Uses shockwaves to break down stones RIRS = Retrograde approach to remove stones</p> Signup and view all the answers

    Ureteric stones greater than ______ mm require ureteroscopic removal.

    <p>5</p> Signup and view all the answers

    Match the following conditions with their associated characteristics:

    <p>Primary bladder stones = Formed in sterile urine, usually in children Secondary bladder stones = Due to infection or obstruction, seen in adults Ureteric stones = Require ureteroscopic removal if &gt;5mm Bladder diverticula = Contraindication for perurethral cystolithotomy</p> Signup and view all the answers

    What is the primary causative organism in emphysematous pyelonephritis?

    <p><em>E. coli</em></p> Signup and view all the answers

    Xanthogranulomatous pyelonephritis is more common in males than females.

    <p>False</p> Signup and view all the answers

    What is the treatment approach for emphysematous pyelonephritis?

    <p>IV antibiotics and drainage via pigtail catheter, and possibly nephrectomy if there is treatment failure.</p> Signup and view all the answers

    A simple cyst is classified under Bosniak classification as Class _____ with a malignancy risk of _____%.

    <p>1, 0</p> Signup and view all the answers

    Match the following Bosniak classes with their respective descriptions:

    <p>Class 1 = Simple cyst Class 2 = Minimally complex Class 3 = Indeterminate Class 4 = Clearly malignant</p> Signup and view all the answers

    Which of the following is a clinical feature of Vesico Ureteric Reflux (VUR)?

    <p>Recurrent UTI</p> Signup and view all the answers

    Grade 3 VUR involves severe distention of the ureter along with loss of papillary impressions.

    <p>False</p> Signup and view all the answers

    What does MCU stand for in the context of VUR investigations?

    <p>Micturating cystourethrogram</p> Signup and view all the answers

    In the management of Grade 1-3 VUR, _______ prophylaxis is recommended.

    <p>antibiotic</p> Signup and view all the answers

    Match the grades of VUR with their characteristics:

    <p>Grade 1 = Reflux into non-dilated ureter Grade 2 = Reflux into pelvis but no distention Grade 3 = Reflux with mild distention Grade 4 = Blunting of calyces/tortuous ureter Grade 5 = Severe distention of ureter along with loss of papillary impressions</p> Signup and view all the answers

    What is the primary origin of angiomyolipoma?

    <p>Perivascular epithelioid cells (PEC)</p> Signup and view all the answers

    Oncocytoma is the most common benign renal tumor.

    <p>True</p> Signup and view all the answers

    What is the management for symptomatic angiomyolipoma larger than 4 cm?

    <p>Partial nephrectomy or nephron sparing surgery followed by partial nephrectomy</p> Signup and view all the answers

    The clinical feature known as __________ syndrome is associated with spontaneous retroperitoneal hemorrhage in angiomyolipoma.

    <p>Wunderlich</p> Signup and view all the answers

    Match the following terms related to benign tumors with their descriptions:

    <p>Angiomyolipoma = Tumor of blood vessel, muscle, and fat Oncocytoma = Rich in mitochondria with eosinophilic cytoplasm Wunderlich syndrome = Spontaneous retroperitoneal hemorrhage Bosniak 3 = Classification for bilateral lesions</p> Signup and view all the answers

    Study Notes

    Kidney Injury Grades

    • Grade 1-3: Conservative management
    • Grade 4:
      • Sterile: DJ stent implantation
      • Infected: Pigtail catheter drainage
      • Urinoma: Requires specific management
    • Grade 5: Partial/total nephrectomy

    Features of Kidney Injury

    • Grade 4: Specific features not detailed
    • Grade 5:
      • Expanding hematoma
      • Pulsatile leak
      • Non-visualization on IVU

    Management Strategies

    • Exploration and repair of Grade 4 and 5 injuries may be required

    Retroperitoneal Trauma Zones

    • Zone 1: Major vessels (aorta, IVC, pancreas) - high mortality
    • Zone 2: Kidney, ureter, and renal vessels
    • Zone 3: Pelvic structures - most common involvement

    Renal Injury Investigations

    • Stable patient: CT scan (CECT)
    • Unstable patient: Intravenous urogram (IVU)
    • IVU: Dye injection (urograffin)

