Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UROLOGY > 5: Obstruction & Urolithiasis/ Disorders of the Prostate > Flashcards

5: Obstruction & Urolithiasis/ Disorders of the Prostate Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 classes of prostatitis

A

acute
chronic
chronic non-bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the main causative pathogens of acute prostatitis

A

E.coli
proteus and staph species
STI pathogens: C.trachomatis and N.gonorrhoea
- inflammation can be focal or diffuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does a patient with acute prostatitis present

A

general symptoms: malaise, rigor, fever
local symptoms: difficulty passing urine, dysuria and perineal tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does a rectal examination of acute prostatitis reveal

A

soft, tender, enlarged prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does chronic prostatitis arise

A
  • inadequately treated infection
  • can occur because some antibodies cannot penetrate prostate effectively
  • often a history of recurrent prostatic and urinary tract infections
  • same causative organisms as acute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is diagnosis of chronic prostatitis confirmed

A
  • Histological examination showing neutrophils, plasma cells and lymphocytes
  • A positive culture from a sample of prostatic secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the most common type of prostatitis

A

chronic non-bacterial
- results in enlargement of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the usual causative organism of chronic non-bacterial prostatitis

A

C. trachomatis
- typically sexually active men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does histological examination of chronic non-bacterial prostatitis

A

fibrosis as result of chronic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe BPH

A
  • detectable in nearly all men over the age of 60
  • non-neoplastic enlargement of the prostate gland can eventually lead to bladder outflow obstruction
  • cause is unknwon but may be related to levels of male sex hormones (testosterone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why do symptoms develop in BPH

A

enlarging prostate gland compresses on the prostatic urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what symptoms do pt w BPH exhibit

A

obstructive lower urinary tract symptoms
- difficulty or hesitancy in starting to urinate
- a poor stream
- dribbling postmicturition
- frequency and nocturia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what would DRE of pt w BPH show

A

firm, smooth and rubbery prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what can untreated BPH present with

A
  • acute urinary retention which is accompanied by distended and tender bladder and desparate urge to pass urine
  • alternatively the pt may have progressive bladder distention –> chronic painless retention
  • can lead to bilateral upper tract obstruction and renal impairment, w the pt presenting w CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe the medical and surgical treatment of BPH

A

medical
- a-blockers: relax smooth muscle at bladder neck and within prostate
- finasteride (5a reductase inhibitor): presents the conversion of testosterone to the more potent androgen dihydrotestosterone

surgical
- transurethral resection of the prostate (TURP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

describe urinary tract obstructions

A
  • can occur at any level
  • can be unilateral or bilateral, complete or incomplete and of gradual or acute onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what do urinary tract obstructions increase the risk of

A

UTI, reflux and stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are causes of urinary retention

A
  • calculi
  • pregnancy: high levels of progesterone relax muscle fibres in renal pelvis and ureters = dysfunctional obstruction
  • BPH
  • recent surgery
  • drugs
  • urethral strictures
  • pelviureteric junction obstruction
  • pelvic masses
  • constipation
  • inflammation
  • tumour
  • neurogenic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what do neurogenic disorders result from (3)

A
  • congenital abnormalities affecting spinal cord
  • external pressure on the cord or lumbar nerve roots
  • trauma to the spinal cord e.g. cauda equina syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

differentiate between acute and chronic urinary retention

A

acute
- painful inability to void
- Residual volume 300 -1500ml
- hot, sweaty
- pain relieved by drainage

  • no upper tract insult (hydronephrosis)

chronic
- Painless
- May still be voiding
- Residual volume 300 –4000ml
- larger clothes
- may have obstructive uropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is involved in the management of acute urinary retention

A
  • catheterise and record any residual volume
  • history taking e.g. last void, complete sensation of void or some left, pain, fluid intake, stream (splitting, dribbling, symptoms of urge incontinence)
  • exam (abdo - may be able to palpate bladder if distended, external genitalia, DRE)
  • urine dip
  • U&Es
  • treat any obvious causes e.g. constipation
  • BPH: alpha blocker, may trial w/out catheter after 1-2 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

describe the management of chronic urinary retention

A
  • Catheterise and record residual volume
  • History
  • Exam
  • Urine dip, U&Es
  • plan for long term catheterisation or intermittent self-catheterisation - would not attemp TWOC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

distinguish high vs low pressure chronic urinary retention

A

High pressure:
* Abnormal U&Es due to kidney dysfunction, unable to clear K+, hydronephrosis
* Repeat episodes can cause permeant renal scaring and CKD

