Genitourinary Flashcards
1
Q
KIDNEY CANCER
What Type accounts for 90% of cases?
A
Renal cell carcinoma
2
Q
KIDNEY CANCER
Where does renal cell carcinoma arise from?
A
Proximal renal tubular epithelium
3
Q
KIDNEY CANCER
Aetiology?
A
Loss in 3p chromosome tumour suppressor gene which causes increased expression of epidermal growth factors
4
Q
KIDNEY CANCER
Risk factors
A
Smoking
Drinking
Long term dialysis
5
Q
KIDNEY CANCER
Symptoms?
A
1) Haematuria
2) Loin pain
3) Abdo pain
4) weight loss
5) anorexia
6
Q
KIDNEY CANCER
Diagnostic tests?
A
- incidental ultrasound- 25% will have mets
-10% have classic symptoms
7
Q
KIDNEY CANCER
How can it spread?
A
It can spread directly through the renal vein or haematogenously via the blood
Direct- Varicocele
Blood- bone, liver, lung
8
Q
KIDNEY CANCER
Investigations?
A
- ultrasound
- CT of chest and abdomen to find mets
- IV contrast CT to check individual renal function
- high blood pressure
- FBC- polycythaemia due to EPO secretion
9
Q
KIDNEY CANCER
Treatment?
A
- radical or partial nephrectomy
- Angiogenesis- targeting agents for unresectable tumours/ mets
(Tyrosine kinase inhibitors- Sunitinib and sorafenib if mets)
chemo or radio resistant
10
Q
KIDNEY CANCER
Prognosis score?
A
- stage
- size
- grade
- necrosis
11
Q
BLADDER CANCER
What type accounts for 90% of cases?
A
Transitional cell carcinoma
There is also squamous cell carcinoma
12
Q
BLADDER CANCER
What is the cause?
A
Schistosomiasis (snail fever- parasitic flatworms called schistosomes)
13
Q
BLADDER CANCER
Risk factors?
A
- smoking
- alcohol
- schistosomiasis
- aromatic amines from the rubber industry
14
Q
BLADDER CANCER
How is it graded?
A
Grade 1 = differentiated
Grade 2 = intermediate
Grade 3 = poorly differentiated
15
Q
BLADDER CANCER
Common spreads?
A
Blood- lung, livers
Lymph- iliac & para-aortic nodes
16
Q
BLADDER CANCER
Symptoms?
A
Painless and haematuria
Recurrent UTIs
Irritable voiding
17
Q
BLADDER CANCER
Diagnostic Tests?
A
Urine analysis- ‘MC&S and cytology
Cystoscopy with biopsy
CT urogram for staging
18
Q
BLADDER CANCER
Risk groups\?
A
1) >45 with unexplained visible haematuria
2) >60 with unexplained non visible haematuria
3) Visible haematuria that persists after a UTI
19
Q
BLADDER CANCER
Staging?
A
Tis- carcinoma in situ
Ta- just epithelium
T1- lamina propria
T2- superficial muscle involved
T3- deep muscle involved
T4- invasion beyond bladder
20
Q
BLADDER CANCER
Treatment of Tis/ Ta/ T1 tumours?
A
1) Transurethral resection of bladder tumour (TURBT)
2) Diathermy
3) Chemo for multiple small tumours
21
Q
BLADDER CANCER
Treatment for T2/ T3 tumours?
A
1) Radical cystectomy or radiotherapy as this preserves the bladder
22
Q
BLADDER CANCER
treatment for T4 tumour?
A
palliative chemo/ radio + chronic catheter
23
Q
ACUTE KIDNEY INJURY
Diagnostic criteria/ what is it?
A
1) Rise in creatinine >26 umol/ L in 48 hrs
2) rise in creatinine >1.5x baseline
3) Urine outpyut <0.5ml/kg/hr for 6 hours
24
Q
ACUTE KIDNEY INJURY
If there is reduced excretion, what rises?
A
urea
25
ACUTE KIDNEY INJURY
Risk Factors?
- Age >75
- CKD
- HF
- Peripheral Vascular Disease
- Sepsis
- Dehydration
26
ACUTE KIDNEY INJURY
Tests?
