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Year 2 - Theme A > Block 10 > Flashcards

Block 10 Flashcards

0
Q

Describe the fat and fascia that surrounds the kidney

A

It is surrounded by perinephric/ perirenal fat.
Covering this is the renal fascia.
Behind the kidneys is the paranephric fat.
Behind the paranephric fat is the transversalis fascia.
At the very front is the peritoneum.

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1
Q

What vertebral level do the kidneys lie?

A

T12 - L3

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2
Q

Describe the anatomy of the kidney

A

Outer renal cortex
Inner renal medulla
Extensions of renal Cortex are the renal columns
These split the medulla into renal pyramids
Bases of pyramids directed out
Apex is called the renal papilla and it points to the renal sinus

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3
Q

What are the functions of the kidney in terms of homeostasis?

A

Excretion of metabolic waste and foreign chemicals
Regulation of water and electrolyte balance
Regulation of body fluid osmolarity and electrolyte balance
Regulation of arterial pressure and acid base balance
Secretion, metabolism and excretion of hormones
Gluconeogenesis

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4
Q

What are the 2 capillary beds within the kidneys?

A

Glomerular - high hydrostatic pressure = rapid filtration

Peritubular - low hydrostatic pressure = fluid reabsorption

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5
Q

What are the components of a nephron?

A 
Bowmans capsule
Proximal tubule
Loop of Henle
Macula densa
Distal tubule
Cortical collecting tubule
Collecting duct
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6
Q

What are the 2 types of nephrons?

A

Cortical

Justamedullary

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7
Q

What are the differences between cortical and juxta medullary nephrons?

A

Cortical
Glomeruli in outer cortex, short loops of Henle that just enter the medulla

Juxtamedullary (25%)
Lie deep in the renal cortex, close to the medulla. Long loops of Henle , long efferent arterioles from glomeruli form vasa recta

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8
Q

What determines GFR?

A

Balance of hydrostatic and colloid osmotic forces acting across capillary membrane

The capillary filtration coefficient Kf

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9
Q

What are the 3 layers of the glomerular capillary membrane?

A

Endothelium of capillary
Basement membrane
Epithelial cells, podocytes

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10
Q

How does the capillary membrane filter?

A

Size, Small fenestrae

Fixed negative charges that repel

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11
Q

What determines glomerular hydrostatic pressure?

A

Arterial pressure
Afferent arteriolar resistance
Efferent arteriolar resistance

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12
Q

How can glomerular filtration be controlled?

A
  1. Sympathetic nervous system increase increases GFR
  2. Constricting renal blood vessels - adrenaline, NA, endothelin - constricting efferent and efferent decreases GFR
  3. Constrict efferent arterioles - angiotensin 2 to increase GFR
  4. Decrease renal vascular resistance - nitrous oxide decreases vascular resistance and decreases GFR
  5. Vasodilation - caused by Prostaglandins and bradykinin. Increase GFR
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13
Q

What is the macula densa?

A

A group of specialised epithelial cells that comes in close contact with arterioles.
The cells sense changes in volume delivery to the distal tubule.

Detects decrease in NaCl

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14
Q

What happens when the volume of fluid being delivered to the kidneys is reduced?

A

Macula densa cells detect this by a drop in NaCl
This causes
Decreased resistance to blood flow in afferent arterioles
Increased renin release from juxta glomerular cells that leads to the construction of the efferent arterioles

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15
Q

What effect do ACE inhibitors have on a reduced Renal arterial pressure?

A

They prevent the formation of angiotensin 2 and causes greater reductions of GFR when renal arterial pressure falls

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16
Q

What is the first part of the nephron and what moves across the membrane (in and out)?

A

Proximal tubule
Out: Na, Cl, HCO3, K, H2O, glucose, amino acids
In: H, organic acids, bases

Na co transported with amino acids and glucose
Na/K ATPase
Na with Cl due to higher Cl in later proximal

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17
Q

What moves in and out in the thin descending loop of Henle?

A

Out: water 20% is reabsorbed

Highly permeable to water and occurs by simple diffusion

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18
Q

What moves in and out of the thick ascending loop of Henle?

A

Out: Na, Cl, K, Ca, HCO3, Mg
In: H

Na/K ATPase
Na crosses membrane by Na/2Cl/K

Loop diuretics act here
Impermeable to water

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19
Q

What moves in and out of the early distal tubule?

A

Out: Na, Cl, Ca, Mg

Na/Cl co transporter - thiazide diuretics act here

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20
Q

What moves in and out of the medullary collecting duct?

A

Out - Na, Cl, h2o, urea, HCO3
In - H

Actively reabsorbs Na and secrete H
Permeability to water is controlled by ADH
Regulates acid base balance

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21
Q

What moves in and out across the late distal tubule membrane?

A

Principal cells reabsorb Na and secrete K+
Potassium sparing diuretics act here,
Intercalated cells secrete H and reabsorb K and HCO3

Reabsorbs Na controlled by aldosterone
PH regulation
Active H ATPase

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22
Q

What is the function of intercalated cells?

A

Regulate pH

Secrete H+ and reabsorb HCO3

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23
Q

ALDOSTERONE

Effects
Site of action
MOA

A

Increase NaCl, increased water, increased potassium

Collecting tubule and duct (principal cells)

Stimulates Na/K ATPase on basolateral membrane to increase sodium permeability of luminal side. Prevents decreases of Na and increased K

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24
Q

ANGIOTENSIN 2

Effects
Site of action
MOA

A

Increased NaCl and Water reabsorption
Increased H secretion, retains sodium

Proximal tubule, distal tubule and collecting tubule

Stimulates aldosterone and constricts efferent arterioles. Stimulates NaK ATPase and NaH exchange

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26
Q

ANTIDIURETIC HORMONE, ADH

Effects
Site of action
MOA

A

Increased water reabsorption

Distal tubule, collecting tubule and duct

No ADH= increased dilute urine. Binds to V2 receptors, increased camp, stimulates aquaporin 2 to open water channels

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26
Q

What controls body water levels?

A

Fluid intake

Renal excretion of water

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27
Q

ATRIAL NATIURETIC PEPTIDE

Effects
Site of action
MOA

A

Decreased NaCl reabsorption

Distal tubule, collecting tubule and duct

inhibits reabsorption of Na and water. Increased urinary excretion to decrease blood volume

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28
Q

What is the function of ADH and where is it secreted?

A

Concentrates urine

Secreted from posterior pituitary when water levels are too high

Doesn’t alter solute excretion, reduces permeability of distal tubule to water

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29
Q

What are the 3 categories for acute renal failure and their causes?

A 
Prerenal (decreased renal blood flow)
intrarenal (blood vessels, glomeruli, tubules)
post renal (obstruction of urinary collection)
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30
Q

What are some causes for acute prerenal renal failure?

A

Intravascular volume depletion - haemorrhage, diarrhoea, vomiting, burns

Cardiac failure - MI, vascular damage

Peripheral vasodilation - hypotension, anaphylactic shock, anaesthesia, sepsis

Primary renal haemodynamic abnormalities - renal artery stenosis, embolism or thrombosis

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31
Q

What are some causes for acute intrarenal renal failure?

A

Small vessel and/or glomerular injury - vasculitis, cholesterol emboli, malignant hypertension, acute glomerulonephritis

Tubular epithelial injury - acute tubular necrosis due to ischemia or due to toxins

Renal interstitial injury - acute pyelonephritis, acute allergic interstitial nephritis

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32
Q

What are some causes for acute postrenal renal failure?

A

Bilateral obstruction of ureters
Large stones or clots
Bladder obstruction
Obstruction of urethra

If only one is blocked the other will compensate

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33
Q

Describe glomerulonephritis

A

Usually caused by an abnormal immune reaction that damages the glomeruli.
Occurs 1-3 weeks after an infection with group A beta streptococci.
Antibodies develop against the antigen and forms an insoluble immune complex that gets trapped in glomeruli
Deposit in kidneys, attract WBCs and either block glomeruli or cause them to become overly permeable

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34
Q

Describe tubular necrosis

A

Ischaemia can impair the delivery of oxygen and nutrients causing the destruction of epithelial cells
Tubular cells slough off plugging nephrons
reducing urine output
certain toxins can damage basement membrane e.g. heavy metals of tetracyclines

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35
Q

What are the physiological effects of acute renal failure?

A 
water, electrolyte and waste retention
oedema and hypertension
metabolic acidosis due to H+ retention
Hyperkalcaemia
Complete stop of urine formation
Death within 8-14 days
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36
Q

Define chronic renal failure

A

Progressive and irreversible loss of functioning nephrons

Symptoms occur at 70% below normal

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37
Q

Causes of chronic renal failure

A

Metabolic disorders (diabetes, obesity, amyloidosis)
Hypertension
Renal vascular disorders (atherosclerosis, nephrosclerosis)
Congenital disorders (polycystic disease, renal hypoplasia)
Infections (pyelonephritis, tuberculosis)
Primary tubular disorders (nephrotoxins)
Urinary tract obstruction (renal calculi, hypertrophy of prostate, urethral constriction)

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38
Q

What is the vicious cycle of end stage renal disease

A

Primary kidney disease causes a reduction in nephron number

The reduction in nephron number caused hypertrophy and vasodilation of surviving nephrons and an increase in arterial pressure

Both of these lead to an increase in glomerular pressure and/or infiltration

Leading to glomeruloscelersis

Which causes a reduction in the number of nephrons! :(

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39
Q

Define azotemia

A

elevation of blood urea nitrogen and creatinine levels

usually reflects a decrease in GFR

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40
Q

What is nephritic syndrome

A

Haematuria (with dysmorphic RBC and casts in urine)
Oliguria and azotemia
hypertension

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41
Q

What are the top 3 causes of nephritic syndrome?

A

acute post-streptococcal glomerulonephritis
IgA nephropathy
Hereditary nephritis

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42
Q

What is nephrotic syndrome?

A

Proteinuria
Hypoalbuminaemia
Hyperlipidaemia

(oedema)

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43
Q

What are the top 3 causes of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis
membranous nephropathy
membranoproliferative glomerulonephritis

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44
Q

What are the top 3 causes of nephrotic syndrome in children?

A

Minimal change disease
focal segmental glomerulosclerosis
membranoproliferative glomerulonephritis

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45
Q

What is acute kidney injury?

A

Dominated by oliguria or anuria and recent onset azotemia

Glomerular injury, GN, interstitial injury, vascular injury, acute tubular injury

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46
Q

What is minimal change disease?

A

glomeruli have normal appearance by light microscopy but show diffuse effacement of podocyte foot processes

1-7 years
corticosteroid therapy

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47
Q

What is focal segmental glomerulosclerosis?

A

Sclerosis affecting SOME glomeruli (focal)
Involving segments of affecting glomerulus (segmental)

Injury to podocytes

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48
Q

What is membranous nephropathy?

A

presence of subepithelial immunoglobulin containing deposits along GBM

Caused by autoantibodies that cross react with antigens expressed by podocytes
Form of chronic immune complex glomerulinephritis

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49
Q

What is isasthenuria?

A

inability to concentrate or dilute urine

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50
Q

What are the effects of renal failure?

A 
generalised oedema
acidosis
increased non protein nitrogen concentration
uremia
anaemia
osteomalacia
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51
Q

What is BPH?

A

Benign prostatic hyperplasia

Hyperplasia of prostatic stromal and epithelial cells forming nodules in periurethral region of the prostate

It compresses and narrows the urethral canal

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52
Q

What is the incidence of BPH?

A

20% by 40
70% by 60
90% by 80

50% develop clinical symptoms

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53
Q

What is the main androgen in the prostate and how is it formed?

A

Dihydrotestosterone (DHT)

Testosterone + type 2 5 alpha reductase = DHT

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54
Q

Where is DHT found?

