Block 10 key things to learn Flashcards
What are the main buffers in the body and where do they act?
Phosphate- important renal tubule buffer
HP04 + H = H2po4
Ammonia- renal tubular buffer
NH3 + H = NH4
Proteins- intracellular and plasma buffer
H + Hb = HHb
Bicarbonate- most important extracellular and renal tubule buffer
H2O + CO2 = H2CO3 = H + HCO3
What do you look at to work out if acidosis is due to respiratory or metabolic cause?
Arterial blood gases- see pH first- if under 7.35 = acidosis, if over 7.45 = alkalosis
Then look at levels of CO2 and HCO3- either one is high and other normal, or both high or both low- never 1 high and 1 low.
e.g. if ph is acidic and CO2 and HCO3 are both high then it must be a resp acidosis and HCO3 is high to try to compensate
What is the treatment for BPH?
Alpha blockers- help symptoms and act quickly
5 Alpha reductase inhibitors- help stop further prostate growth but take a while to act
What is the leading cause of end stage renal disease in the west?
Diabetic Nephropathy
Which level do the kidneys lie at?
T12- L3
Where do the renal arteries arise from?
From aorta at L1-2
Where does horseshoe kidney get stuck under?
Inferior mesenteric artery
What role does prostaglandins have in the kidneys?
dilates the afferent arteriole to increase blood flow to the tubule, but taking NSAIDs can cause renal damage by reducing prostaglandins and causing afferent arteriole constriction.
What do ACE inhibitors do to the kidney?
Efferent arteriole dilation- so can cause kidney damage
How do you diagnose an AKI?
rise in serum creatinine over 26umol in 48 hours
creatinine rise 1.5 x baseline in 7 days
Oliguria of less than 0.5ml / kg/ hr for 6 days
Where does BPH usually occur?
Transitional zone
What substances increase GFR by dilating afferent arteriole?
Prostaglandins Kinins Low dose dopamine ANP NO
Where are calcium and magnesium mostly reabsorbed?
calcium mostly reabsorbed in proximal convoluted tubule
Magnesium mostly reabsorbed in thick ascending limb of loop of hence
What is stress incontinence and how is it treated?
Weeing when cough etc. Lifestyle changes- reduce caffeine Pelvic floor exercises Alpha agonists Duloxetine Oestrogen Tricyclic antidepressants Vaginal wall suspension procedures Suburethral slings Urethral sphincter augmentations
What is urge incontinence and how is it treated?
Overactive bladder Treat underlying cause Behavorial therapy Botox Acticholinergics- oxybutynin Meribagron Sacral nerve stimulation Detrusor myomectomy Interstim therapy- sacral nerve stimulation Tibial nerve stimulation- stimulate S2-4 nerves to stop extra bladder contractions
