Ureterosigmoidostomy and Hyperchloremic Acidosis
Hyperchloremic acidosis is a known complication primarily associated with urinary diversion procedures that involve the bowel, such as Ureterosigmoidostomy.
Mechanism in Ureterosigmoidostomy
- In Ureterosigmoidostomy, the ureters are surgically connected to the sigmoid colon, diverting urine into the bowel.
- The colonic mucosa actively exchanges chloride ions (Cl-) from the urine for bicarbonate ions (HCO3-) secreted into the urine remaining in the colon.
- This process leads to excessive loss of bicarbonate from the body via the urine, resulting in a hyperchloremic metabolic acidosis (an increase in serum chloride with a corresponding decrease in bicarbonate).
Analysis of Other Options
- Diarrhoea: Severe diarrhea can cause metabolic acidosis due to the loss of bicarbonate in the stool. However, it is not the specific condition most commonly linked to *hyperchloremic* acidosis in the context of surgical diversion compared to ureterosigmoidostomy.
- Vomiting: Persistent vomiting leads to the loss of gastric acid (HCl) and typically causes metabolic alkalosis, not acidosis.
- Ileostomy: Diversion of ileal contents, which are rich in bicarbonate, can lead to a non-anion gap metabolic acidosis. However, the specific mechanism of chloride-bicarbonate exchange occurring in the colon makes Ureterosigmoidostomy the more direct and common cause of *hyperchloremic* acidosis among the options.
Therefore, Ureterosigmoidostomy is the condition most directly linked to hyperchloremic acidosis due to the physiological exchange occurring in the colon.
Important Questions from Urinary System & Surgical Disorders
Which of the following statements are correct regarding renal cell carcinoma?
1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for disease. organ-confined
Select the answer using the code given below.
Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.
Select the correct answer using the code given below.
- Extracorporal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of
Which of the following are correct regarding pathology of stress urinary incontinence?
1. Hypermobility of urethra
2. Ascend of bladder neck and proximal urethra above diaphragm
3. Lowered urethral pressure
4. Increased detrusor activity
Select the answer using the code given below.
Which of the following are correct about ectopic ureters ?
1. They are more common in males
2. They drain the upper pole of kidney
3. They are associated with duplex ureter
4. They may cause incontinence
Select the correct answer using the code given below :
