Whats the right renal artery's relationship to the IVC
Right renal artery crosses posterior to the IVC
Whats is the relationship between the ureters and iliac vessels
Ureters cross over iliac vessels
Can you ligate the left renal vein?
the left renal vein can be ligated from the IVC secondary to increased collaterals (left adrenal vein, left gonadal vein, and left ascending lumbar vein)
what does the epididymis connect to?
What is the most common cause of acute renal insufficiency following surgery?
What are the symptoms of kidney stones?
severe colicky pain, restlessness
What does urinalysis show with kidney stones?
What can abdominal CT show w/kidney stones?
can demonstrate stones and associated hydronephrosis
Name the different types of kidney stones:
1) calcium oxalate (phosphate) stones-
1- most common (75%); radiopaque
2- inceased in patients with terminal ileum resection due to increased oxalate absorption in colon
2) Mg ammonium phosphate (struvite stones)-
1- 15% radiopaque
2- can occur with infections (proteus mirabilis) that are urease producing
3- can cause staghorn calculi (fill the renal pelvis)
3) Uric acid stones
1- 7%; radiolucent
2- increased in patients with ileostomies, gout and myeloproliferative disorders
4) Cysteine stones
1) 2%; radiolucent and radiopaque
2) associated with congenital disorders in the reabsorption of cysteine
Surgery for kidney stones:
1) intractable pain or infection
2) progressive obstruction
3) progressive renal damage
4) solitary kidney
5) 90% of kidney stones opaque; >6mm not likely to pass
1) ESWL (extracorporeal shock wave lithotripsy)
2) ureteroscopy with stone extraction or placement of stent past the stone obstruction
3) percutaneous nephrostomy tube
4) open nephrolithotomy
1) #1 cancer killer in men 25-35
2) Symptom: painless hard mass
3) Testicular mass- the patient needs an orchiectomy through an inguinal incision (not a trasscrotal incision --> does not want to disrupt lymphatics). The testicle and attached mass constitute the biopsy specimen.
Are most testicular masses benign or malignant?
most testicular masses are malignant
What imagining modality can help with the diagnosis of testicular cancer?
2) chest x-ray to check for pulmonary metastases
3) chest and abdominal CT- to check for retroperitoneal and mediastinal burden
Which marker is correlated with tumor bulk?
Also need a B-HCG and AFP level
What type of tumors are most testicular cancers?
90% of tumors are germ cells- seminoma or nonseminoma
How are undescended testicles associated with testicular Ca
1) Undescended testicles (crytorchidism) increases the risk of testicular Ca.
2) most likely to get seminoma
1) #1 testicular tumor
2) 10% of seminomatous tumors have beta-HCG elevation
3) should not have AFP elevation (if elevated, need to treat like nonseminomatous)
4) spreads to retroperitoneum
5) seminoma is extremely sensitive to XRT
1- all stages get oriectomy and retroperitoneal XRT- some patients have occult retroperitoneal metastases
2- if the paraaortic nodes in the abdomen are enlarged, need to extend XRT to the mediastinum