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Phase 2a med mine > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A

Kidney stones/renal calculi
Calcium oxalate stones form in CD, deposited anywhere (renal pelvis->urethra)

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2
Q

What are the different types of kidney stones?

A

Calcium oxalate: 90%
Struvite stones
Calcium phosphate
Uric acid
Cysteine

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3
Q

Which kidney stones are radio-opaque and which are radiolucent?

A

Calcium oxalate: Radio-opaque
Uric acid stones: radiolucent

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4
Q

Name some risk factors for developing nephrolithiasis

A

Chronic dehydration
Primary kidney disease
Hyperparathyroidism
UTI’s
Hx of previous stones

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5
Q

Is nephrolithiasis more common in males or females?

A

Slightly more common in males

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6
Q

What age range is nephrolithiasis most common in?

A

20-40 years

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7
Q

Describe the pathophysiology of nephrolithiasis

A

Excess solute in CD->supersaturated urine: favours crystalisation
Stones can cause regular outflow obstruction: hydronephrosis->dilation and obstruction of the kidney

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8
Q

Name a complication of nephrolithiasis

A

Hydronephrosis->increases damage and infection risk

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9
Q

How do you treat hydronephrosis?

A

Surgical decompression ASAP

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10
Q

How does nephrolithiasis lead to dilation of renal pelvis?

A

Obstruction causes prostaglandin release->results in natural diuresis

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11
Q

Which drug class makes pain associated with nephrolithiasis worse?

A

Diuretics and fluid

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12
Q

Describe the symptoms of nephrolithiasis

A

Renal colic: loin to groin unilateral colicky pain (peristaltic waves)
Patient can’t lie still
Haematuria
Dysuria

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13
Q

Name a differential diagnosis for the pain associated with nephrolithiasis

A

Peritonitis

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14
Q

Name a red flag symptom of nephrolithiasis and what does this indicate?

A

Fever->suggests superimposed infection, like pyelonephritis

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15
Q

What are the 3 most common sites of obstruction related to nephrolithiasis?

A

1) PUJ (petro-ureteric junction)
2) Pelvic brim (ureters cross over iliac vessels)
3) VUJ (vesicoureteric junction)

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16
Q

How is nephrolithiasis diagnosed?

A

1st line: KUB(kidney ureter bladder) XR: 80% specific
Gold standard: non-contrast CT: 99% specific
Bloods: FBC, urinalysis (haematuria, rule out pregnancy), U&E(hydronephrosis), urine dipstick: UTI

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17
Q

Why do you use a non contrast CT to diagnose nephrolithiasis?

A

Contrast would need to be excreted through the kidney->harmful
NEVER use contrast in patient with kidney damage

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18
Q

Name a con of using non-contrast CT to diagnose nephrolithiasis

A

18 months worse of radiation

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19
Q

Describe the treatment for nephrolithiasis

A

Symptomatic: Hydrate, analgesia like IV diclofenac for severe pain
If UTI present: antibiotics
<5mm stones normally pass spontaneously-watch and wait
Elective surgery: ESWL/PCNL if causing pain and too big to pass, consider uretoscopy

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20
Q

What is an ESWL?

A

Extracorporeal shock wave lithotripsy
Breaks stones apart with sound waves
Smaller stones: 6-10mm, up to 20mm

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21
Q

What is a PCNL?

A

Percutaneous nephrolithotomy
Keyhole removal of stone
Larger stones:>20mm

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22
Q

What is a uretoscopy?

A

Pass uterescope up into ureter and remove stone

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23
Q

What is acute kidney injury?

A

Abrupt decline in kidney function (hours-days) characterised by increased serum creatinine and urea and decrease in urine output

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24
Q

What is acute kidney injury?

A

Abrupt decline in kidney function (hours-days) characterised by increased serum creatinine and urea and a decrease in urine output

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25
Q

What is classified as AKI?

A

KDIGO
Serum creatinine increased by 26micromol/L in 48 hours or 1.5 x baseline n 7 days
OR
Urine output <0.5ml/kg/hr for >6 hours

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26
Q

Describe the old staging of AKI

A

RIFLE
Risk
Injury
Failure
Loss
ESrenal failure

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27
Q

Describe the new staging of AKI

A

AKIN
Stage 1,2,3
Higher stage->lower likelihood of recovering

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28
Q

What are the 3 categories of AKI causes

A

Pre-renal
Renal
Post-renal

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29
Q

What is meant by pre-renal as a cause of kidney failure?

