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Phase 2a Green Conditions > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A
  • kidney stones
  • slightly more common in men → testosterone = increased oxalate
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2
Q

What are kidney stones made of?

A
  • calcium oxalate → radio-opaque
  • uric acid → radio-lucent
  • struvite → radio-opaque
  • cystine
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3
Q

Risk factors for nephrolithiasis

A
  • chronic dehydration
  • obesity
  • high protein/salt diet
  • recurrent UTIs
  • hyperparathyroidism → hypercalciuria
  • congenital abnormalities
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4
Q

Presentation of nephrolithiasis

A

renal colic

  • severe unilateral abdominal pain
  • starts in loin, radiates to ipsilateral groin/testicle/labia
  • sudden onset early in morning
  • restlessness
  • N&V
  • haematuria
  • dysuria
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5
Q

Investigations for nephrolithiasis

A
  • dipstick → haematuria, leukocutes, nitrites
  • bloods → FBC, CRP, U&E

GOLD STANDARD = non-contrast CT KUB

  • US in pregnancy
  • radio-opaque only visible on US
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6
Q

Management of nephrolithiasis

A
  • symptomatic relief → hydration, NSAIDs, opioids
  • small pass spontaneously

if too big:

  • ESWL → break stone into smaller fragments using shockwaves
  • uteroscopy
  • PCNL → percutaneous access, use nephroscope to remove stone
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7
Q

When should treatment be provided immediately for nephrolithiasis?

A
  • intolerable pain/vomiting
  • signs of obstruction/infection/AKI
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8
Q

What are the functions of the kidney?

A
  • water/hormone homeostasis
  • waste/toxin removal
  • RBC production
  • activated vitD
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9
Q

Risk factors of CKD and AKI

A
  • emergency surgery → risk of sepsis/hypovolaemia
  • CVD risk
  • diabetes
  • HF
  • age >65
  • liver disease
  • use of nephrotoxic drugs
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10
Q

Which drugs are nephrotoxic?

A
  • NSAIDs
  • aminoglycosides
  • ACEi
  • ARBs
  • loop diuretics
  • metformin
  • digoxin
  • lithium
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11
Q

What is AKI?

A
  • sudden decline in renal function
  • determined by increased serum creatinine +/- decreased urine output
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12
Q

Causes of pre-renal AKI

A
  • hypovolaemia secondary to D&V
  • renal artery stenosis
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13
Q

Causes of intrinsic AKI

A
  • glomerulonephritis
  • acute tubular necrosis ATN
  • acute interstitial nephritis AIN
  • rhabdomyolysis
  • tumour lysis syndrome
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14
Q

Causes of post-renal AKI

A
  • kidney stone in ureter or bladder
  • BPH
  • external compression of ureter
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15
Q

Presentation of pre-renal AKI

A
  • normal Na+
  • raised urea and creatinine
  • responds well to fluid therapy
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16
Q

Presentation of intrinsic AKI

A
  • T1DM
  • HTN
  • low urine osmolality
  • high urine Na+
  • high blood K+
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17
Q

Presentation of post-renal AKI

A
  • acute colicky pain radiating from loin to groin
  • microscopic haematuria
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18
Q

Diagnosis of AKI

A
  • rise in creatinine to 1.5-1.9 times baseline
  • >50% rise in creatinine over 7 days
  • fall in urine output to less than 0.5 for >6hrs in adults (8hr in kids)
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19
Q

Management of AKI

A
  • fluid balance
  • remove nephrotoxic drugs
  • treat hyperkalaemia → risk for arrythmia
  • treat underlying cause
  • RRT if no response to medical treatment
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20
Q

Complications of AKI

A
  • end stage renal failure
  • metabolic acidosis
  • uraemia
  • CKD
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21
Q

What is CKD

A
  • abnormal kidney structure/function
  • present for >3 months with implications for health
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22
Q