- Urgent ABG (K+)
- Urine dipstick
- Bloods- U&E, creatinine, CRP
- ECG
- CXR
27
ACUTE KIDNEY INJURY
Aetiology of Pre-Renal? (70%)
- Hypotension of any cause
- SEPSIS/ hypovolaemia
- ACE inhibitors
28
ACUTE KIDNEY INJURY
Aetiology of Intrinsic Renal? (20%)
- Acute tubular necrosis
- result of pre-renal damage such as nephrotoxins
29
ACUTE KIDNEY INJURY
Aetiology of Glomerular?
Primary golmeruolnephritis
30
ACUTE KIDNEY INJURY
Aetiology of Post-Renal?
- Obstruction (stones, clots, tumours, BPH)
31
ACUTE KIDNEY INJURY
What happens if it is left untreated?
Acute tubular necrosis
32
ACUTE KIDNEY INJURY
How is pre-renal damage suggested and investigated?
Suggested by hypotension/ history
Ix- fluid assessments and treated with IV fluids/ resus
33
ACUTE KIDNEY INJURY
How is Intrinsic Renal suggested, investigated and treated?
suggested by: Causative drugs/ haematuria. proteinuria on dipstick
Ix- dipstick / renal screen / biopsies
Treat= Early referral
34
ACUTE KIDNEY INJURY
Investigation and treatment of Post-Renal?
Ix= USS and CT of ureter kidney and bladder (CTKUB)
catheterise and refer to urology to treat obstruction
35
ACUTE KIDNEY INJURY
Complications?
1) Hyperkalaemia
2) Acute pulmonary oedema
3) ECG- tall T waves, wide QRS, absent P waves
36
ACUTE KIDNEY INJURY
How is acute pulmonary oedema treated?
high flow O2 + furosemide + Diamorphine + GTN
37
ACUTE KIDNEY INJURY
How is hyperkalaemia treated?
Calcium gluconate / insulin/glucose and salbutamol
38
ACUTE KIDNEY INJURY
What is the treatment if the injury is very severe?
haemodialysis / haemofiltration
39
CHRONIC KIDNEY DISEASE
Definition?
Impaired renal function for >3 months, based on abnormal structure or function of the kidney,
OR GFR <60ml/min/1.73m2 with or without kidney damage
40
CHRONIC KIDNEY DISEASE
What is evidence of other renal damage?
1) haematuria
2) proteinuria
3) evidence of systemic disease
41
CHRONIC KIDNEY DISEASE
Cause?
1) DM
2) HTN
3) Glomerulonephritis
4) Pyelonephritis
5) 20% unknown
42
CHRONIC KIDNEY DISEASE
Which groups are screened for CKD? (checking eGFR)
1) HTN
2) DM
3) Systemic diseases that affect kidney
4) CVS disease
5) Structural renal damage
43
CHRONIC KIDNEY DISEASE
Signs and Symptoms?
Anaemia = reduced EPO
CNS = fits and coma
PNS = polyneuropathy
CVS = HF, HTN , PVD, Pericarditis
Renal = polyuria, nocturia, oedema
44
CHRONIC KIDNEY DISEASE
Possible affects on bone?
1)renal phosphate retention
2) Impaired vit-D production
3) Bone pain/ osteodystrophy/ osteomalacia
45
CHRONIC KIDNEY DISEASE
Tests?
Bloods- Hb, FBC, Glucose (DM), U+E, Calcium, PTH
Urine- dipstick, albumin : creatine ratio, MC&S
46
CHRONIC KIDNEY DISEASE
What are the 5 different stages?
GFR SCORES (ml/min/1.73m2)
1- >90
then go down in 15s e.g 2=60+ 3a=45+ 3b= 30+
5- <15 = established renal failure (over 3 months)
47
CHRONIC KIDNEY DISEASE
treatment?
(lifestyle control)
(oedema)
(acidosis)
(anaemia)
(CVS)
(osteodystrophy)
1) Smoking and glycaemic control, BP with ACE-I, CCB, ARB
6) Osteodystrophy and PTH levels - give vit D and calcium
5) CVS- statins and aspirin
4) Anaemia - Iron
2) Oedema - diuretics
3) Acidosis - bicarbonate
48
KIDNEY STONES/ RENAL COLIC/ CALCULI
Epidemiology?
M:F 3:1, 15% so common, onset around 40-60 years
49
KIDNEY STONES/ RENAL COLIC/ CALCULI
Where are they classically deposited?
1) Pelviuretic junction
2) Pelvic brim
3) Vesicouretic junction
50
KIDNEY STONES/ RENAL COLIC/ CALCULI
Types?