A

Hypoperfusion
Decreased cardiac output->cardiorenal syndrome

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30
Q

Name some pre-renal causes of AKI

A

CHF, cardiogenic shock, cardiorenal syndrome
Liver failure: hepatorenal syndrome
Renal artery blockage or stenosis
Drugs: NSAID’s, ACE i, IV contrast

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31
Q

How are ACEi’s nephrotoxic?

A

Cause constriction of the afferent arteriole-> decreased perfusion to glomerulus

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32
Q

Name the top 3 causes of AKI?

A

Sepsis
Cardiogenic shock
Major surgery

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33
Q

What does renal mean as a cause of AKI?

A

Damage to nephron and perenchyma

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34
Q

What is the most common cause of renal AKI?

A

Acute tubular necrosis

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35
Q

Name some causes of renal AKI?

A

Tubular: acute tubular necrosis
Interstitial
Glomerular
Toxins (sepsis)

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36
Q

Name a sign of acute tubular necrosis

A

Muddy brown casts in urine: dead tubular cells

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37
Q

What is meant by ‘post renal’ as a cause of AKI

A

Obstructive uropathy

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38
Q

Name some causes of post-renal AKI

A

Stones: ureteral/bladder/urethra
BPH(common in older men)
Drugs (anticholinergics, CCB’s)

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39
Q

Name some risk factors for AKI

A

Increasing age
Comorbidities: hypertension, T2DM, CHF
Hypovolaemia of any cause
Nephrotoxic drugs

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40
Q

Describe the pathophysiology of AKI

A

Decreased blood filtration and urine output->accumulation of substances that should be excreted

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41
Q

What 4 things accumulate as a result of AKI?

A

K+
H+
Urea
Fluid

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42
Q

Name the consequences of an accumulation of K+ as a result of AKI

A

Hyperkalaemia->arrhythmias

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43
Q

Name the consequences of an accumulation of urea as a result of AKI

A

Hyper uraemia->pruritus(urea deposits in skin)+uremic frost
Confusion if severe-> HE: ammonia build up as by product of urea metabolism

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44
Q

Name the consequences of an accumulation of fluid as a result of AKI

A

Oedema: both pulmonary and peripheral

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45
Q

What does an accumulation of H+ as a result of AKI lead to?

A

Acidosis

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46
Q

Describe the presentation of patients with AKI

A

Result of substance accumulation
Uraemia->encephalopathy, pericarditis, skin manifestations
Fluid overload->oedema, oligouria, palpable bladder
H+->metabolic acidosis
K+->arrhytmias
Also haematuria/proteinuria

47
Q

Which electrolyte imbalance is heavily associated with AKI and what ECG changes can be seen with it?

A

Hyperkalaemia
Tall tented T wave
P wave flattening
Wide QRS

48
Q

How is AKI diagnosed?

A

Establish cause with KDIGO classification(serum creatinine and urine output)
Check K+, H+, urea, creatinine, FBC and CRP to rule out infection
Renal biopsy will confirm intrarenal cause, USS for post renal

49
Q

How is AKI treated?

A

Treat complications
Treat underlying cause
Last resort: RRT, haemodialysis

50
Q

In what AKI conditions is hemodialysis indicated in?

A

Acidosis: pH<7.1
Fluid overload-oedema
Uraemia (symptomatic)
K+>6.5/ECG hcanges

51
Q

How would you treat hyperkalemia from AKI?

A

Calcium gluconate

52
Q

How would you treat metabolic acidosis from AKI?

A

Sodium bicarbonate

53
Q

How would you treat fluid overload from AKI?

A

Diuretics

54
Q

What is the best way to distinguish between pre-renal, renal and post-renal causes of AKI?

A

Urea:creatinine ratio
>100:1-pre renal
<40:1-renal
40-100:1-post renal

55
Q

What is CKD?

A

eGFR<60mL/min/1/73m2 for >3months

56
Q

Which 4 parameters are used to calculate eGFR

A

Creatinine
Age
Gender
Ethnicity

57
Q

Name a drug that is contraindicated when eGFR <30?