Causes of CKD

A
  • diabetes
  • HTN
  • glomerulonephritis
  • PKD
  • VHL
  • persistent pyelonephritis
  • obstruction → stones, BPH, tumours
  • nephrotoxic drugs
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23
Q

Presentation of CKD

A
  • often asymptomatic until ESRF
  • fluid retention → oedema, raised JVP
  • oliguria
  • uraemia → pruritus, uraemic frost, yellow-grey complexion, reduced appetite
  • cardiac arrythymias
  • pallor
  • bone pain
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24
Q

Diagnosis of CKD

A
  • eGFR <60
  • eGFR <90, signs of renal damage
  • albuminuria >30, albumin:creatinine >3
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25
Q

Management of CKD

A
  • treat DM, HTN, glomerulonephritis
  • reduce risk of CVD → atorvastatin
  • manage complications
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26
Q

Managing complications of CKD

A
  • mineral bone disease → low vitD
  • HTN
  • proteinuria
  • anaemia → ESA
  • RRT
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27
Q

When should renal replacement therapy be considered?

A
  • ESRF
  • acidosis not responsive to bicarb
  • persistent electrolyte disturbances
  • persistent oedema
  • severe symptoms of uraemia
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28
Q

What are the types of RRT?

A
  • haemodialysis
  • peritoneal dialysis
  • renal transplant
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29
Q

Physiology of prostate

A
  • produces testosterone and dihydrotestosterone
  • production of PSA → liquefies semen
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30
Q

What is BPH?

A
  • hyperplasia of inner transitional zone of prostate gland
  • partially blocks urethra
  • normal part of ageing for men
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31
Q

Presentation of BPH

A

LUTS

storage

  • frequency
  • urgency
  • nocturia
  • urgency incontinence

voiding

  • poor/intermittent stream
  • post-micturition dribbling
  • straining
  • incomplete emptying
  • hesitancy
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32
Q

Investigations for BPH

A
  • DRE → smooth but enlarged prostate
  • PSA → not very accurate
  • bladder diaries
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33
Q

Management of BPH

A
  • lifestyle → reduce caffeine/alcohol, relax when voiding
  1. alpha blockers eg tamsulosin
  2. 5-alpha reductase inhibitors eg finasteride
  • consider surgery if no response to drugs

GOLD STANDARD = TURP
- required if acute urinary retention, gross haematuria,

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34
Q

Features of prostate cancer

A
  • most common male malignancy
  • most slow growing but can be aggressive/malignant
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35
Q

Risk factors for prostate cancer

A
  • Afro-Caribbean
  • family history/genetics
  • increasing age
  • anabolic steroids
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36
Q

Presentation of prostate cancer

A
  • LUTS
  • weight loss
  • fatigue
  • night sweats
  • bone pain
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37
Q

Whee does prostate cancer metastasise to?

A
  • bone → sclerotic bony lesions
  • brain
  • liver
  • lung
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38
Q

Investigations for prostate cancer

A
  • community → DRE, PSA
  • DIAGNOSTIC = transrectal USS and biopsy
  • gleason grading system
39
Q

Management of prostate cancer

A

local

  • prostatectomy <70
  • active surveillance >70, low risk
  • radiotherapy

metastatic

  • chemo
  • radiotherapy
  • bilateral orchidectomy
  • goserelin
  • palliative care to relieve symptoms
40
Q

What is urethritis?

A
  • uretheral inflammation due to infectious or non-infectious cause
  • non-gonococcal uretheritis more common than gonococcal
41
Q

Causes of urethritis

A
  • N.gonorrhoea
  • chlamydia
  • trauma
  • urethral stricture
  • urinary calculi
42
Q

Presentation of urethritis

A
  • skin lesion
  • dysuria +/- discharge (blood/pus)
  • urethral pain
  • penile discomfort/pruritus
43
Q

Investigations for urethritis

A
  • STI testing
  • M&C urethral discharge
  • bood cultures
  • urine dipstick
  • urethral smear
44
Q

Management of urethritis

A
  • management of underlying cause → Abs, partner notification
45
Q

What condition is important to think about with urethritis?

