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Urinary > 9- Dev of Urinary Tract, Obstruction and Prostate > Flashcards

9- Dev of Urinary Tract, Obstruction and Prostate Flashcards

1
Q

What is the order of the fetal kidney systems

A

Pronephros (week 4), Mesonephros (form trigone), Metanephros

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2
Q

What mesodermal layer does the kidney develop from

A

Intermediate

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3
Q

Where does the first kidney structure appear

A

Cervical region

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4
Q

What does the pronephros do

A

Makes duct from cervical region to cloaca and drives development of next developmental stage

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5
Q

What is the urogenital ridge

A

Intermediate mesoderm that gives rise to embryonic kidney and gonad.

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6
Q

Where does mesonephric tubule develop

A

Caudal to pronephric region

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7
Q

What is the embryonic kidney made of

A

Mesonephric tubules and mesonephric duct

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8
Q

Can this stage conserve water

A

No

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9
Q

Importance of mesonephros

A

Reproductive system in males. Also sprouts ureteric bud which induces development of definitive kidney.

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10
Q

What does the ureteric bud do

A

Induces development (by releasing growth factors) of undifferentiated intermediate mesoderm (metanephric blastema) to form mesonephros.

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11
Q

Collecting system is derived from

A

Ureteric bud

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12
Q

Excretory component is derived from

A

Intermediate mesoderm under influence of ureteric bud

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13
Q

Ascent of kidney

A

Caudal to cranial. Cross arterial fork of vessels from fetus to placenta. This occurs due to elogation of trunk and expansion of pelvic volume.

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14
Q

Vascularisation of ascending kidney

A

Vascularised from aorta at higher level. Sometimes accessory renal arteries are kept.

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15
Q

What can go wrong

A 
Renal agenesis- bud doesn't interact effectively
Migration awry
Duplication defects
Ectopic ureter- incontinence
Cystic disease
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16
Q

Name 2 anomalies related to migration

A

Pelvic kidney

Horseshoe kidney

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17
Q

Why does duplication defects and ectopic urethral orifices occur

A

Splitting of bud

Ability to drive differentiation = more lobes or distal part of bud opens ectopically.

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18
Q

What 3 systems start by sharing common caudal opening

A

Repro, Urinary, GI

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19
Q

Is the cloaca open to outside

A

No there is cloacal membrane

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20
Q

What is the function of urorectal septum

A

Divide the GI from urinary and repro. Creates urogenital sinus. The cloacal membrane ruptures giving access to outside

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21
Q

Urogenital sinus becomes…

A

Superior part connects to umbilicus. Majority becomes bladder, inferior part develops into urethra.

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22
Q

Development with NO Y chromosome present

A

Mesonephric duct reaches urogenital sinus and ureteric bud sprouts from mesonephric duct. The sinus expands and duct regress. Bud connected directly to bladder = development of ureter and bladder from sinus.

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23
Q

Development with Y chromosome present

A

Duct reaches sinus. Bud sprouts from duct. Sinus expands. Bud and duct make independent opening in sinus. Duct becomes vas deferens and connects epididymis to urethra. Interaction between trigone of bladder and ducts = prostate develops.

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24
Q

Parts of male urethra

A

Pre-prostatic, prostatic, membranous, spongy.

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25
Q

Male urethra development

A

Genital tubercle elongates and genital folds fuse = spongy urethra.

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26
Q

What is required for genital folds to fuse

A

Androgens and responsive tissue.

27
Q

What is hypospadias

A

Defect in fusion of urethral folds. Urethra opens onto ventral surface not the end of glans.

28
Q

Growth factors and metanephric blastema

A

Release growth factors which cause uteric bud to form . This then release GF = reciprocal induction

29
Q

What are main pathogens for acute prostatitis

A

Escherichia Coli. Staphylococcus. Chlamydia Trachomatis. Neisseria Gonorrhoeae.

30
Q

Symptoms of acute prostatitis

A

Malaise, rigors, fever, passing urine difficulty, dysuria, perineal tenderness

31
Q

Cause of chronic prostatitis

A

Chlamydia trachomatis.