A

Metformin

58
Q

Describe the staging of CKD

A

1)>90 with renal signs
2)60-89 with renal signs
3)A:45-59 B:30-44
4)25-29
5)<15

59
Q

What are the best readings used to quantify CKD?

A

eGFR
ACR(albumin:creatinine ratio)

60
Q

Name some risk factors for CKD

A

Diabetes mellitus
Hypertension
Glomerulonephritis
PKD
Nephrotoxic drugs

61
Q

Describe the pathophysiology of CKD

A

Damage to lots of nephrons->decreased GFR and increased burden on remaining nephrons
Compensatory RAAS to increase GFR but increase in transglomerular pressure->shearing and loss of basement membrane selective permeability->proteinuria and haematuria
Angiotensin 2 upregulates TGF beta and plasminogen activatori-inactivator 1->mesangial scarring

62
Q

Describe the symptoms of CKD

A

Asymptomatic early on: lots of nephrons left
Sx due to substance accumulation and renal damage
Haematuria/proteinuria

63
Q

Name some complications of CKD

A

Anaemia(decreased EPO)
Osteodystrophy(decreased vitamin D activation)
Neuropathy and encephalopathy
CVD (highest mortality complication)

64
Q

How is CKD diagnosed?

A

FBC(anaemia of chronic disease)
U+E
Urine dip: proteinuria
US: bilateral renal atrophy
GFR: staging 1-5 and ACR ratio
ACR ratio>3-significant proteinuria

65
Q

How is AKI different to CKD?

A

AKI:
High serum creatinine and low urine output
Shorter symptoms onset
No anaemia
Normal US
CKD:
Low eGFR
>3 months symptoms
Anaemia of CKD
US: bilateral small atrophied kidneys

66
Q

Describe the treatment for CKD

A

No cure so treat complications:
Anaemia: EPO and Fe
Osteodystrophy: Vitamin D supplements
CVD: ACEi and statins
Oedema: diuretics
Stage 5: RRT(dialysis)
End stage: renal transplant

67
Q

How are ACEIs used to treat AKI and CKD?

A

AKI: avoid: exacerbate
CKD: Used to reduce CVD

68
Q

What is meant by brown tumour?

A

Bone tumour secondary to CKD

69
Q

Name some risk factors for developing BPH

A

Increasing age
Ethnicity: afrocaribbeans->more testosterone
Castration is protective

70
Q

Describe the pathophysiology of BPH

A

Inner transitional zone of prostate (muscular, gland) proliferate and narrow urethra

71
Q

What condition involves proliferation of the outer transitional zone of the prostate

A

Prostate cancer

72
Q

What are LUTS?

A

Lower urinary tract symptoms

73
Q

Describe the signs and symptoms of BPH

A

LUT’s->more voiding symptoms
Storage: frequency, urgency, nocturia, incontinence
Voiding: Poor stream, dribbling incomplete emptying, straining, dysuria
Anuria if totally occluded->retention, hydronephrosis, UTI

74
Q

How is BPH diagnosed?

A

DRE(rectal exam)->smooth enlarged
PSA->rule out prostate cancer-unreliable as can be raised in both though
Exclude other causes of symptoms: stones, UTI’s

75
Q

What finding would you expect on DRE in a patient with prostate cancer?

A

Hard and irregular

76
Q

How is PBH treated?

A

Lifestyle changes: decrease caffeine, may need catheter acutely
1st line: alpha blocker: tamsulosin->relaxes bladder neck
2nd line: 5 alpha reductase inhibitors: finasteride0>reduces testosterone production
Surgery as last resort: TURP-transurethral resection of prostate

77
Q

How does tamsulosin work to treat BPH?

A

Relaxes bladder neck
alpha blocker

78
Q

How does finasteride work to treat BPH?

A

5 alpha-reductase inhibitor
Reduces testosterone production->decreases prostate size

79
Q

Name a complication of a TURP procedure

A

transurethral resection of prostate
Complication: retrograde ejaculation

80
Q

What is renal cell carcinoma?

A

Proximal convoluted tubule epithelium carcinoma

81
Q

Name some risk factors for developing renal cell carcinoma

A

Smoking
Haemodialysis
Hereditary: von hippell-lindau syndrome

82
Q

Name some signs and symptoms of renal cell carcinoma

A

Often asymptomatic-25% metastasized at presentation
Triad:
Flank pain
Haematuria
Abdominal mass
-May have left sided varicocele, hypertension, anaemia

83
Q

How can renal cell carcinoma cause hypertension?