A

reactive arthritis

  • conjunctivitis
  • urethritis
  • arthritis

can’t see, can’t pee, can’t climb a tree

46
Q

What is cystitis?

A
  • infection of urinary bladder
  • most common in sexually active young women
47
Q

Risk factors of cystitis

A
  • history of UTI
  • diabetes
  • pregnancy
  • catheterisation
48
Q

Microorganisms that cause cystitis

A

KEEPS

  • klebsiella
  • E.coli → most common
  • enterococci
  • proteus species
  • staph aureus
49
Q

Presentation of cystitis

A
  • dysuria
  • frequency
  • urgency
  • suprapubic pain
  • haematuria and polyuria
  • incontinence
  • confusion in elderly
  • cloudy smelly urine
50
Q

Investigations for cystitis

A
  1. urine dipstick → high leukocytes/nitrates, blood

GOLD STANDARD = mid-stream MC&S

51
Q

Management of cystitis

A
  • trimethoprim/nitrofurantoin → 3 days (f), 7 days (m)
  • in pregnancy → amoxicillin, cefalexin
52
Q

What is variocele?

A
  • abnormal dilation of testicular veins in pampiniform venous plexus
  • left side more commonly affected
53
Q

Presentation of variocele

A
  • feels like a bag of worms
  • dragging/soreness/heaviness of scrotum
54
Q

Management of variocele

A
  • conservative
  • surgical repair if pain infertility, testicular atrophy
55
Q

Diagnosis of variocele

A

US and Doppler

56
Q

What is testicular torsion?

A
  • medical emergency
  • twisting of spermatic cord with rotation of testicle
57
Q

Presentation of testicular torsion

A
  • acute severe pain
  • unilateral, swollen, tender
  • retracted upwards
58
Q

Diagnosis of testicular torsion

A

examination

  • firm swollen testicle
  • rotation → epididymis is not in normal posterior position
  • Prehn’s -ve

can do US but not essential → whirlpool sign

59
Q

Management of testicular torsion

A

de-torsion → orchiopexy

60
Q

What is nephrotic syndrome?

A

issue with filtration barrier

61
Q

What is the characterising triad in nephrotic syndrome?

A
  • proteinuria >3
  • hypoalbuminaemia → loss of albumin in urine
  • oedema → loss of oncotic pressure
62
Q

Presentation of nephrotic syndrome

A
  • frothy urine
  • infection
  • xanthelasma
  • xanthomata
  • athersclerosis
  • fatigue
  • dyspnoea
  • leukonychia
63
Q

Pathophysiology of nephrotic syndrome

A
  1. inflammation
  2. damage to podocytes → protein leakage
  3. increased liver activity → increases albumin and then cholesterol, coag factors
  4. reduced oncotic pressure
64
Q

Causes of nephrotic syndrome

A

occurs due to renal disease disrupting kidney function

  • minimal change disease
  • focal segmental glomerulosclerosis
  • membranous nephropathy
65
Q

Secondary causes of nephrotic syndrome

A
  • diabetic nephropathy
  • SLE
  • amyloidosis
  • hepB,C
  • HIV
66
Q

Investigations of nephrotic syndrome

A
  • urinalysis
  • urine protein:creatinine → degree of proteinuria
  • blood tests → renal function, elevated lipids

GOLD STANDARD = needle biopsy and microscopy

  • looks for changes in glomerulus
  • gives cause
67
Q

Management of nephrotic syndrome

A
  • fluid/salt resuscitation
  • treat cause → 12 weeks prednisolone
  • treat complications
  • protein loss → ACEi/ARBs
68
Q

Treatment of complications in nephrotic syndrome

A
  • oedema → loop diuretics
  • hyperlipidaemia → statins
  • VTE → heparin
  • infection → Abs
69
Q

