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Block 34 metabolic -Ellen > Benign urological disease > Flashcards

Benign urological disease Flashcards

1
Q

typicaly presentation of renal stones

A

-acute renal colic

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2
Q

signs and symptoms of renal stones (6)

A
  • acute, severe flank pain
  • colicky pain radiating to groin
  • N&V
  • urinary frequency and urgency
  • haematuria
  • testicular pain
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3
Q

chance of recurrance of renal stones

A

50%

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4
Q

what size stone can pass through ureter and urethra without symptoms

A

<5mm

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5
Q

what size stone can cause symptoms

A

> 5mm

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6
Q

nephrolithiasis=

A

formation of crystallised minerals in kidneys

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7
Q

why is urine concentrated (2)

A
  • due to an increase mineral solutes

- decreased volume from dehydration

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8
Q

what happens to concentrated urine

A

becomes supersaturated

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9
Q

supersaturation=

A

urine solvent containing more solutes than it can hold in the solution

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10
Q

what does supersaturation cause

A

mineral crystals (nidus) to form which encourage aggregation and form a stone

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11
Q

what is supersaturation dependant on

A

urine pH

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12
Q

pH of urine for supersaturation to occur

A

acidic

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13
Q

2 chelating agents that inhibit nucleation and formation of crystals

A

magnesium

citrate

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14
Q

which stones can dietary magnesium and citrate inhibit

A

calcium oxalate

calcium phosphate

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15
Q

> 90% of stones =

A

calcium oxalate

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16
Q

risk factors for calcium stones

A

hypercalciruia

hyperoxaluria

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17
Q

2 conditions causing hypercalciruia

A

sarcoidosis and hyperparathyroidism

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18
Q

when is oxalate more readily absorbed from the gut

A

when dietary calcium is low

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19
Q

calcium oxalate stones on X-ray=

A

radiopaque

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20
Q

colour of calcium oxalate stones

A

dark brown

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21
Q

what type of stone does alkaline urine with hypercaclyiuria form

A

calcium phosphate

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22
Q

what does hypophosphatemia stimulate

A

calcitriol synthesis

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23
Q

what does excess calcitriol synthesis lead to

A

hypercalciuria

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24
Q

calcium phosphate stones colour

A

dirty white stones

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25
Q

calcium phosphate stones on X-ray

A

radiopaque

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26
Q

what stones does excess purine ingestion cause

A

uric acid stones

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27
Q

risk factors for uric acid stones (3)

A
  • low urine pH
  • low urine volume
  • hyperuricosuria
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28
Q

colour of uric acid stones

A

red-brown

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29
Q

uric acid stones on X-ray

A

transulcent

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30
Q

struvite stones are made up of (3)

A

magnesium
ammonium
phosphate

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31
Q

why are struvite stones refered to as infectious stones

A

urinary tract infection precipitates their formation

32
Q

what causes struvite stones

A

urea splitting microorganisms

-proteus, staphylococcus, Klebsiella

33
Q

what do urea splitting microorganisms do to urea

A

hydrolyse it to produce ammonia and OH- forming alkaline urine

34
Q

struvite stones appearance

A

stag-horn dirty white

35
Q

struvite stones on X-ray

A

radiopaque

36
Q

least common stones=

A

cysteine stones

37
Q

what can cause cystinuria

A

iheritible autosomal recessive condition

38
Q

risk factors for renal stones (6)

A 
high protein
high salt intake 
white ancestry 
male 
dehydration 
obesity
39
Q

urinalysis for renal stones

A

microhematuria
nitrates
leukocytes

40
Q

conservative management of renal stones

A

hydration
pain control
anti-emetics

41
Q

antibiotic therapy for stones

A

trimethoprim

nitrofurantoin

42
Q

3 treatments for renal stones

A
  • surgical decompression
  • medical expulsive therapy
  • extracorporeal shock wave lithotripsy
43
Q

medical expulsive therapy=

A

tamsulosin alpha blocker

44
Q

surgical decompression for stones (2) =

A
  • ureteric stent for renal drainage

- nephrostomy

45
Q

what coordinates micturition

A

pontine micturition centre

46
Q

at what level of bladder fullness is the pontine micturition centre activated

A

200-400ml (half-full)

47
Q

3 bladder nerves

A

splanchnic nerve
hypogastric nerve
pudendal nerve

48
Q

splanchnic nerve=

A

parasympathetics - M3 receptors

49
Q

hypogastric nerve =

A

sympathetic nerve

50
Q

pudendal nerve=

A

somatic nerve

51
Q

in bladder contraction which nerves are active

A

the splanchnic nerve (PS)

52
Q

in bladder contraction which nerves are inactive

A

hypogastric

Pudendal

53
Q

pudendal nerve innervates

A

external sphincter

54
Q

hypogastric nerve innervates

A

internal sphincter

destrusor bladder muscle

55
Q

splanchnic nerve innervates

A

M3 receptor of bladder wall contraction

56
Q

4 types of incontinence

A

urge
stress
overflow
neurogenic bladder

57
Q

urge incontinence =

A

sudden urgency and need to urinate - overactive bladder

58
Q

stress incontinence=

A

involuntary loss of urine during coughing, sneezing, laughing or exercise

59
Q

common causes of stress incontinence (2)

A
  • following pregnancy and birth -weakened internal sphincter and pelvic floor muscles
  • post-menopause
60
Q

overflow incontinence=

A

involuntary loss of urine without urgency

61
Q

when can overflow incontinence occur (4)

A
  • BPH
  • prostate cancer
  • urethral narrowing
  • ineffective detrusor muscle
62
Q

neurogenic bladder =

A

bladder dysfunction caused by neurological damage

63
Q

symptoms of neurogenic bladder

A
  • overflow
  • frequency
  • urgency
  • urge
  • retention
64
Q

2 types of neurogenic bladder

A

flaccid

spastic

65
Q

volume of urine in a flaccid bladder

A

large (750ml)

66
Q

volume of urine in spastic bladder

A

low

67
Q

main causes of flaccid neurogenic bladder (2)

A
  • peripheral nerve damage

- cord damage at S2,3

68
Q

main cause of spastic neurogenic bladder

A

brain damage or spinal cord damage above T12

69
Q

prostatic carcinoma symptoms 6

A
  • urinary frequency, hesitancy and dysuria
  • nocturia
  • weight loss
  • lethargy
  • bone pain
  • palpable lymph nodes
70
Q

BPH is

A

hyperplasia of epithelial and stromal prostatic components

71
Q

in BPH anatomically which lobes are most enlarged

A

medial and lateral lobes due to higher glandular tissue

72
Q

why is the prostate enlarged in BPH

A

increased activity of aromatase and 5-alpha reductase enzymes

73
Q

risk factors for BPH (5)

A
  • over 50 years old
  • family history
  • obesity
  • type 2 diabetes
  • erectile dysfunction
74
Q

treatment of BPH

A
  • alpha blocker (doxazosin)
  • Slidenafil inhibitor
  • NSAIDs
  • Finasteride
75
Q

Finasteride =

A

5-alpha reductase inhibitor

Block 34 metabolic -Ellen (8 decks)

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