Conditions/Disease Flashcards
ED summary
Def: failure to achieve or maintain a penile erection suitable for sexual intercourse
Risk Factors: Chronic Medical conditions (HTN, DM) Surgical procedures Lifestyle Trauma Drugs
SS:
Eval:
Txt: Non Pharm: Lifestyle changes psychotherapy Vacuum erection device Surgical
Pharm:
Phophodiesterase Type 5 Inhibitors
- Avanafil (Stendra) 100 mg po 30 min prior sex
- Sildenafil (Viagra) 50 mg po 60 min prior sex
- Vardenafil (Levitra) 10 mg po 60 min prior sex
- Tadalafil (Cilalis) 10 mg po 30 min prior sex
Alprostadil
Testosterone
BPH (Benign Prostatic Hyperplasia) summary
Def: nonmalignant enlargement prostate
SS:
Difficulty voiding
Eval: Mild - asymptomatic - urinary flow rate < 10 mL/s - residual urine volume > 25 - 50 mL - BUN and SCr increased Moderate - Mild symptoms and obstructive/irritative voiding symptoms Severe - Moderate symptoms and complications of BPH
Txt: Mild - watchful waiting Moderate - Pharm - alpha1 blockers - alpha1a blockers - 5 alpha-reductase inhibitor - PDE5 inhibitor - Herbals Severe - Surgery
Urinary Incontinence Summary
Def: Involuntary loss of urine
SS:
Urge Incontinence (bladder overactive)
stress incontinence (urethral underactive)
overflow incontinence (urge or stress)
functional incontinence (not bladder or urethral related)
Mixed
Risk Factors: Delerium Infection Atrophic urethritis/vaginitis Pharmaceuticals Psychological Excessive urine output Restricted mobility Stool impaction
Txt:
NonPharm
- bladder training (Urge)- result in higher improvemtn rate than the the use of naticholinergic medications
- bladder control strategies
- pelvic muscle training (stress); Kegel exercises work best in mild cases of stress inconctinence
- fluid management
-surgery (stress)
Pharm: Urge - anticholinergic - TCA - topical estrogen - Beta-3 agonist Stress - Duloxetine - alpha-adrenergic agonist - Topical estrogen - Imipramine Overflow - cholinomimetics
Renal Cell carcinoma
Def: MC kidney cancer
Epidemiology: Northern European descent M>F AA > W Age ~64
Types: von Hippel-Lindau Hereditary Papillary Renal Carcinoma - bilateral familial Renal Oncocytoma - bilateral Birt-Hogg-Dube Syndrome Hereditary Renal Carcinoma
SS: flank pain hematuria flank mass weight loss fever
Eval: Urinalysis CBC with diff Electrolytes Renal Profile Ultrasound - 1st choice CT
Txt;
*radical nephrectomy-remains the only known effective tx
chemo
bladder cancer summary
Def: *transitional cell carcinoma MC with high recurrence rate
Risk:
*Smoking (risk increase continues long after quitting >10y)
Environment
Drugs
SS: painless gross hematuria irritative bladder symptoms flank pain palpable mass
Eval:
Urinalysis
FISH
cystoscopy
Txt: Surgery - TURBT/cystectomy 1 of 3 drugs - doxorubicin - Mitomycin C - BCG
Testicular cancer summary
Def: MC solid malignant tumor in men
*Risk: cryptochidism genetics FHx Infertility Environment
SS: painless swelling or nodule of one testicle
Eval: alpha-fetoprotein beta-hCG Ultrasound CT
Txt:
* radical Inginual orchiectomy and retroperitoneal lymph node dissection
Prostate Cancer summary
Def: MC noncutaneous cancer in men
*Risks:
elevated levels of luteinizing hormone and
testosterone:dihydrotestosterone ratios
Epidemiology:
AA > W
SS:
urinary complaints or retention
back pain
hematuria
Eval:
PSA
biopsy
Txt: watchful waiting *metastatic prostate cancer is rarely cureable radical prostatectomy radiation cryotherapy
Wilm’s Tumor summary
Def: *MC childhood abdominal malignancy
SS:
asymptomatic abdominal mass
Eval: CBC chemistry profile Kidney function tests electrolytes urinalysis coagulation studies Ultrasound CT
Txt:
Nephrectomy and contralateral kidney explored
Urinary Tract Infection Summary
Def: infection/inflammation of lower urinary tract
Epidemiology:
F > M
Risk: poor wiping technique sexually active preg obstruction incontinence
Cause: Serratia E coli (MC) Enterobacter Klebsiella Proteus Pseudomonas
SS: Frequency Urgency Dysuria suprapubic pain Hematuria Odiferous urine
Eval: History Urinanalysis Preg test Xrays - usually not done
Txt:
antibiotics
OTC
Fluids
Pyelonephritis summary
Def: Infection/inflammation of kidneys
Risks: UTI preg PMHx catheters
Cause: E. coli Proteus Klebsiella Pseudomonas Staph
SS: N/V dysuria frequency urgency flank/loin/back pain fever CVA tenderness ab tender dry mouth
Eval: Urinalysis CBC CT - stones, abscessess blood culture
Txt:
antibiotics
pain meds
fluids
urethritis summary
Def: sexually transmitted infection in men
Cause: Gonorrhea Chlamydia (MC) Trichomonas HSV
SS:
dysuria
discharge
Eval:
Urethral swab
first void urine
Txt:
abx
partner txt
Upper Urinary Tract obstruction summary
Def: blockage anywhere in the path from Kidney to where ureter enters bladder
Cause: spasms of ureter Acute/Chronic renal failure UTI pelvic tumors prostate gynecologic/ab surgery
SS: Acute: flank Pain ipsilateral back/groin pain N/V Fever, chills, dysuria Hematuria
Chronic:
asymptomatic
fever, chills, dysuria
Eval: UA RBC Urine pH Metabolic panel Hyperkalemia CBC US CT Cystoscopy
Txt:
Partial:
analgesics
abx
Surgery
- catheter
- stent
- percutaneous nephrostomy tube
Lower Urinary Tract Obstruction summary
Def: blockage anywhere in the path below bladder/urethra
Cause: spasms of ureter Acute/Chronic renal failure UTI pelvic tumors prostate gynecologic/ab surgery
SS: urgency frequency incontinence decreased stream dysuria hematuria uterine/bladder prolapse
Eval: UA RBC Urine pH Metabolic panel Hyperkalemia CBC US CT Cystoscopy
Txt:
Partial:
analgesics
abx
Surgery
- catheter
- stent
- percutaneous nephrostomy tube
Kidney Stones summary
Def: renal calculi (usually *calcium)
Cause:
Genetics
*diet protein/salt high (supersaturation mechanism or deopsition of calcium oxalate)
*low fluid intake (low volume of urine production and high concentrations of stone forming solutes)
SS:
pain flank/groin (majority will have CVA tenderness)
Eval: Urinary sediment Urine culture SCr CBC Serum and urinary pH level *CT (1st) Nonconstrast abdominopelvic CT scan US XRAY
Txt:
Encourage spontaneous passage of stone
Surgery if needed
hydrocele
def: fluid filled sac surrounding a testicle that results in swelling of the scrotumnon-communicating gets stuck in the middle of the processes vaginalis
communicating flows straight through to processes vaginalis and *accumulates in the front of the testes
- S/s: painless, *cremasteric reflex intact
tx: observation, especially in infants; surgical intervention for sx lesions; aspiration not appropriate by itself
varicocele
def: abnormal dilation of a vein within the spermatic cord* Left side is affected nearly 100% of the time
s/s: painlesstx: surgery to relieve sx
epididymitis
def: inflamm of the epididymis; usually caused by infection
men 35: enterobacteriea, pseudomonas aureoginosa
s/s: painful palpation of the epididymis, swelling, *positive Prehn sign (pain is relieved with elevation), *cremasteric reflex intact
Dgx: radionuclide scan is most accurate imaging study for dgx
Tx: 35: TMP/SMX, ciprofloxacin
Orchitis
def: acute inflamm of the the testes and is uncommon
s/s: inflamm, may have systemic infection (mumps is MC), local extension of epididymitis
Tx: elevation, support, hot/cold packs, abx, anti-inflamm
crytochordism
condition of testicular maldescent
s/s: undescended testes
tx: needs to be followed carefully and surgically corrected if not resolved by one year of age
make sure to r/o physiologic crytochordism from a cold room d/t the cremasteric reflex
testicular torsion
rotation of the testes; twisting of the testes and the spermatic cord resulting in acute ischemia, impeded venous and lymphatic drainage
s/s: acute scrotal pain, N/V, anorexia, trauma may contribute; testes “riding high”, swelling, extreme tenderness, *ABSENT cremasteric reflex, *negative prehn sign (elevation does NOT decrease pain)
tx: *surgical emergency!! cell necrosis can occur in a few hours; manual detorsion by untwisting towards the middle
testicular malignancy
peak incidence between 20-40 years old, *MC germ cell tumors (split into 2 categories)-seminoma (40%): MC (best one to have) only seminomatous elements on histopathology-nonseminoma (worse prognosis)
s/s: solid tumors DO NOT transilluminate, dgx: there are dif labs for dif cancers : increase AFP r/o seminoma, increase beta human chorionic gonadotropin more indicative of nonseminoma
tx: ext beam radiation, surgery
prostatitis
inflamm of the prostate; ascending urethral infectionmany diff classifications (see other section)
tx: abx, alpha-blockers
benign prostatic hyperplasia
hyperplasia of the prostatic epithelium defined histologically
s/s: irritative voiding sx of dysuria, nocturia, urgency, frequency and sx of bladder outlet obstruction
dgx: PSA may be elevated, may have an enalarged gland
tx: 5 alpha reductase inhibitors, alpha blockers
urethritis
gonococcal and non-gonococcal (C. trachomatis, mycoplasma); could be d/t caffeine, irritants
s/s: urethral discharge or dysuria and urethral inflamm documented by mucopurulent discharge or leukocytes on gram stain
tx: appropriate eval and abx (azithro or doxy) consider metronidazole, decease caffeine, avoid irritants