Minimal change disease

A
  • mainly kids
  • unclear cause → immune mediated
  • normal appearance in microscopy but abnormal function
  • diagnosis = biopsy → EM = loss of podocytes
70
Q

Features of UTIs

A
  • presence of microorganisms in the urinary tract
  • name depends on location
  • can occur from untreated urolithiasis
71
Q

What are the 5 most common pathogens causing UTIs

A

KEEPS

  • klebsiella
  • e.coli → most common
  • enterococci
  • proteus
  • staph coagulase -ve
72
Q

Presentation of UTIs

A

voiding symptoms = FUND

  • frequency
  • urgency
  • nocturia
  • dysuria
73
Q

What is pyelonephritis?

A
  • infection of kidneys/upper ureter
  • most commonly acquired by ascending transurethral spread
  • can be via blood or lympatics
  • majority caused by uropathic e.coli
74
Q

Presentation of pyelonephritis

A
  • triad of loin pain, fever, pyuria
  • costovertebral joint pain
  • severe headache
  • N&V
  • septic shock if advanced
75
Q

Investigations of pyelonephritis

A
  1. urine dipstick → WBC, microscopic haematuria
  • bloods → inflammatory markers
  • urgent US → stones, obstruction

GOLD STANDARD = mid-stream MC&S → diagnosis of causative agent

76
Q

Treatment of pyelonephritis

A

Abs
- cefalexin 7-10 days
- trimethoprim/amoxicillin if sensitive

analgesia → PCM

77
Q

What is prostatitis?

A
  • inflammation and swelling of prostate gland
  • most common cause = e.coli
78
Q

Presentation of prostatitis

A
  • very tender prostate → seen on DRE
  • systemic symptoms → fever, chills, malaise
  • voiding symptoms
79
Q

Investigations for prostatitis

A
  • U&C → blood and WBCs, bacteria
  • bloods cultures if patients febrile
80
Q

Management of prostatitis

A

Abs
- ciprofloxacin/levofloxacin 14 days

81
Q

Which Abs should you avoid in pregnancy?

A
  • trimethoprim = teratogenic
  • nitrofurantoin → avoid at full term
82
Q

What is nephritic syndrome?

A

syndrome presenting as inflammation within the kidney

83
Q

Key features of nephritic syndrome

A
  • haematuria → kidney inflammation
  • oliguria → decreased GFR
  • proteinuria
  • HTN → fluid overload
84
Q

Causes of nephritic syndrome

A
  • SLE
  • post strep glomerulonephritis
  • small vessel vasculitis
  • Goodpasture’s
  • IgA nephropathy
85
Q

Investigations for nephritic syndrome

A

DIAGNOSTIC = kidney biopsy → cause

  • urinalysis → haematuria
  • bloods → high ESR, CRP
86
Q

Management of nephritic syndrome

A
  • treat underlying cause
  • ACEi/ARB → reduced proteinuria, preserves renal function
  • corticosteroids → reduce inflammation
87
Q

What is IgA nephropathy?

A
  • AKA Berger disease
  • deposition of IgA into mesangium of kidney → inflammation and damage
88
Q

Presentation of IgA nephropathy

A
  • asymptomatic
  • microscopic haematuria
89
Q

Diagnosis of IgA nephropathy

A
  • biopsy
  • same management as nephritic syndrome
90
Q

What is post strep GN?

A
  • nephritic syndrome following infection 3-6 weeks before
  • deopsition of atrep antigen in glomeruli → inflammation and damage
91
Q

What is post strep GN?

A
  • nephritic syndrome following infection 3-6 weeks before
  • deopsition of atrep antigen in glomeruli → inflammation and damage
92
Q

Presentation of post strep GN

A
  • haematuria
  • acute nephritis

diagnosed by evidence of strep infection

93
Q

Presentation of post strep GN

A
  • haematuria
  • acute nephritis

diagnosed by evidence of strep infection

94
Q

Treatment of post strep GN

A
  • Abs to clear strep
  • supportive care

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