Long cases Volume 2

  1. UPJO?
    Palpable flank mass in neonates 

    In adults - intermittant flank pain, associated with nausea and vomiting, hematuria - spontaneous or with minor trauma,
  2. Renal Cell Carcinoma
    Smoking (2.5), Obesity (1.07) and HTN history, family hisoty in 1 and 2 degree relative (2.9) NSAIDS (1.5)

    uterine fibroids- many females give history of hyesterectomy, cutaneous leiomyomas - familial HLRCC

    • Symptoms due to 
    • - Local tumor growth - 
    • - Hemorrhage - always rule out RCC in perirenal hemorrhage, 
    • - Paraneoplastic syndrome 
    • - Metastasis - cervical lymphadenopathy, non reducing varicocele, bilateral edema,


    Symptoms of IVC involvement - lower extremity edema, isolated right sided varicocele that does not collapse on recumbency, proteinuria, pulmonary embolism, right arterial mass

    Pain - from invasion  of posterior abdominal wall, nerve roots, or paraspinous muscles



    Never forget to examine scrotum and supraclavicular LN in abdominal examination#

    Stigmanta of familial  RCC - facial angiofibromas

    Performance status 

    Dont say cyanosis, clubbing as part of examination - you have to proove significance 

    Focus on cervical lymphadenotpathy 


    • Examination finding 
    • - upper margin 
    • - bimanual palpable
    • - balllotable - because it is fixed in hilum 
    • - insinuation of finger below costal margin 
    • - Varicocele - non reducible varicocele 
    • - Lower limbs edema, rule out DVT (for bland thrombus)
    • - ascitis
    • - parietal wall veins 
    • - status of epididymis - epididymal cysts in VHL 
    • - DRE - prostatic mass, bladder cancer - leading to renal mass - need to to do DRE, there might be peritoneal deposits -  Blumer's shelf
  3. Differential diagnosis of flank pain and flank mass?
    • History pertaining to the system 
    • - Urinaty systme 
    • - GI system 
    • - Only retroperitonela mass 

    • Nature of mass 
    • - Inflammatory mass 
    • - Neoplastic mass 

    • Differential diagnosis - 
    • Stone disease due to HDN 
    • Renal mass 
    • ADPKD 
    • GUTB 


    • Mass - how did the patient noticed, what has happened to the mass after it has been diagnosed 
    • Rule out CKD features -

    • Past surgical history 
    • Family history
  4. UTUC?
    Most common symptoms - Hematuria - MC in around 90%, Flank pain - 2nd MC in around 30%
  5. Stone disease?
    Previous stone surgery, lithuria 

    • Lithuria - lithuria usually rules out staghorn calculus 
    • - size 
    • - color 
    • - number 


    Dont forget GUTB in any cases of stone disease


    • Recurrent UTI,
    • Familial history of nephrolithiasis, gout, and conditions that increase enteric oxalate absorption: inflammatory bowel disease, short gut syndrome, or cystic fibrosis

    • Fluid intake history 
    • Vitamin supplementation 
    • calcium intake 

    CKD features - to rule out chronic stone disease leading to renal failure 

    Venous blood gas - for evaluation of possible RTA (C12-350)

    Growth failure/failure to thrive - Distal RTA
Author
prem7777
ID
352629
Card Set
Long cases Volume 2
Description
Long
Updated