    Renal Injury Grading on Diagram

    • Grade 1: Laceration less than 1 cm, no urinary extravasation

    Urology - Notes

    • Clinical Features:
      • Hematuria
      • Pain
      • Mass
      • Weight Loss
    • Investigations:
      • IOC: CT urography
      • Urine Routine microscopy: Pus cells (+) Sterile pyuria
      • Urine Culture & sensitivity: Sterile
      • Gold standard: TB culture
    • Management:
      • Perinephric abscess: ATT (Anti tubercular therapy) before intervention (exception: early drainage followed by ATT)
      • Surgical intervention:
        • Perinephric abscess: Pigtail catheter
        • Kinking of ureter: DJ stenting
        • Golf hole ureteric orifice: Reimplantation of ureter
        • Thimble bladder: Augmentation cystoplasty (using ileum)

    Pyelonephritis

    • Clinical features:
      • Pain
      • Fever
    • Risk factors:
      • Females > males
      • Pregnancy
    • Pathogenesis:
      • Causative organism: Most common - E. coli
      • Mechanisms:
        • Hematogenous
        • Ascending infection (VUR)

    Renal Tuberculosis

    • Secondary infection via hematogenous route
    • Pathogenesis:
      • Multiple ulcers → Caseous necrosis → Pus filled → Calcification
    • Other possible findings:
      • Papillary ulcer (earliest)
      • Perinephric abscess:
        • Ghost calyx
      • Putty kidney
      • Cement kidney
      • Kerr's kink of ureteropelvic junction
      • Golf hole ureteric orifice:
        • Stricture (remains open)
        • Shortening of ureter
      • Thimble bladder: ↓ capacity
      • Cortical abscess with rupture into the perinephric space
      • Ureteral stricture
      • Thickened bladder wall (tumble bladder)
      • Urethral stricture
      • Beaded ureter
      • Moth-eaten calyx (ghost calyx)
      • Testis + Epididymis → Epididymo-orchitis:
        • Beading of vas
        • Sinus formation
      • Prostate: Boggy

    Ureteric Injury

    • Complications:
      • Hematuria
      • Urinomas
      • AV fistula
      • Renal artery thrombosis (Renal infarct)
      • Meteorism (Colonic distension 48-72 hours after renal injury d/t pressure over splanchnic nerves)
      • HTN (resistant to antihypertensives)

    Ureteric Injury Causes

    • Surgery
    • Hysterectomy
    • Pelvic tumor resection

    Ureteric Injury Management & Outcomes

    • Partial injury: Repair with absorbable suture
    • Complete Tear (without segment loss): Anastomose over DJ stent
    • Complete Transection (with segment loss): Boari Flap repair, Psoas hitch

    Ureteric Injury Realized After Surgery

    • Presentations:
      • Urinomas (Pigtail catheter → DJ stent)
      • Renal atrophy (d/t complete ureteric tie off)
      • Fistula (most common: uretero-vaginal fistula)
    • Diagnosis:
      • CT urography
      • IVU
    • Treatment: Repair

    Kidney Procedures

    • URS (Ureteroscopic Removal of Stones):
      • Visualize and remove stones via ureter
      • Laser: Holmium-YAG
    • PCNL (Percutaneous Nephrolithotomy):
      • Indications:
        • Stones > 7 mm
        • Lower pole stones, unfavorable for SWL (Shockwave Lithotripsy)
        • Failed ESWL/RIRS (Extracorporeal Shockwave Lithotripsy/Retrograde Intrarenal Surgery)
        • Staghorn calculi
        • Hydronephrotic kidney
        • Mini PCNL: < 22 Fr tract in children and patients with smaller disease burden
      • Complications:
        • Bruising
        • Hematuria

    Ureteric Stones

    • IOC: NCCT
    • Differential Diagnosis:
      • Gall Bladder stone (on lateral X-ray: Anterior)
      • Pills
      • Foreign body
      • Calcified 12th rib
    • Management:

      • 5mm: ureteroscopic removal/Dormia basket

    Bladder Stones

    • Types:
      • Primary:
        • Formed in sterile urine
        • Usually in children
        • Most common: mixed urate stones
      • Secondary:
        • 2° to infection/obstruction
        • Adults
        • Calcium oxalate (Jack stones)
    • Presentation:
      • Hematuria
      • Pain
    • IOC: NCCT
    • Management:
      • 1st Line: Perurethral Cystolithotomy
      • Contraindications:
        • Urethral stricture
        • Bladder diverticula
    • Alternative Management: Suprapubic cystolithotomy

    Vesico Ureteric Reflux (VUR)

    • Upward flow of urine on micturition
    • Clinical Features:
      • Recurrent UTI
      • Pyelonephritis
      • Renal scarring → ↓ renal function
    • Investigation:
      • 10C: MCU (Mictrurating cystourethrogram)
    • Grading:
      • Grade 1: Reflux into non dilated ureter
      • Grade 2: Reflux into pelvis but no distention
      • Grade 3: Reflux with mild distention
      • Grade 4: Blunting of calyces/tortuous ureter
      • Grade 5: Severe distention of ureter along with loss of papillary impressions
    • Management
      • Grade 1-3: Antibiotic prophylaxis
      • Grade 4-5: Antibiotic prophylaxis + intervention:
        • Endoscopic:
          • STING (Subureteric Teflon Injection)
          • Alternative: Deflux
        • Open Sx: Reimplantation of ureters:
          • Politano - Leadbetter technique
    • HIT: Hydrodistension implantation technique

    Kidney: Part 2

    • Investigations:
      • Urine: WBC cast
      • Urine culture & sensitivity
      • CECT: IOC
    • Types of pyelonephritis:
      • Emphysematous pyelonephritis:
        • Causative organism: E. coli
        • Associated with immunocompromised state, DM
        • Presentation: Fever, flank pain close to renal angle
        • IOC: CECT → Gas around kidney
        • Mx: IV antibiotics + Drainage via pigtail catheter. Failure → Nephrectomy
      • Xanthogranulomatous pyelonephritis:
        • Causative organism: Proteus > E. coli
        • Seen in middle-aged females
        • Associated with DM
        • Presentation: Flank pain, pyrexia, abdominal mass, calculi
        • IOC: CECT → Non-functional kidney, low density mass, staghorn calculi
        • Mx: Antibiotics + Subcapsular nephrectomy
    • Treatment:
      • IV antibiotics x 7-10 days
      • If pus → Drain

    Renal Tumors

    • IOC: CECT

    Bosniak Classification

    • Class 1: Simple cyst - Nil workup - 0% malignant
    • Class 2: Minimally complex - Nil workup - 0% malignant
    • Class 2F: Minimally complex (Need follow up) - USG or CT follow-up - 5% malignant
    • Class 3: Indeterminate - Partial nephrectomy - 50% malignant
    • Class 4: Clearly malignant - Partial/Total nephrectomy - 100% malignant

    Benign Tumors

    1. Angiomyolipoma

    • Tumor of blood vessel, muscle, and fat
    • Origin: Perivascular epithelioid cells (PEC)
    • Age of onset: 5th-6th decade of life
    • Associated with: Tuberous sclerosis (2nd-3rd decade of life, multiple bilateral lesions, dermatological lesions, Ash leaf macules, Shagreen patches, Adenoma sebaceum, and familial syndrome)
    • Clinical Features:
      • Asymptomatic
      • Pain
      • Lump
      • Wunderlich syndrome (Spontaneous retroperitoneal hemorrhage, Lenk triad: No hematuria, Hypotension, Pain)
    • Investigations:
      • IOC: CECT
      • B/L lesions: Bosniak 3
    • Management:
      • 4 cm & symptomatic: Partial nephrectomy/Nephron sparing surgery followed by partial nephrectomy
      • Bleeding angiomyolipoma: Angioembolisation

    2. Oncocytoma

    • Most common benign renal tumor
    • Origin: Cells rich in mitochondria
    • Cytoplasm: Eosinophilic

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on the grading of kidney injuries, their management strategies, and the clinical features associated with each grade. This quiz covers topics from investigation techniques to trauma zones, providing a comprehensive overview of renal injury management in urology.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser