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Y3 - Cs - renal > condition part 2 > Flashcards

condition part 2 Flashcards

1
Q

definition of urinary tract calculi

A

renal stones consisting of crystal aggregates form in collecting ducts and maybe deposited anywhere from the renal pelvis to the urethra although classically at pelvoureteric junction, pelvic brim, vesicoureteric junction

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2
Q

what are the different types of urinary tract calculi

A 
calcium oxalate - 75%
magnesium ammonium phosphate/struvite -15% 
urate -5%
hydroxyapatite -5%
brushite/cystine - 1%
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3
Q

how common is urinary tract calculi

A

common, lifetime incidence up to 15%

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4
Q

who is affected the most by urinary tract calculi

A

peak age - 20-40 yrs

males 3 times more than female

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5
Q

causes of urinary tract calculi

A

supersaturation of urine

  • necessary but not sufficient condition for development of any urinary calculus
  • factors influence this - Ph (better dissolve in alkaline rather than acidic soultions), fluid volume (dec volume - greater conc)
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6
Q

what can inhibit renal stone

A

citrate and magnesium (together can work synergistically to inhibit the renal stones

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7
Q

RF for renal stones

A

life style - dehydration, salt, oxalate in tea bitter leaf vegetables, nuts, berries, chocolate, calcium supplements, animal protein

biological
recurrent UTIs
metabolic abnor - hypercalciuria, hypercalcaemia, hyperparathyroidism, hyperuricosuria, hyperoxaluria, cystinuria, renal tubular acidosis
urinary tract abnor - PVJ obstruction, hydronephrosis, vesicoureteric reflux, ureteral stricture
foreign bodies -stents, catheters
Crohn’s disease - associated with hyperoxaluria and dec absorption of magnesium

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8
Q

symptoms of UT stones

A

can be asymptomatic

renal colic - excruciating ureteric spasm loin to goin, radiate to genitals, inner, thighs, constant pain

haematuria
anuria
N+v

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9
Q

sign of TU calculi

A

loin tendernes
suprapubic pain
prostatic enlargement

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10
Q

differential for UT calculi

A 
Biliary colic/acute cholecystitis/gallstones 
aortic dissection 
pyelonephritis 
acute pancreatitis 
acute appendicitis 
peritonitis 
perforated peptic ulcer 
MSK back pain 
ectopic pregnancy 
epididymitis/testicular torsion
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11
Q

investigation for UT calculi

A

urine dipstick
bloods - FBC, U+Es, CRP, calcium, phosphate, urate, renal function
MSU MS+C
imaging - CT KUB, X-ray KUB, IV pyelogram, USS
24 hrs for calcium, oxalates, urate, citrate, sodium, creatinine
stone biochemistry

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12
Q

treatment for UT Calculi

A

analgesia, ABx if infection

medical expulsion therapy

  • alpha blocker
  • calcium channel blocker - nifedipine

extracorporeal shockwave lithotripsy (ESWL) - USS waves to shatter stone

surgical

  • percutaneous nephrolithotomy - laparo surgery
  • ureteroscopy - insertion of stent or ureteroscopic lithotripsy
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13
Q

definition for UTI

A

the presence of a pure growth of >10(5) organisms/mL of fresh MSU. Bacteria might be present in MSU but pt might be asymptomatic. It can affect other organs such as bladder (cystitis), urethra (urethritis), prostate (prostatitis), lower UTI or renal pelvis (pyelonephritis) - upper UTI

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14
Q

how common is UTI

A

50,000/1mn/year, 1-2% presentation to GP, recurretn infection can cause considerable morbidity and renal failure

up to a 1/3 of women with symptoms have -ve MSU (abectrial cystitis or urethral syndrome)

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15
Q

Who is affected the most by UTI

A

newborn male - due to higher GU abnor
Teenage women - due to beginning of sexual activity
men when older - mostly due to prostate problems
women post-menopause - low oestrogen makes it easier for bacteria to adhere
women more so than men - due to shorter and straight urethra if men or children have UTI then investigate further for abnor –> complicated cystitis

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16
Q

causes of UTI

A

bacteria from person’s own bowel flora (gut) transfer via ascending transurethral route but maybe via blood stream, lymphatic or direct extension eg vesicocolic fistula

relapse - when bacteruria within 7 days of the same organisms

reinfection - when bacteriuria is absent after treatment for at least 14 days followed by recurrence of infection with the same or different organisms

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17
Q

RF of UTI

A

female
sexual intercourse
exposure of spermicide in females (by diaphragms or condoms)
pregnancy - not usually picked up unless severe pyelonephritis develop
menopause
immunosuppression
urinary tract obstruction/stones/malformation
long term catheter

18
Q

symptoms of UTI

A

Symptomatic infection related to bacteria virulence but inflammation and injury determined by host response not bacteria.

cystitis - frequency, urgency, nocturia, dysuria, haematuria, suprapubic pain

acute pyelonephritis - fever, rigors, vomiting, loin pain and tenderness, oliguria

prostatitis - flu-like symptoms, low backache, swollen/tender prostate on PR, few urinary symptoms

in older pts, UTI can cause confusion too

19
Q

sign of UTI on exam

A 
pyerxial, 
abdo pain/loin tenderness
foul-smelling urine 
distended bladder
enlarged prostate
20
Q

differential diagnosis for UTI

A

urethral syndrome - similar presentation to UTI but not related to infection

interstitial cystitis/bladder pain syndrome - chronic inflammatory condition of bladder

chronic nonbacterial prostatitis/chronic pelvic pain syndrome - non-infective and similar presentation for UTI

vaginitis/vulvovaginal infections - itching, irritation, discharge, pain on intercourse

STI

21
Q

investigation for UTI

A

urine dipstick - MSU, urine inspection (cloudy, red), if infection present - inc leucocytes inc nitrites, haematuria (might be microscopic)

urine MS+C - white bottle, red bottle - contains bolic acid which stops contaminate overgrowth that could affect results. only do if pt symptomatic, dipstick +ve, male, child, pregnant, immunosuppressed

bloods - FBC, U+E, CRP, culture - if systemically unwell

imaging - USS - pyelonephritis, kidney stones etc
CT KUB, cystoscopy, MRI

22
Q

management of UTI

A
  • prevent - drink plenty of water, cranberry/lingo juice, antibiotic prophylaxis
  • treatment (only treat >10(5) organism/mL or <10(5) and pyuric and symptomatic)
23
Q

what are the causes of sterile UTI

A 
previous treated UTI (<2 weeks prior) 
inaduqately treated UTI 
appendicitis 
calculi 
prostatitis 
bladder tumour 
UTI with fastidious organism (organisms only grow in special environment eg Neisseria gonnorhoeae)
tubulointersitital nephritis 
papillary necrosis 
polycystic kidney 
chemical cystitis
24
Q

treatment for UTI

A

empirical

  • trimethorim or nitrofuranotoin
  • cefalexin for pregnant women

if pyelonephritis

  • ciprofloxacin for 7 days or co-amoxiclav for 14 days
  • cefalexin for 10-14 days if pregnant
25
Q

how common is renal cell carcinoma

A

1-2% of all tumours, most common renal tumour in adults

26
Q

who is affected the most by renal cell carcinoma

A

M:F 2:1, rarely present <40yrs, average age of presentation is 55

27
Q

core symptoms of RCC

A

Often asymptomatic; though possible haematuria, loin pain and mass in the flank
Malaise, anorexia and weight loss (30%)

28
Q

signs on exam for RCC

A

common - polycythaemia (5% - genetic condition when bone marrow produce too much RBC) but in this cause due to secreation fo renin by the tumour, anaemia due to depression of EPO production, maybe pyrexial

rare - lef-sided varicocele due to invasion of renal vein and obstruction of left testicular vein into renal vein

29
Q

causes f RCC

A

arise from proximal tubular epithelium

30
Q

RF for RCC

A

Von Hippel-Linau disease - AD disorder, bilateral RCC, haemangioblastomas, phaeochromocytomas, renal cysts common

31
Q

investigation for RCC

A

USS, MRI

32
Q

mangement for RCC

A

nephrectomy (partial of whole)- unless bilateral RCC or contralateral kidney function poor. Should still go ahead even if mets are present asa they might dec after.

medroxyprogesterone acetate - help with mets
IL-2 therapy
temsirolimus - new, inhibits rapamycin kinase improve overall survival rates in those with mets RCC

33
Q

definition of bladder/urothelial tumours

A

cancer of the bladder, ureters and/or urethra

90% are transitional cell carcinomas (TCC) also known as urothelial cell carcinoma (UCC)

34
Q

how common is bladder cancer

A

1/6000 people per year in the UK
3% of deaths from all cancers
Bladder tumours are 50x more common than those of ureter or renal pelvis

35
Q

who is affected the most by bladder cancer

A

m:f 5:2

ncommon in <50s

36
Q

RFF for bladder cancer

A

smoking (biggest risk factor), exposure to industrial carcinogens, exposure to some drugs (phenacetin, cyclophosphamide - lupus etc), chronic inflammation

37
Q

symptoms of bladder cancer

A 
painless haematuria
recurrent UTI
dysuria
urgency
frequency
metastatic symptoms
38
Q

differentials for bladder cancer

A

UTI, renal/urinary stones, BPH, prostatitis

39
Q

investigation for bladder cancer

A

cystoscopy, urine cytology/microscopy, CT urogram, MRI/lymphangiography

40
Q

treatment for bladder cancer

A

TURBT
radical cystectomy
palliative chemo/radiotherapy

Y3 - Cs - renal (2 decks)

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