Low pressure:
- Normal renal function
- No hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is post obstructive diuresis and what can it lead to

A
  • following resolution of urinary retention kidney can over-diurese and large amounts of water are lost from the body
  • gradient is lost to concentrate urine due to urine previously backing up into the kidney and ureter so can’t reabsorb as much water (massive loss of electrolytes)
  • can lead to worsening AKI (pre renal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the management plan of post-obstructive diuresis

A
  • urine output should be monitored for 24hrs post catheterisation
  • pt w high urine volumes should be supported w IV
  • monitor Cr, eGFR
  • check lying standing BP, daily weight
  • do not give back residual volume
27
Q

what is hydronephrosis

A

dilation of the renal pelvis and calyces due to obstruction at any point along the urinary tract causing increased pressure and blockage
- post renal cause of AKI

28
Q

what are the 2 forms of hydronephrosis

A
  • Unilateral – caused by an upper urinary tract obstruction
  • Bilateral – caused by obstruction in the lower urinary tract e.g. englarged prostate
29
Q

what happens in hydronephrosis

A
  • reflux of urine back up into kidney
  • progressive atrophy of the kidney develops, back pressure from obstruction is transmitted to the distal parts of the nephron
  • GFR declines and if the obstruction is bilateral, pt goes into renal failure
30
Q

why does GFR decline in hydronephrosis

A

so much fluid in bowmans capsule so pressure is larger than pressure in capillaries - filter doesnt filter out

31
Q

what are the different levels at which hydronephrosis can occur

A
  • Obstruction at the pelviureteric junction = hydronephrosis
  • Obstruction at the ureter = hydroureter, eventually developing hydronephrosis
  • Obstruction of the bladder neck/urethra = bladder distension with hypertrophy, eventually leading to hydroureter and thus hydronephrosis
32
Q

what type of pain can acute ureteric obstruction result in

A

renal colic (pain radiating from site of obstruction loin to groin pain)

33
Q

what is acute ureteric obstruction usually caused by

A

calculus but can be due to blood clots or sloughed papilla
- usually but not always a unilateral problem

34
Q

what does acute ureteric obstruction lead to if bilateral

A

acute renal failure
- presents as anuria or oliguria

35
Q

what can develop as a result of acute ureteric obstruction

A

pyonephrosis - infected, obstructed system

36
Q

what is pyonephrosis

A
  • infected, obstructed kidney
  • urological emergency!!
  • pus in renal pyramids
37
Q

what can failure of decompression in pyonephritis result in

A

death from sepsis and permanent loss of renal function

38
Q

how can an upper urinary tract obstruction be diagnosed

A
  • CT or USS to show structure not function
  • diuretic renograpgy (MAG3) is a functional test
  • give radioactive tracer, give furosemide at around 20 mins to eliminate tracer from body
39
Q

how can the upper urinary tract be drained

A
  • nephrostomy: thin tube inserted into renal pelvis which drains urine into bag (prevents hydronephrosis)
    - in interventional radiology under LA by radiologist
  • JJ stent: coiled at both ends, passed up urethra
    - done in theatre under GA by urologist
40
Q

what is urolithiasis

A

urinary calculi

41
Q

where are the most common sites for urinary calculi (3)

A

pelviureteric junction
pelvic brim
vesicoureteric junction

42
Q

what is a predisposing factor of urolithiasis

A

dehydration as it inc conc of urine
- high recurrence rate

43
Q

who does urolithasis affect

A

10% of the population
- more common in men and Caucasian

44
Q

what is the gold standard for diagnosing urolithiasis

A

CT of kidneys, ureters and bladder (non contrast)