A

Only found in stromal cells and these are the cells responsible for androgen dependent prostatic growth

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55
Q

Pathogenesis of BPH

A

Impaired cell death resulting in accumulation of senescent cells

DHT binds to nuclear androgen receptor in epithelial and stromal cells

DHT+AR = activates transcription of androgen dependent genes that increase growth factors

FGF7 - fibroblast growth factor 7

Increased proliferation of stromal cells and decreased death of epithelial cells

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56
Q

In BPH where does the hyperplasia occur?

A

inner aspect or the transition zone

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57
Q

Clinical features of BPH?

A 
Urethral obstruction
Bladder hypertrophy and distension
Urine retention
Unable to empty bladder completely 
Increased infection due to residual urine
Increased urine frequency
Nocturia
Difficulty starting and stopping
Overflow dribbling
Dysuria
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58
Q

Management of BPH

A

Mild - decreased fluid intake

Mediation - alpha 1 blockers reduce prostate muscle tone. 5 alpha reductase inhibitors decrease DHT

TURP - transuretral resection of prostate

Intensity focused ultrasound
laser therapy
needle ablation

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59
Q

Name some lower urinary tract symptoms

A 
urinary frequency
urgency
dysuria
nocturia
poor stream
hesitancy
dribbling
incomplete voiding
overflow incontinence
haematuria
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60
Q

Where do the ureters enter the pelvic cavity?

A

bifurcation of the common iliac artery

61
Q

Describe the anatomy of the kidney

A

Outer cortex
Inner medulla - pyramids

Minor calyx - major calyx

62
Q

Renal blood supply?

A

Renal arterys from the aorta at L1-L2

Renal artery
Segmental (5)
Lobar (2)
Interlobar (2/3)
Arcuate 
Interlobular
Afferent arterioles
63
Q

Histology of ureter

A

muscular tubes lined with transitional epithelium

2 layers of smooth muscle - longitudinal and circular

64
Q

What are the 3 narrowings of the ureters?

A

junction of renal pelvis with abdominal part of ureter

pelvic brim, where ureter enters pelvis

pelviureteric junction, where ureter enters bladder wall

65
Q

What are the 4 parts of the ureter and their blood supplies?

A

Renal pelvis - aorta and renal arteries

abdominal - aorta, renal, testicular/ovarian

pelvic - testicular/ovarian, internal iliac

intravesicular - internal iliac, inferior vesicular

66
Q

What are the ligaments what anchor the neck of the bladder?

A

Female - pubovesical

Male - puboprostatic

67
Q

What forms the trigone of the bladder?

A

internal meatus

2 uteric orifices

68
Q

Describe the internal urethral sphincter

A

Circular smooth muscle fibres - trigone

69
Q

Describe the external urethral sphincter

A

striated muscle (part of urogenital diaphragm)

70
Q

Blood supply to the bladder?

A

internal iliac artery –> superior and inferior vesiscular branches

71
Q

Innervation of the bladder?

A

interior hypogastic plexus L1-2

Splanchnic nerves S2-4

72
Q

What are the 4 parts of the male urethra?

A

Preprostatic - 1cm

Prostatic - 4cm. Longitudinal fold of mucosa forms the urethral crest. The depression on either side of the crest = prostatic sinus
Midway down the urethral crest is elevated - seminal coliculus

Membranous - narrow, passes through the perineal pouch

Spongy - surrounded by erectile tissue

73
Q

Describe urothelium

A

Stratified with 3-6 layers of cells

Basal cells are cuboidal or columnar
Surface cells are umbrella cells

Maintain impermeability even at full stretch

74
Q

How May kidney disease present?

A

A symptomatic
Hypertension
Kidney pain
Bleeding from urothelium

75
Q

Causes of polyuria

A

Early chronic kidney disease - due to loss of concentrating ability
Osmotic diuretic e.g. Glucose in diabetes
Post renal obstruction

76
Q

What causes oliguria?

A

Acute kidney injury

77
Q

What causes anuria?

A

Severe acute kidney injury
Long standing end stage renal failure
Complete post renal obstruction

78
Q

Features of urine in disease to be aware of

A 
Colour
Volume
Odour
Cloudiness
Thickness
Frothiness - excess protein
Gravel
Debris I.e. Infection
Air
79
Q

What does the urine dipstick test for?

A 
Leukocyte esterase
Nitrites
Urobilinogen
Protein
PH
Blood
Specific gravity
Ketones
Bilirubin
Glucose
80
Q

What does urobilinogen in urine suggest?

A

Haemolysis

81
Q

What does protein in the urine suggest?

A

Glomerular injury

82
Q

What does blood in the urine suggest?

A

Glomerular injury

Bleeding from uroepithelium

83
Q

What are the functions of the kidney?

A

Excretion - urea, creatinine, Uric acid, phosphate
Water and sodium balance
Electrolyte control
Acid base control
Endocrine - erythropoietin, vitamin D and renin

84
Q

What is the first line way of viewing the kidneys?

What are the benefits to this?

A

Ultrasound

Cheap, non invasive, no radiation, no risk, no contrast

Operator dependent

85
Q

What methods can be used to view the kidneys?

A 
Ultrasound
CT - contrast is nephrotoxic
MRI
Angiography
Nuclear medicine - static or dynamic
86
Q

Disadvantages and advantages of screening?

A

Difficulty with employment or insurance
Ethical issues with passing on to next generation

Aware of possible problems
Monitoring and treating
Supervision during pregnancy

87
Q

Advantages of dialysis

A

Immediately life saving
Mdt support
Bridge to transplantation
Relief from loneliness and isolation

88
Q

Impacts of dialysis

A 
Often have multiple medical problems
Frequent hospital admissions
Depressed and psychological illness common
Heavy time burden
Limitation if travel because of treatment 
Restrictions on fluid intake and diet
Employment difficulties
Cost to health care providers
89
Q

What is glomerular filtration dependent on?

A

Surface area
Membrane permeability
Net filtration pressure

90
Q

How do you calculate net filtration pressure?

A

Blood hydrostatic pressure - filtrate hydrostatic pressure in bowmans space + colloid oncotic pressure

91
Q

What does auto regulation maintain?

A

Maintains renal blood flow over a range of systemic blood pressures
Maintains glomerular filtration rate over a range of systemic blood pressures

92
Q

What are the 2 mechanisms of renal auto regulation?

A

Myogenic (fast) - protects against high pressure
Increased blood flow - increased pressure in afferent - increased smooth muscle stretch - vasoconstriction of afferent - decreased glomerular pressure

Tubuloglomerular - slow. Dependent on the macula densa (juxta glomerular apparatus)
Decreased blood flow and GFR - decreased Cl to macula densa - renin release - increased efferent arteriolar resistance

93
Q

Where is angiotensinogen produced?

A

Liver

94
Q

What are the effects of angiotensin 2?

A 
Increased tubular sodium and chloride resorption
Efferent arteriolar vasoconstriction
Systemic arteriolar vasoconstriction
Activates sympathetic nervous system
Vasopressin /ADH release
Aldosterone release
95
Q

What is the normal GFR rate?

A

120ml per minute

96
Q

What are the qualities required in a substance to measure GFR?

A

Freely filtered
Not secreted
Not resorbed

97
Q

How do you calculate creatinine clearance?

A

Concentration in urine x urine flow rate

/plasma concentration

99
Q

What are the problems for using serum creatinine to measure GFR?

A

It is actively secreted by the tubules - it over estimated GFR
Insensitive for early marker of kidney disease
Affected by muscle mass
Affected by certain drugs

100
Q

What are the general causes of glomerular injury?

A

Abnormalities of the slit diaphragm between podocytes

e. g. defect in gene that codes for nephrin
e. g. defect in podocyin (change in cytoskeleton)

Immune complex trapping blocking the glomerulus
e.g. SLE

In situ antigen
e.g. Good pastures disease

Implanted antigen - infectious GN (post streptococcal)

Endothelial cell injury

101
Q

What are the consequences of the loss of function of the GBM?

A
  1. Protein loss (asymptomatic or nephrotic syndrome)

2. Blood loss (non visible, visible, nephritic syndrome)

102
Q

Why do people with nephrotic syndrome develop oedema?

A
  • capillary hydrostatic pressure is forcing fluid into interstital space
  • interstital hydrostatic pressure pushes it back
  • Also have capillary oncotic pressure maintains pressure in capillary (due to albumin)

Capillary oncotic pressure is reduced due to hypoalbuminaemia

103
Q

What are the causes of nephritic syndrome in children?

A

Haemolytic uraemic syndrome

Post streptococcal GN

104
Q

What are the main causes of nephritic syndrome in adults?

A

Goodpastures syndrome
SLE
Primary or secondary mesangiocapillary GN

105
Q

What are the causes of intrarenal acute kidney injury?

A 
Glomerulonephritis
Pyelonephritis
Drug induced interstitial nephritis
Hypertension
Vasculitis
Kidney failure in type 1 diabetes
106
Q

How many stages of chronic kidney disease are there and how are they determined?

A

5
Determined based on eGFR

Symptoms develop at stage 4

107
Q

What are the main causes of chronic kidney disease in adults?

A 
Diabetes
Glomerulonephritis
Interstital nephritis
Vascular nephropathy
Polycystic kidney disease
108
Q

What are the main causes of chronic kidney disease in children?

A

Renal dysplasia and reflux
Obstructive uropathy
Glomerular disease
Congenital nephrotic syndrome

109
Q

What are the symptoms of uraemia?

A 
Non specific
metallic taste
anorexia
nausea and vomiting
itching
fatigue
chest pain (percarditis)
breathlessness
cognitive impairment
110
Q

What type of anaemia would you expect in kidney failure?

A

No production of EPO

normocytic normochromic anaemia

111
Q

Where in the kidney to carinomas most frequently occur?

A

Renal cortex

112
Q

What are the predisposing factors for kidney cancer?

A 
Smoking
Obesity
High blood pressure
Acquired cystic renal disease
Transplantation
Familial
113
Q

What are the most common kidney cancers?

A

Clear cell renal cell

Papillary

114
Q

What grading system is used to stage kidney tumours?

A

Fuhrman nuclear grade

1-4

115
Q

What are the different types of bladder cancer and how common are they?

A

Urothelial (TCC) 90%
Adenocarcinoma 5%
Squamous 5%

116
Q

What are the predisposing factors for transitional cell carcinomas?

A

Smoking
Chemicals
Age
Chronic infection/calculi/drugs

117
Q

What is the typical presentation of someone with a transitional cell carcinoma?

A

Haematuria
Hydronephritis
Retention (urethral)

Can be silent

118
Q

What is the typical presentation of someone with a transitional cell carcinoma?

A

Haematuria
Hydronephritis
Retention (urethral)

Can be silent

119
Q

What is the smooth muscle of the bladder?

A

detrusor muscle

120
Q

Describe the micturation reflex

A
  • Bladder fills due to increased urine
  • detected by sensory stretch receptors
  • conducted to sacral plexus via pelvic nerves
  • reflexively back via parasympathetic

The fuller the bladder gets the stronger the reflex and the harder it is to override.

Completely autonomic but can be inhibited or facilitated by areas in the brain

121
Q

What is the management for bladder cancer?

A

cystoscopy
biopsy, TURBT
Surgery

122
Q

Describe the control the brain has over urination

A
  1. Higher centres keep the reflex partially inhibited except when desired
  2. Can prevent micturation via continual tonic contraction of external sphincter until convienient
  3. Cortical centres can initiate the relflex
123
Q

What are the 4 zones to the prostate?

A

Peripheral
Transitonal
Anterior fibromuscular
Central

124
Q

Where do the most common prostate cancers occur?

A

Peripheral zone

125
Q

What are the symptoms of a urinary tract infection?

A 
frequency
dysuria
haematuria
foul smelling and cloudy urine
urgency
urinary incontinence
pyrexia
confusion
126
Q

What are the symptoms of a urinary tract infection?

A 
frequency
dysuria
haematuria
foul smelling and cloudy urine
urgency
urinary incontinence
pyrexia
confusion
127
Q

What are the signs and symptoms of pyelonephritis?

A 
fever
nausea 
vomiting
costovertebral pain
haematuria
anorexia
128
Q

What is the incidence of UTIs?

A

females more common
increases with age
18-30 due to sexual contact
post menopausal

129
Q

Presdisposing factors for UTIs?

A 
Female
sexually active
post menopausal 
catheterisation
pregnancy
developmental abnormalities
renal transplantation
diabetes
130
Q

What would expect to find on a urine dipstick with someone with a UTI?

A

Nitrites
Proteins
Hb
leukocyte esterase

131
Q

What are the 2 types of testicular cancer?

A

Germ cell tumour 95%

non germ cell tumour

132
Q

What antibiotic treatment would you use for a UTI?

A

trimethoprim

2nd line - cefalexine or co-amoxiclav

133
Q

What can cause a UTI?

A 
E. Coli
Coagulase negative staphylococci
Proteus
Klebsiella
Adenovirus
134
Q

What are the 2 routes of UTI acquisition?

A

Ascending (most common)

Haematogenous

135
Q

What are the 3 layers to the

A

Outer adventitial connective tissue layer
Middle smooth muscle (detrusor)
Inner - transitional epithelium

136
Q

What area of the brain is responsible to bladder voiding?

A

pontine micturition centre

137
Q

Describe the prostatic part of the urethra

A

Midline ridge - urethral crest
On either side of the ridge is a depression 0 prostatic sinus

Elevation midway down - colliculus seminalis
This contains - 2 ejaculatory ducts and the prostatic utricle

138
Q

define acute urinary retention

A

painful inability to void, with relief of pain following bladder drainage by catheterisation

139
Q

What are the effects of alpha blockers when used for BPH?

A

Improves symptoms and flow
Onset of symptom relief in 1-2 weeks
Delay symptoms progression

140
Q

What are the effects of 5 alpha reductase inhibitors when used for BPH?

A

Improve symptoms
Delay symptom progression
Reduce prostate volume and maintain the reductions
Reduce longer term risk of surgery

141
Q

Define incontinence

A

The complaint of an involuntary loss of urine

Can seriously influence the physical, psychological and social wellbeing of those effected.

142
Q

What are the different types of incontinence?

A
  1. Stress - weakness of urinary outlet
  2. Urge - failure of the bladder to store urine
  3. Overflow - overfilling bladder
143
Q

What are some of the causes of urinary incontinence in men?

A

overactive bladder
neuropathic bladder
prostatectomy
overflow incontinence

144
Q

What is the prevalence of urinary incontinence?

A

15-44years = 5%
45-64 years = 8-15%
65+ years = 10-20%

Nursing homes = 40%

145
Q

What do people with urinary incontinence worry about?

A 
Coughing or sneezing
Getting worse as they age
Smelling of urine
Embarrassed 
Sex
Limiting clothing
146
Q

What are the risk factors for urinary incontinence?

A 
Pregnancy and childbirth
Age/menopause
Obesity
Constipation
Pelvic organ prolapse
Chronic cough
Smoking
147
Q

What are some of the treatments available for women with stress incontinence?

A 
Behaviour therapy
Pelvic floor exercises 
Vaginal weights
alpha adrenergic agonists
oestrogens
tricyclic antidepressants
vaginal wall suspension
suburethral retropubic slings
suburethral obturator foramen procedures
148
Q

How common are UTIs?

A

5% of women each year present to their GP each year with UTI symptoms

50% of women will in their life time

149
Q

At what points in life are you more likely to get a UTI?

A

honeymoon cystitis - beginning sexual activity
Pregnancy
(small amount at pre-school/infancy)
increasing age

150
Q

What are the 2 points in which males are more likely to present with a UTI than a woman?

A

Infancy - congential urinary tract infections are higher in males

Prostatism

151
Q

What are the most common bacterial causes of nosocomial UTI?

A

E.Coli (40%) - less than community acquired
Gram negatives - Klebsiella, enterobacter, psudomonas
Proteus

Year 2 - Theme A (7 decks)

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