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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
What is classified as AKI?
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
26
Describe the old staging of AKI
RIFLE Risk Injury Failure Loss ESrenal failure
27
Describe the new staging of AKI
AKIN Stage 1,2,3 Higher stage->lower likelihood of recovering
28
What are the 3 categories of AKI causes
Pre-renal Renal Post-renal
29
What is meant by pre-renal as a cause of kidney failure?
Hypoperfusion Decreased cardiac output->cardiorenal syndrome
30
Name some pre-renal causes of AKI
CHF, cardiogenic shock, cardiorenal syndrome Liver failure: hepatorenal syndrome Renal artery blockage or stenosis Drugs: NSAID's, ACE i, IV contrast
31
How are ACEi's nephrotoxic?
Cause constriction of the afferent arteriole-> decreased perfusion to glomerulus
32
Name the top 3 causes of AKI?
Sepsis Cardiogenic shock Major surgery
33
What does renal mean as a cause of AKI?
Damage to nephron and perenchyma
34
What is the most common cause of renal AKI?
Acute tubular necrosis
35
Name some causes of renal AKI?
Tubular: acute tubular necrosis Interstitial Glomerular Toxins (sepsis)
36
Name a sign of acute tubular necrosis
Muddy brown casts in urine: dead tubular cells
37
What is meant by 'post renal' as a cause of AKI
Obstructive uropathy
38
Name some causes of post-renal AKI
Stones: ureteral/bladder/urethra BPH(common in older men) Drugs (anticholinergics, CCB's)
39
Name some risk factors for AKI
Increasing age Comorbidities: hypertension, T2DM, CHF Hypovolaemia of any cause Nephrotoxic drugs
40
Describe the pathophysiology of AKI
Decreased blood filtration and urine output->accumulation of substances that should be excreted
41
What 4 things accumulate as a result of AKI?
K+ H+ Urea Fluid
42
Name the consequences of an accumulation of K+ as a result of AKI
Hyperkalaemia->arrhythmias
43
Name the consequences of an accumulation of urea as a result of AKI
Hyper uraemia->pruritus(urea deposits in skin)+uremic frost Confusion if severe-> HE: ammonia build up as by product of urea metabolism
44
Name the consequences of an accumulation of fluid as a result of AKI
Oedema: both pulmonary and peripheral
45
What does an accumulation of H+ as a result of AKI lead to?
Acidosis
46
Describe the presentation of patients with AKI
Result of substance accumulation Uraemia->encephalopathy, pericarditis, skin manifestations Fluid overload->oedema, oligouria, palpable bladder H+->metabolic acidosis K+->arrhytmias Also haematuria/proteinuria
47
Which electrolyte imbalance is heavily associated with AKI and what ECG changes can be seen with it?
Hyperkalaemia Tall tented T wave P wave flattening Wide QRS
48
How is AKI diagnosed?
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
How is AKI treated?
Treat complications Treat underlying cause Last resort: RRT, haemodialysis
50
In what AKI conditions is hemodialysis indicated in?
Acidosis: pH<7.1 Fluid overload-oedema Uraemia (symptomatic) K+>6.5/ECG hcanges
51
How would you treat hyperkalemia from AKI?
Calcium gluconate
52
How would you treat metabolic acidosis from AKI?
Sodium bicarbonate
53
How would you treat fluid overload from AKI?
Diuretics
54
What is the best way to distinguish between pre-renal, renal and post-renal causes of AKI?
Urea:creatinine ratio >100:1-pre renal <40:1-renal 40-100:1-post renal
55
What is CKD?
eGFR<60mL/min/1/73m2 for >3months
56
Which 4 parameters are used to calculate eGFR
Creatinine Age Gender Ethnicity
57
Name a drug that is contraindicated when eGFR <30?
Metformin
58
Describe the staging of CKD
1)>90 with renal signs 2)60-89 with renal signs 3)A:45-59 B:30-44 4)25-29 5)<15
59
What are the best readings used to quantify CKD?
eGFR ACR(albumin:creatinine ratio)
60
Name some risk factors for CKD
Diabetes mellitus Hypertension Glomerulonephritis PKD Nephrotoxic drugs
61
Describe the pathophysiology of CKD
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
Describe the symptoms of CKD
Asymptomatic early on: lots of nephrons left Sx due to substance accumulation and renal damage Haematuria/proteinuria
63
Name some complications of CKD
Anaemia(decreased EPO) Osteodystrophy(decreased vitamin D activation) Neuropathy and encephalopathy CVD (highest mortality complication)
64
How is CKD diagnosed?
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
How is AKI different to CKD?
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
Describe the treatment for CKD
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
How are ACEIs used to treat AKI and CKD?
AKI: avoid: exacerbate CKD: Used to reduce CVD
68
What is meant by brown tumour?
Bone tumour secondary to CKD
69
Name some risk factors for developing BPH
Increasing age Ethnicity: afrocaribbeans->more testosterone Castration is protective
70
Describe the pathophysiology of BPH
Inner transitional zone of prostate (muscular, gland) proliferate and narrow urethra
71
What condition involves proliferation of the outer transitional zone of the prostate
Prostate cancer
72
What are LUTS?
Lower urinary tract symptoms
73
Describe the signs and symptoms of BPH
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
How is BPH diagnosed?
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
What finding would you expect on DRE in a patient with prostate cancer?
Hard and irregular
76
How is PBH treated?
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
How does tamsulosin work to treat BPH?
Relaxes bladder neck alpha blocker
78
How does finasteride work to treat BPH?
5 alpha-reductase inhibitor Reduces testosterone production->decreases prostate size
79
Name a complication of a TURP procedure
transurethral resection of prostate Complication: retrograde ejaculation
80
What is renal cell carcinoma?
Proximal convoluted tubule epithelium carcinoma
81
Name some risk factors for developing renal cell carcinoma
Smoking Haemodialysis Hereditary: von hippell-lindau syndrome
82
Name some signs and symptoms of renal cell carcinoma
Often asymptomatic-25% metastasized at presentation Triad: Flank pain Haematuria Abdominal mass -May have left sided varicocele, hypertension, anaemia
83
How can renal cell carcinoma cause hypertension?
Tumour releases renin
84
How can renal cell carcinoma cause anaemia?
Decreased EPO
85
What is the most common renal cancer?
Renal cell carcinoma
86
What ages is renal cell carcinoma not commonly found?
<40
87
How is renal cell carcinoma diagnosed?
1st line: USS Gold standard: CT chest/abdo/pelvis-more sensitive
88
What classification system is used for renal cell carcinoma?
Robson staging 1-4
89
How is renal cell carcinoma treated?
Nephrectomy: full/partial if bilateral If metastasised: IFN alpha or biologics
90
What is Von hippell-lindau syndrome?
Autosomal dominant condition->loss of tumour suppressive gene 50% present with renal cell carcinoma bilaterally Renal and pancreas cysts and cerebellum cancers
91
What is Wilms tumour?
Aka nephroblastoma Renal mesenchymal stem cell tumour seen in children:<3 years Much rarer
92
What kind of cancer is bladder cancer
Transitional cell carcinoma od the bladder
93
Name some risk factors for developing bladder cancer
Occupational exposure to dyes/paints/rubber Smoking Chemo and radiotherapy Age Being male
94
At what age is bladder cancer most seen?
73
95
Name 3 jobs that could increase you risk of developing bladder cancer
Painter Hairdresser Mechanics working with tyres
96
Name the signs and symptoms of bladder cancer
Painless haematuria
97
How is bladder cancer diagnosed?
Flexible cystoscopy and biopsy
98
Describe the treatment for bladder cancer
Conservative: support e.g. with specialist nurse Medical: chemo/radiotherapy Surgery: TURBT(transurethral resection of bladder tumour) or cystectomy as a last resort
99
How does the cancer classification of bladder cancer change if the patient has schistosomiasis?
More likely to have squamous cell carcinoma than transitional cell carcinoma
100
What is the most common subtype of transitional cell carcinoma?
Transitional urothelium Lines renal pelvis->bladder
101
What is the most common male malignancy?
Prostate cancer
102
Describe the pathophysiology of prostate cancer
Malignant proliferation of outer zone of peripheral prostate->neoplasm
103
Name some risk factors for developing prostate cancer
Genetics: BRCA2, HOXB13 Increasing age Afro-Caribbean ethnicity Family history
104
Which genes can increase your risk of prostate cancer?
BRCA2 HOXB13
105
Describe the signs and symptoms of prostate cancer
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
Where does prostate cancer typically metastasize to?
Bone-sclerotic lesions Liver Lung Brain
107
How is prostate cancer diagnosed?
DRE and PSA in community Transrectal US and biopsy-gold standard
108
Describe how prostate cancer is staged
Gleason score Based off biopsy Higher->worse prognosis
109
Describe the treatment for prostate cancer
Local: prostatectomy Metastatic: Hormone therapy Radio/chemo
110
What hormone therapies can be used to treat prostate cancer?
Bilateral orchiectomy(surgical castration) GnRH receptor agonist like Goserelin
111
How does goserelin work?
GnRH receptor agonist Increases LH and FSH but results in exogenous suppression of the HPG axis
112
Name some side effects of goserelin
Libido loss Erectile dysfunction
113
What is the most hormone sensitive cancer?
Prostate cancer
114
What are the 2 types of testicular cancer?
Germ cell tumour(>90%) Non-germ cell tumour(<10%)

Phase 2a med mine (11 decks)

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