A

Tumour releases renin

84
Q

How can renal cell carcinoma cause anaemia?

A

Decreased EPO

85
Q

What is the most common renal cancer?

A

Renal cell carcinoma

86
Q

What ages is renal cell carcinoma not commonly found?

A

<40

87
Q

How is renal cell carcinoma diagnosed?

A

1st line: USS
Gold standard: CT chest/abdo/pelvis-more sensitive

88
Q

What classification system is used for renal cell carcinoma?

A

Robson staging 1-4

89
Q

How is renal cell carcinoma treated?

A

Nephrectomy: full/partial if bilateral
If metastasised: IFN alpha or biologics

90
Q

What is Von hippell-lindau syndrome?

A

Autosomal dominant condition->loss of tumour suppressive gene
50% present with renal cell carcinoma bilaterally
Renal and pancreas cysts and cerebellum cancers

91
Q

What is Wilms tumour?

A

Aka nephroblastoma
Renal mesenchymal stem cell tumour seen in children:<3 years
Much rarer

92
Q

What kind of cancer is bladder cancer

A

Transitional cell carcinoma od the bladder

93
Q

Name some risk factors for developing bladder cancer

A

Occupational exposure to dyes/paints/rubber
Smoking
Chemo and radiotherapy
Age
Being male

94
Q

At what age is bladder cancer most seen?

A

73

95
Q

Name 3 jobs that could increase you risk of developing bladder cancer

A

Painter
Hairdresser
Mechanics working with tyres

96
Q

Name the signs and symptoms of bladder cancer

A

Painless haematuria

97
Q

How is bladder cancer diagnosed?

A

Flexible cystoscopy and biopsy

98
Q

Describe the treatment for bladder cancer

A

Conservative: support e.g. with specialist nurse
Medical: chemo/radiotherapy
Surgery: TURBT(transurethral resection of bladder tumour) or cystectomy as a last resort

99
Q

How does the cancer classification of bladder cancer change if the patient has schistosomiasis?

A

More likely to have squamous cell carcinoma than transitional cell carcinoma

100
Q

What is the most common subtype of transitional cell carcinoma?

A

Transitional urothelium
Lines renal pelvis->bladder

101
Q

What is the most common male malignancy?

A

Prostate cancer

102
Q

Describe the pathophysiology of prostate cancer

A

Malignant proliferation of outer zone of peripheral prostate->neoplasm

103
Q

Name some risk factors for developing prostate cancer

A

Genetics: BRCA2, HOXB13
Increasing age
Afro-Caribbean ethnicity
Family history

104
Q

Which genes can increase your risk of prostate cancer?

A

BRCA2
HOXB13

105
Q

Describe the signs and symptoms of prostate cancer

A

Same as BPH:LUTS
Also systemic cancer symptoms (weight loss, fatigue, night sweats)
Bone pain: typically lumbar back pain as prostate cancer often forms sclerotic lesions

106
Q

Where does prostate cancer typically metastasize to?

A

Bone-sclerotic lesions
Liver
Lung
Brain

107
Q

How is prostate cancer diagnosed?

A

DRE and PSA in community
Transrectal US and biopsy-gold standard

108
Q

Describe how prostate cancer is staged

A

Gleason score
Based off biopsy
Higher->worse prognosis

109
Q

Describe the treatment for prostate cancer

A

Local: prostatectomy
Metastatic:
Hormone therapy
Radio/chemo

110
Q

What hormone therapies can be used to treat prostate cancer?

A

Bilateral orchiectomy(surgical castration)
GnRH receptor agonist like Goserelin

111
Q

How does goserelin work?

A

GnRH receptor agonist
Increases LH and FSH but results in exogenous suppression of the HPG axis

112
Q

Name some side effects of goserelin

A

Libido loss
Erectile dysfunction

113
Q

What is the most hormone sensitive cancer?

A

Prostate cancer

114
Q

What are the 2 types of testicular cancer?

A

Germ cell tumour(>90%)
Non-germ cell tumour(<10%)

Phase 2a med mine (11 decks)

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