20. What are the clinical manifestations of urinary obstruction?

The urinary obstruction results in reverse pressure of the urine into the kidney, producing distention and progressive loss of function.

Complications of untreated urinary tract obstruction include:

• Infection (cystitis, pyelonephritis, abscess formation and sepsis).

• Urinary extravasation.

• Fistula formation.

• Renal insufficiency or failure.

• Bladder dysfunction.

• Pain.

Signs and symptoms of urinary obstruction include:

• Inability to pass urine (urinary retention)

• Weak stream of urine

• Blood in the urine

• Pain in either flank (side) or in the back

• Abdominal pain and/or swelling

Causes of urinary obstruction include:

• Stones (can be in the kidneys, ureter, or bladder)

• Tumor (can be anywhere in or outside the urinary tract, compressing it)

• Infection

• Blood clots

• Enlarged uterus in pregnant women

• Weak bladder that cannot push the urine out (due to certain medications or neurologic conditions)

• Abnormal congenital structures (abnormal tissue that blocks the connection between the kidney and the ureter, or within the urethra ), especially seen in children

• Abnormal tissue that results from instrumentation of the urinary tract (also called strictures)

Diagnosis of urinary obstruction is

These studies include plain kidney x-rays , kidney ultrasound, CAT scan, intravenous pyelogram ( IVP) and magnetic resonance imaging (MRI). Some of these studies may require administration of oral or intravenous contrast (dye). Cystoscopy—passing a scope through the urethra into the bladder

• Ultrasound—measurement of how much urine is left in the bladder after the patient feels like the bladder has been emptied

Treatment of urinary obstruction depends on the cause. Passing a catheter in the bladder may be all that is needed to relieve the obstruction (a catheter is a soft tube that is inserted into the urethra). Medication can sometimes help if the obstruction is due to an infection, or sometimes in the case of an enlarged open surgery

21.Nephrolithiasis (kidney stones) is a disease affecting the urinary tract. Kidney stones are small deposits made of calcium, phosphate and other components of foods. They are a common cause of blood in urine.

Symptoms of renal stone disease may include:

• Pain: unilateral or bilateral flank or back pain. Is is normally severe and colicky (spasm-like) in nature, radiating to the pelvis, groin and/or genitals.

• Nausea,

• Vomiting,

• Urinary frequency/urgency,

• Haematuria (blood in the urine),

• Abdominal pain,

• Dysuria (painful urination),

• Nocturia (excessive at night),

• Urinary hesitancy,

• Fever,

• Chills and

• Abnormal urine color or smell.

How is Nephrolithiasis (Kidney Stones; Renal Calculi; Urinary Stones) Diagnosed?

A number of blood and urine tests , a x-ray of the abdomen

How is Nephrolithiasis (Kidney Stones; Renal Calculi; Urinary Stones) Treated?

These may include such medications as diuretics, phosphate solutions, allopurinol (for uric acid stones), antibiotics (for struvite stones), and medications that make the urine alkaline such as sodium bicarbonate or sodium citrate.

.

• What are the symptoms of acute renal failure?

In the majority of cases, acute tubular necrosis is characterized by a period of oliguria and increasing clinical and chemical evidence of renal failure.Durind first few days of oliguria, the clinical picture is dominated by the underlying illness. The urine is scanty and usually bloody. Fever is uncommon after the first day or two. Leukocytosis is the rule with or without infection. Can be pulmonary edema, coma, convulsions, anemia, stric=king weight loss etc.