32
Q

Histological findings of chronic prostatitis

A

Fibrosis as a result of chronic inflammation

33
Q

What is BPH and who is it common in

A

Common over 60

Non-neoplastic enlargement - can lead to obstruction

34
Q

Cause of BPH

A

Unknow, maybe levels of testosterone

35
Q

Symptoms of BPH

A

Enlarged prostate
Compresses prostatic urethra
Obstructive lower urinary tract symptoms- poor stream, dribble, frequency, nocturia

36
Q

Findings of a rectal exam for BPH

A

Firm, smooth, rubbery

37
Q

Risk of untreated BPH

A

Retention, overflow incontinence, bilateral upper tract obstruction, renal impairment - CKD

38
Q

Treatment of BPH- drugs

A

Smooth muscle relaxers- alpha blockers (bladder neck and prostate)
Finasteride- prevents conversion of testosterone into more potent dihydrotestosterone.

39
Q

Risk of obstruction

A

UTI- stasis
Reflux up ureter
Stone formation

40
Q

Causes of renal retension

A

Calculi, pregnancy, tumours, drugs, surgery, strictures, BPH, neurogenic disorders (trauma- interferes with micturition pathway)

41
Q

Symptoms of acute retention

A

Painful to void

Residual volume- 300-1500ml

42
Q

Symptoms of chronic retention

A

Painless
Still void
Residual volume - 300-4000ml

43
Q

Management of acute retension

A 
Catheter
History
Exam 
Urine
U&Es 
Treat causes- constipation
44
Q

Management of chronic retension

A 
Catheterise and measure residual
History
Exam
Dip and U&Es
Long term catheter plan
45
Q

Low pressure vs high pressure

A

Normal renal function
No hydronephrosis
Bladder compliant but not emptying ? neuro problem
VS
Abnormal U&Es, hydronephrosis, renal scarring and risk of CKD development.

46
Q

Post obstructive diuresis

A 
Following resolution of retention
Over diurese
Worsening AKI as electrolytes and fluid excreted. Therefore loss of countercurrent in loop of henle because of back up = more water lost
Monitor for 24 hrs post catheter. 
Treat with IV fluid and
47
Q

Hydronephrosis

When bilateral when unilateral

A

Dilation of renal pelvis and calyces due to obstruction. Leads to increased pressure and blockage.
Bilateral- if lower urinary tract obstruction
Unilateral- if upper urinary tract obstruction

48
Q

Problems with hydronephrosis

A

Progressive atrophy of kidney= increased hydrostatic pressure in Bowman’s capsule = GFR decreases = renal failure if bilateral.

49
Q

Hydronephrosis VS hydroureter

A

Obstruction at pelviureteric junction vs ureter. Hydroureter develops into hydronephrosis.

50
Q

How does hydroureter develop

A

Hydroureter develops from obstruction of bladder neck/urethra –> bladder distension with hypertrophy

51
Q

Acute ureteric obstruction causes what pain

A

Renal colic- pain loin to groin radiating

52
Q

Cause of acute ureteric obstruction

A

Calculus, clots, slough papilla

Can lead to pyelonephritis

53
Q

What is Pyelonephritis

A

Infected, obstructed kidney.

54
Q

Failure to treat pyonephrosis can lead to..

A

need to decompress as it may lead to death from sepsis and permanent loss of renal function.

55
Q

Diagnosis of upper urinary tract obstruction

A

CT
USS
Diuretic renography: furosomide and then expect to see tract decline.

56
Q

Drainage of upper urinary tract

A

nephrostomy (direct from kidney to outside)

JJ stend - helps bladder drain.

57
Q

Urinary calculi affects mostly…

A

White, men

58
Q

What causes increases in occurance

A

Dehydration

59
Q

Where can stones/obstruction form

A

Pelviureteric junction, pelvic brim, vesicoureteric junction
Narrowest point

60
Q

Gold standard for stone diagnosis

A

CT

61
Q

Composition of calculi

A

Calcium oxalate (hypercalcemia, primary hyperparathyroidism)
Calcium phosphate- alkaline urine
Magnesium ammonium phosphate- urea splitting bacteria
Uric acid stone- gout and myeloproliferative disorders
Cystine stones- inherited cystinuria

62
Q

Presentation of stones

A

Dull ache in loins
Radiates if ureteric stones due to peristalsis
Pale, sweaty, restless, nausea, vomiting
Strangury (urge to pass something that won’t)
Recurrent UTIs untreatable, haematuria, renal failure
Asymptomatic

63
Q

Treatment of stone

A

Less than 5mm- wait
Larger than 5mm- extracorporeal shock waves, ureteroscopic destruction and removal, percutaneous nephrolithotomy, open surgical removal.

64
Q

Prevention of stones

A

Hydration

Correct metabolic abnormalities- Ca and PTH

Urinary (11 decks)

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