1) Calcium oxalate (75%)
2) Magnesium ammonium sulphate (15%)
3) Urate (5%)
4) Hydroxyapatite (5%)
5) Cysteine (1%)
51
KIDNEY STONES/ RENAL COLIC/ CALCULI
Aetiology of calcium oxalate stones?
-Hypercalcaemia
- Hyperoxaluria (too much oxalate e.g. from rhubarb/spinach)
- Excessive dietary calcium
- excessive bone resorption
52
KIDNEY STONES/ RENAL COLIC/ CALCULI
Aetiology of Urate stones?
- Hyperuricaemia (gout)
- acidic urine
53
KIDNEY STONES/ RENAL COLIC/ CALCULI
Aetiology of Cysteine stones?
Cysteinuria (genetic)
54
KIDNEY STONES/ RENAL COLIC/ CALCULI
Possible causative organism?
1) Klebsiella
2) proteus
3) psuedomonas
55
KIDNEY STONES/ RENAL COLIC/ CALCULI
How is acidic urine produced?
1) Urease breakdown produces NH3, this increase pH of urine and increases stone risk
2) loss of bicarbonates = acidic & decreased uric acid solubility
56
KIDNEY STONES/ RENAL COLIC/ CALCULI
signs and symptoms/
- Asymptomatic
- Awful 'loin to groin' pain
57
KIDNEY STONES/ RENAL COLIC/ CALCULI
What are the symptoms? (3)
- Haematuria
- Vomit/ nausea
- Sweating
58
KIDNEY STONES/ RENAL COLIC/ CALCULI
tests?
Urine- dipstick + mid-stream specimen for MC&S
Imaging - Non-contrast CT of KUB or KUB X-Ray
59
KIDNEY STONES/ RENAL COLIC/ CALCULI
treatment?
Pain = diclofenac
infection= Abx
If 1-2cm = Extra-corporeal shockwave lithotripsy (ESWL)
- Surgery (uretoscopy) / keyhole (percutaneous stone surgery)
60
Prevention methods for recurrent kidney stones?
1) lots of water
2) Normal dietary calcium
3) Urate = allopurinol/ HCO3-
4) oxalate= pyridoxine
5) Thiazide diuretics reduce calcium excretion
61
URINARY TRACT OBSTRUCTION
Aetiology?
Lumen - stone, cancer, blood clot
Wall - congenital, nephropathic bladder, stricture
Outside of the Wall, prostate disease, tumour, surgery
62
What is Hydronephrosis?
Dilation of renal pelvis
63
URINARY TRACT OBSTRUCTION
upper tract Symptoms?
- loin to groin pain
- worse with fluid
- enlarged kidney
64
What is anuria?
no urine- complete bilateral obstruction
65
What is polyuria?
Partial block and loss of concentration mechanisms = excess urination
66
URINARY TRACT OBSTRUCTION
lower tract symptoms?
- terminal dribbling
- poor flow
- incomplete emptying feeling
- enlarged bladder/prostate
- suprapubic pain
67
URINARY TRACT OBSTRUCTION
tests?
Bloods
urine
ultrasound then CT second line if hydronephrosis
68
URINARY TRACT OBSTRUCTION
treatment?
Upper= nephrostomy (opening between kidney and skin) or uretic stent
Lower= Catheter
69
HAEMATURIA
What are the types?
visible and non visible
70
HAEMATURIA
If the red blood cells shape is normal where is the problem likely to be?
lower tract
71
HAEMATURIA
If the red blood cell shape is abnormal where is the problem likely to be?
upper tract
72
HAEMATURIA
investigation?
dipstick and MSU (mid stream urine)
73
HAEMATURIA
False positive causes?
blood= menstruation/ exercise
redness= rifampicin/ beetroot
74
HAEMATURIA
Causes? pre, renal and post renal
Pre- renal = drugs (NSAIDs/ anti- coagulants)
Renal= Renal stones/ cysts/ disease/ infection
Post renal= kidney/ bladder cancer/ ureteric stones/ strictures `
75
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)
Which two mutations are associated? AND
What is the prevalence
PKD1 (85%) - on chromosome 16
PKD" (15%)- on chromosome 4
1 in 1000
76
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)
Signs?
- loin pain
- polyuria/haematuria
- liver cysts (80%)
- renal enlargement/ cysts
77
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)
treatment?
treat HTN with the target ,130/80
Dialysis for end stage renal failure (ESRF)
increase H20 and reduce salt
78
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)
How do you decrease cyst proliferation?
Tolvaptan = decrease cAMP which decreases cyst proliferation
79
AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)
What mutation is associated and what is the prevalence?
PKHD1 on chromosome 6
1 in 40,000
80
AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)
What is it?
Multiple renal cysts and congenital hepatic fibrosis
81
AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)
treatment?
genetic counselling
82
BENIGN PROSTATIC HYPERPLASIA
What is it?
- Hyperplasia of central glandular and connective tissue
- Inner zone enlarges in contrast to peripheral expansion in prostate carcinoma
83
Give some LUTS?
1) Storage = urgency, frequency, nocturia
2) Voiding = Dribbling, hesitancy, intermittent/ poor flow
3) Post micturition dribbling
84
BENIGN PROSTATIC HYPERPLASIA
Signs?
- nocturia
- frequency increases
- dribbling
- hesitancy
- large smooth prostate
85
BENIGN PROSTATIC HYPERPLASIA
Lifestyle changes?
1) Avoid caffeine/ alcohol
2) Relax when voiding
3) Void twice in a row
4) Bladder training - learning to hold on
86
BENIGN PROSTATIC HYPERPLASIA
Treatment?
1st- alpha blockers - Tamsulosin
2nd - 5-alpha reductase - Finasteride
3rd - Surgery
87
BENIGN PROSTATIC HYPERPLASIA
Side effects of Tamsulosin?
- drowsy
- depression
- dizzy
- low BP
- dry mouth
- ejaculatory problems
88
BENIGN PROSTATIC HYPERPLASIA
How does Finasteride work?
IT DECREASES TESTOSTERONE CONVERSION TO DIHYDROTESTOSTERONE
89
BENIGN PROSTATIC HYPERPLASIA
What are two different types of surgery that can be done?
transurethral resection of prostate (TURP)
transurethral incision of prostate (TUIP)
90
BENIGN PROSTATIC HYPERPLASIA
Side effects of TURP and TUIP?
impotence (no erection) and increased libido
91
PROSTATE CANCER
What is it?
Adenocarcinoma in peripheral prostate
92
PROSTATE CANCER
What's the difference between BPH and cancer?
1) hard craggy prostate with cancer (peach stone rather than peach skin)
2) Metastases (weight loss and possible bone pain)
93
PROSTATE CANCER
If the PSA is normal, what investigation must be done?
transrectal US and prostate biopsy
94
PROSTATE CANCER
How is it staged?
with CT and TNM system.
95
PROSTATE CANCER
How is it graded?
Gleason Score, Pathologist gets 2 samples and grades 1-5, tumour then graded out of 10.
96
PROSTATE CANCER
Treatment?
gold standard= Radical Prostectomy if <70 years
2) radical radiotherapy
3) GnRH/LHRH agonists
97
PROSTATE CANCER
Treatment of metastatic disease?
GnRH agonists
98
What can raise PSA? (prostate-specific antigen)
1) BPH
2) Prostate cancer
3) Perineal trauma
4) Biopsy
5) Surgery
>4ng/ml is abnormal
99
NEPHROTIC SYNDROME
Aetiology?
Primary - focal segmental glomerulosclerosis,
minimal change disease, membranous nephropathy
Secondary - Hep B/C, SLE, Diabetic nephropathy, amyloidosis
100
NEPHROTIC SYNDROME
Three classic symptoms?
1) Proteinuria
2) Hypalbuminaemia
3) Oedema
101
NEPHROTIC SYNDROME
pathology?
Injury to podocytes= proteinuria
102
NEPHROTIC SYNDROME
Features?
- pitting oedema
- protein on urine dipstick
- low serum albumin
103
NEPHROTIC SYNDROME
treatment?
1) Reduce oedema - loop diuretics - furosemide
2) Reduce proteinuria - ACE-I / ARB
3) Reduce risk of complications with statins / vaccines
104
Treatment of Minimal Change disease / Membranous Nephropathy?
- steroids (cyclophosphamide)
- treat underlying cause (ACE-I/ARB)
105
What is Haemodialysis?`
Toxins are removed by blood passing over a semi-permeable membrane against dialysis fluid flowing in the opposite direction, and blood is always meeting a less concentrated solution
106
What is Ultrafiltration?
a negative transmembrane pressure created and is used to clear excess fluid
107
What is Peritoneal Dialysis?
when the peritoneum is used as a S-P membrane and a catheter is inserted into the cavity and water is removed by varying osmolarity of dialysate
108
Why is renal transplant the best treatment?
cost effective and high life expectancy
109
What medicine is given alongside renal transplant?
Immunosuppression = Basiliximab
Maintenance = azathioprine / prednisolone
110
GLOMERULONEPHRITIS
What is it and what are the features of leaky glomeruli?
inflammation of glomeruli and nephrons
haematuria + proteinuria, high BP, deteriorating kidney function and 25% cause of all ESRF
111
NEPHRITIC SYNDROME
What is it and what are the features?
Rapidly deteriorating kidney function
- Oedema
- HTN
- Proteinuria
- Haematuria
- oliguria
112
NEPHRITIC SYNDROME
causes?
ANCA positive vasculitis
SLE
post strep infection
113
NEPHRITIC SYNDROME
tests?
- Dipstick - red cell casts seen on urine microscopy
- MC&S
- Renal Biopsy
- Bloods - Autoantibodies, FBC, U+E, CRP, ESR
114
NEPHRITIC SYNDROME
Treatment?
BP control 130/80 and ACE-I / ARB
115
What is the most common glomerulonephritis?
IgA nephropathy - associated with tonsillitis
116
INCONTINENCE
What does a bladder diary show?
1) no of incontinent episodes
2) Volume of urine
3) no of times passed
4) functional bladder capacity
5) night/ 24 hr volume
117
INCONTINENCE
Storage pathology?
1) high storage centres - pontine storage centre - PAG
2) Pudendal (somatic) and hypogastric (sympathetic, B3)
3) Nerves prevent detrusor contraction
118
INCONTINENCE
Voiding pathology?
1) High centres - pontine micturition centre - PAG
2) Pelvic splanchnic nerve @ M3 receptors
3) Contract detrusor
119
INCONTINENCE
What may cause urge incontinence in a man?
- enlarged prostate
120
INCONTINENCE
Precipitants?
- cold, water, coffee, obesity
121
INCONTINENCE
Causes?
- detrusor overactivity, stroke, DM, UTI
122
INCONTINENCE
Diagnosis?
urodynamic studies show random increases in pressure
123
INCONTINENCE
What is Stress Incontinence
leakage from incompetent sphincter (when intra-abdo pressure increases such as a sneeze)
124
INCONTINENCE
What is Stress incontinence common in?
Pregnancy and the elderly (pelvic floor weakness)
125
INCONTINENCE
treatment of stress?
1) Pelvic floor exercises
2) Surgery
126
INCONTINENCE
treatment of urge?
1) Avoid caffeine and alcohol
2) bladder training and weight loss
3) Pads and condoms catheter
4) M3 antagonists / B3 agonists
127
TESTICULAR CANCER
Types?
- Germ cell tumours
- teratomas
- seminomas
128
TESTICULAR CANCER
Staging?
1- no evidence of mets
2- intradiaphragmatic involved
3- supradiaphragmatic involved
4- lung involvement
129
TESTICULAR CANCER
Clinical features?
- painless lump
- cough
- dyspnoea (LUNG METS)
- back pain (para-aortic mets)
130
TESTICULAR CANCER
Investigations?
1) US to see tumour
2) alpha FP and beta hCG
3) EXCISION BIOPSY
131
TESTICULAR CANCER
treat?
local - radical orchidectomy
seminoma with mets - radiotherapy (below diaphragm) Chemo (above diaphragm)
Teratoma = chemo
132
UTI's
What is bacteriuria?
>10 cubed per ml
133
UTI's
name 3 lower UTI's
- prostatitis
- cystitis
- urethritis
134
UTI's
name an upper UTI
pyelonephritis (renal pelvis)
135
UTI's
Causative organisms?
1) E.coli
2) Coagulase positive staph
3) Proteus mirabilia
4) Klebsiella pneumonia
2,3,4 can cause renal stones due to urease production
136
UTI's
Lower symptoms?
- Dysuria
- Frequency
- Haematuria
- Smelly urine
- Suprapubic pain
137
UTI's
Upper symptoms?
- fever
- vomit
- loin pain
- oliguria
138
UTI's
What is a reinfection?
>2 weeks after eradication
139
UTI's
What is recurrence?
><7 days and implies kidney problem
140
UTI's
Investigation
- Dipstick - if leucocyte and nitrate positive - treat empirically
- send off for MSU for MC&S
141
UTI's
Treat?
1) Drink lots of water
2) Lower = trimethoprim
3) Upper = IV co-amoxiclav
142
STI's
Primary, secondary and tertiary prevention ideas?
P - Posters, school teaching, pre/post exposure prophylaxis of HIV
S- Partner tracing, screening <25 for chlamydia
T- HAART, prophylactic Abx
143
STI's
Partner notification benefits?
- Prevents re-infection
- Breaks chain of infection
- Prevents complications
144
STI's
Causative organisms?
- Chlamydia trochomatis
- Neisseria gonorrheoae
- Treponema Pallidum = syphilis
145
STI's
symptoms of C+G?
- dysuria and discharge
- women = menstruation irregularity
146
STI's
Diagnosis of C+G?
men = first void urine
women = vaginal swab
the nucleic acid amplification test
147
STI's
Treat?
C = PO doxycycline & partner notification
G = IM ceftriaxone and PO azithromycin
148
STI's
What is Syphilis until proven otherwise?
genital ulcer
149
STI's
Treat?
IM penicillin
150
STI's
Symptoms of secondary syphilis?
- MAcular rash
- Mucous membrane lesions
- Bone pain
- Alopecia
151
STI's
Cycle of Syphilis?
- first 2 years is 'early syphilis'
then latent
then 'late syphilis' follows
152
what are Epidydimal Cysts?
collection of fluid in epididymis that can be diagnosed by feeling a cyst in the scrotum separate to testes
153
What is Hydrocele?
Cystic fluid in the tunica vaginalis
154
Primary and secondary cause of Hydrocele?
P - Potent processus vaginalis
S- infection, tumour or trauma
155
What is Varicocele
Dilated pampniform plexus that feels like a bag of worms. Solid and separate from testes that is a dull ache and resolved by surgery
156
TESTICULAR TORSION
What is it?
Twisting of spermatic cord - no blood supply
157
TESTICULAR TORSION
Chances of testes being saved after:
24 hours?
6 hours?
after 24 hours - 90% unsavable
before 6 hours - 90% savable
158
TESTICULAR TORSION
Symptoms?
sudden onset pain in one testes
- nausea
- vomit
- abdo pain
159
TESTICULAR TORSION
Signs?
inflammation one testes (red, tender, swollen)
160
TESTICULAR TORSION
What is the difference between epididymo-orchitis
epididymo-orchitis is normally slower onset of pain + UTI symptoms
161
TESTICULAR TORSION
Treat and Ix?
- Doppler US + Surgeyr (untwisting of SC and fixed to scrotum)
162
EPIDIDYMO-ORCHITIS
Cause?
- <35 chlamydia
- >35 normally UTI
163
EPIDIDYMO-ORCHITIS
Features?
painful testes, discharge, dysuria
164
EPIDIDYMO-ORCHITIS
Investigations?
urine sample
165
EPIDIDYMO-ORCHITIS
Treatment?
STI - Doxycycline + azithromycin
UTI - Ciprofloxacin / Ceftriazone
166
ERECTILE DYSFUNCTION
Pathology of erection?
1) Sexual stimulation by PNS = NO release = NO build up = cGMP build up
2) cGMP closes Ca2+ channels and opens K+
3) hyperpolarises cells and causes of relaxation of smooth muscle
4) This allows engorgement of blood vessels
167
ERECTILE DYSFUNCTION
What is proof of psychological ED?
still get morning erection
168
ERECTILE DYSFUNCTION
Cause?
General - smoke, diabetes, alcohol + CVS disease
Endocrine - hyperthyroidism, hypogonadism,
Neuro - cord lesions, MS
Drugs - Digoxin, Beta blockers, Diuretics, finasteride
169
ERECTILE DYSFUNCTION
Bloods?
- glucose, U+E, FBC, LH/FSH, prolactin, testosterone, thyroid function
170
ERECTILE DYSFUNCTION
treatment?
1st - oral PDE5 inhibitor - increases cGMP - Sildenafil
2nd - Vacuum aids / intracavernosal injection
3rd- prosthetics
171
What drug should be avoided in the 1st trimester of pregnancy?
Trimethoprim, Nitrofurantion should be used instead
172
Complications of Nephrotic Syndrome?
Atherosclerosis due to high cholesterol
high blood pressure
AKI and CKD