45
Q

what are the 5 types of urinary calculi

A
  • Calcium oxalate stones (75%) –most common. Associated with hypercalcemia and primary hyperparathyroidism and hyperoxaluria
  • Mixed calcium phosphate and calcium oxalate stones –associated with alkaline urine
  • Magnesium ammonium phosphate stones –associated with urea splitting bacteria
  • Uric acid stones –associated with gout and myeloproliferative disorders
  • Cystine stones –patients with inherited cystinuria
  • Indinavir stones - HIV, invisible on CT
46
Q

what does the clinical presentation of urolithiasis depend on

A

the site of the stone

47
Q

what kind of pain would a pt w a renal stone present with

A

continuous dull ache in the loin

48
Q

how would a pt with ureteric stones present

A
  • classic renal colic due to inc in peristalsis in the ureters in response to passage of small stone
  • typically radiates from loin to groin
  • pt appears sweaty, pale and restless w nausea and vomiting
49
Q

what can bladder stones cause

A

strangury - urge to pass something that will not pass

50
Q

what 3 things can most urinary calculi cause

A
  • recurrent and unstable UTIs
  • hematuria
  • renal failure

(may be asymptomatic)

51
Q

what does management of urolithiasis involve

A
  • Management involves adequate analgesia and a high fluid intake
  • Urine should be sieved for analysis
  • Stones of 4-5mm or less usually pass spontaneously
  • Larger stones might require surgical intervention
  • Prevention of further stone formation is achieved with a high fluid intake and correction of any underlying metabolic abnormality
  • thiazide: blocks transporter in DCT, favours reabsorption of Ca2+
52
Q

what interventional treatment is available for urolithiasis

A
  • Consider intervention for larger stones (>7mm) or those causing obstruction, intractable pain, or infection
  • Extracorporeal Shock Wave Lithotripsy (ESWL)
  • Ureteroscopy
  • Percutaneous Nephrolithotomy (PCNL)
53
Q

describe Extracorporeal Shock Wave Lithotripsy (ESWL)

A
  • suitable for smaller stones, typically less than 2cm in size
  • a non-invasive procedure that employs shock waves to break down stones into smaller fragments, making them easier to pass or manage
54
Q

describe ureteroscopy

A
  • suitable for stones within the ureter or smaller stones in the kidney
  • involves the use of a thin, flexible instrument to visualize and access stones, making it possible to remove or fragment them.
55
Q

describe Percutaneous Nephrolithotomy (PCNL)

A
  • reserved for larger stones, typically those larger than 2cm within the kidney
  • a more invasive approach, requiring a small incision to access and remove or break down the stones
56
Q

what is a staghorn calculus

A

type of kidney stone that can block the renal pelvis and the calcyes

57
Q

how does renal colic typically present

A
  • sudden, severe flank pain radiating to groin/scrotum
  • constant or colicky
  • rolling around
  • O/E: temp, unremarkable abdo exam
58
Q

what are ddx for renal colic

A
  • ruptured AAA (pt >60!)
  • pancreatitis
  • biliary colic
  • appendicitis
  • gynae pathology in women e.g. ovarian cysts
59
Q

what investigations are indicated in renal colic

A
  • urine dip + pregnancy test in women
  • FBC, U&Es, calcium
  • CT KUB
60
Q

what is the acute management of renal colic

A
  • NSAIDs: often diclofenac PR
  • opiates prn e.g. morphine
  • monitor pain and watch closely for signs of sepsis/pyrexia
  • initial severe pain improves due to reduced urine output from affected kidney and pyelo-venous and pyelo-lymphatic shunting
61
Q

what is the importance of features of sepsis in a patient with confirmed or suspected renal colic

A

fever or signs of sepsis + obstructed kidney is a urological emergency
- irreversible loss of renal function
- worsening sepsis
- multi-organ failure and death

62
Q

what is the management of stone formers

A
  • check serum calcium: if it is high v likely to have hyperparathyroidism so check PTH (may need parathyroidectomy)
  • advise 2-3l water/day
  • avoid excessive salt/red meat
  • citrate beneficial
  • maintain normal calcium intake
63
Q

what are causes of post obstructive diuresis

A
  • fluid overload
  • osmotic diuresis
  • polyuric phase of ATN
  • iatrogenic e.g. unnecessary IV fluids

UROLOGY (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions