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3RD YEAR - Long Term Conditions/FOCP > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

When taking a prostate history, what are some symptoms of obstructive problems?

A

Poor flow
Hesitancy
Post micturitional dribbling
Incomplete voiding

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2
Q

When taking a prostate history, what are some symptoms of inflammatory problems?

A

Dysuria

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3
Q

What can cause acute urinary retention?

A
  • Prostatic obstruction
  • Urethral strictures
  • Anticholinergics
  • Constipation
  • Post-op
  • Infection
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4
Q

What can cause chronic urinary retention?

A
  • Prostatic enlargement (carcinoma, BPH)
  • Pelvic malignancy
  • CNS disease
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5
Q

What is BPH?

A

Nodular or diffuse proliferation of the prostate - typically the inner zone enlarges (in contrast to peripheral layer in carcinoma), fuelled by testosterone.

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6
Q

What are the symptoms of BPH?

A

Nocturia, frequency, urgency, dribbling, poor flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

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7
Q

How is BPH managed?

A

Conservative - avoid caffeine, alcohol
Medical - a-blocker, 5a-reductase inhibitors (finasteride)
Surgical - catheters, resection/incision of prostate

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8
Q

What investigations should be done in somebody with urinary symptoms, in which you suspect prostate problems?

A
  • International prostate symptom score
  • Urinalysis
  • FBC, U&E, PSA
  • Flow rate and residual volume
  • DRE
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9
Q

What are you assessing in a DRE?

A

Anal tone
Rectal wall and contents
Prostate surface, size, symmetry and consistency

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10
Q

What causes a raised PSA?

A

BPH, prostatitis, prostate cancer

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11
Q

What is prostatitis?

A

Inflammation of the prostate causing UTI, retention, pain, haematospermia and a swollen/boggy prostate

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12
Q

What organism commonly causes prostatitis?

A

E. coli and S. faecalis

Treat with levofloxacin

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13
Q

What is epididymo orchitis?

A

Pain, swelling and inflammation of the epididymus and testes, most commonly due to:

  • STD (gonorrhoea/chlamydia)
  • UTI (E.coli)
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14
Q

What is balanitis, and what is it associated with?

A

Acute inflammation of the foreskin and glans.

Associated with staph and strep infections and diabetes

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15
Q

What is phimosis and what is it associated with?

A

Narrowing of the foreskin so that it can’t be retracted, causing recurrent banalities.
Associated with painful intercouse

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16
Q

What is paraphimosis?

A

Foreskin can no longer be pulled forward over the penile tip, leading to oedema and ichaemia

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17
Q

Describe the typical prostate cancer, and its risk factors?

A

Adenocarcinoma, arising in the peripheral zone of the prostate

RF: family history, high testosterone

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18
Q

What are the symptoms of prostate cancer?

A

Nocturia, hesitancy, poor stream, terminal dribbling (immediate), obstruction

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19
Q

How would a prostate cancer feel on DRE?

A

Hard, irregular prostate

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20
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus, associated with subfertility

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21
Q

What is an epididymal cyst?

A

Cyst containing clear or milky fluid which lies above the testis

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22
Q

A boy comes in with acute, tender enlargement of the testis. What is the likely diagnosis?

A

Testicular torsion - this is a medical emergency

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23
Q

What does renal pain feel like and what causes it?

A

Dull ache from loin to groin

Causes - pyelonephritis, nephrotic syndrome, polycystic kidneys, renal infarction

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24
Q

What does renal colic feel like and what causes it?

A

Extreme intermittent loin to groin pain, associated with fever and vomiting

Causes - renal stones, clots

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25
Q

What can cause haematuria?

A
  • GU malignancy
  • Infections
  • Glomerular nephritis
  • Kidney stones
  • Prostate disorders
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26
Q

What causes high urea?

A 
Dehydration
GI bleed (blood meal - releases urea)
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27
Q

What are the functions of the kidney (A WET BED)?

A 
Acid-base balance
Water removal
Erythropoeisis
Toxin removal
Blood pressure control
Electrolyte balance
D (vit) activation
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28
Q

How much urine do the kidneys usually produce?

A

1ml/kg/hr (1.5L/day)

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29
Q

What is the definition of oliguria?

A

<400 ml/24 hours

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30
Q

What is the role of PTH?

A

Promotes calcium reabsoprtion in the distal convoluted tubule

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31
Q

What is the role of aldosterone?

A

Promotes sodium, chloride and water reabsorption in the distal convoluted tubule

32
Q

What is the role of ADH?

A

Promotes water reabsorption in the collecting duct, by formation of aquapores

33
Q

What are the actions of angiotensin II?

A

Secreted in response to low BP, causing:

  • Increased sympathetic activity
  • Tubular Na/CL reabsorption via aldosterone
  • Arteriolar vasoconstriction
  • Water reabsorption via ADH
34
Q

What is an AKI?

A

Rapid deterioration or loss of renal function, causing urea and creatinine retention and subsequent fluid and electrolyte and acid-base imbalance

35
Q

How is AKI diagnosed?

A
  • Rise in creatine >26umol/L in 48hrs
  • Rise in creatinine >1.5x baseline
  • Urine output <0.5ml/kg/h for >6 hours
36
Q

What are the symptoms and signs of an AKI?

A

Symptoms - dysuria, oliguria, anuria, haematuria, generally unwell with fever, nausea and vomiting

Signs - hypo/hypervolaemia, leukonchyia, rash, AV fistula, polycystic kidneys

37
Q

What are the pre-renal causes of an AKI?

A

HYPOPERFUSION (dehydration, hypotension, heart/liver failure)

38
Q

What are the renal causes of an AKI?

A

Tubular damage - drugs
Glomerular - autoimmune, drugs, infection (glomerulonephritis)
Interstitial - drugs, infection
Vascular - vasculitis, malignancy

39
Q

What are the post-renal causes of an AKI?

A

Urinary tract obstruction causing pressure on the kidney - stones, BPH, stricutres

40
Q

Name some nephrotoxic drugs (cause AKI but fine to use in CKD)

A 
ACE inhibitors
Diuretics 
NSAIDS
Immunosuppresants
Antibiotics (penicillins, quinolones, sulphonamides, aminoglycosides)
Omeprazole
41
Q

How should an AKI be managed generally?

A
  • Assess volume status and aim for euvolaemia
  • Stop nephrotoxic drugs
  • MONITOR!!!!
  • Maintain nutrition
42
Q

How should a pre-renal AKI be managed?

A

General measures + rehydration

43
Q

What is acute tubular necrosis?

A

Hypoperfusion of they kidneys causing ischaemia, build up of nephrotoxins and renal tubular damage

44
Q

What causes acute tubular necrosis?

A 
Nephrotoxic drugs
CT contrast
Untreated pre-renal AKI
Shock
Rhabdomyolysis
45
Q

How should a renal AKI be managed?

A

General measures + REFER and potential dialysis

46
Q

How should a post-renal AKI be managed?

A

General measures + catheterise and CT renal tract

47
Q

What are the complications of an AKI?

A

These require urgent dialysis:

  • Hyperkalaemia (>6.5)
  • Metabolic acidosis
  • Symptoms of uraemia (encephalopathy, pericarditis)
  • Fluid overload
  • Pulmonary oedema (SOB)
48
Q

What is the definition of CKD?

A

Impaired renal function for >3 months based on abnormal structure of function
OR
GFR <60mL/min for >3 months with no evidence of kidney damage

49
Q

What causes CKD?

A
  • Diabetes Mellitus
  • Glomerulonephritis
  • Hypertension
  • AKI
  • Polycystic kidney disease (related to stroke)
  • Genetics - Alport syndrome
50
Q

What is Alport’s syndrome?

A

A rare inherited disorder affecting only MALES causing a triad of:

  1. Kidney disease
  2. Hearing loss
  3. Visual problems
51
Q

What are the symptoms of CKD and why do these occur?

A

Before stage 4 - asymptomatic
Stage 4:
- Low erythropoietin - weakness, fatigue, easily brushing, anaemia
- Pulmonary oedema - breathlessness
- Uraemic toxins - headaches, altered mental status, encephalopathy
- Low vit D production - itching, bone pain, fractures

52
Q

What blood tests are raised and decreased in CKD?

A

Raised - urea, glucose, phosphate, ALKP, PTH, ESR (increased inflammation)
Decreased - Hb, calcium

53
Q

What imaging should be done for CKD?

A

Renal USS, then biopsy if severe (although this will cause bleeding so should only be done if it will influence management)

(also do MSU)

54
Q

How is CKD staged?

A 
Stage 1 (>90)
Stage 2 (60-89)
Stage 3a (45-59) b (30-44)
Stage 4 (15-29)
Stage 5 (<15)
55
Q

How is mild CKD managed?

A

Lifestyle advice
Blood pressure control (below 140/90)
Low cholesterol (4.5)

The main cause of death for CKD is cardiovascular

56
Q

What medications should someone with severe CKD be on?

A 
BP - aceinhibitors/ARB
Cholesterol - statin
Fluid overload - loop diuretic
Bone - phosphate binder + VitD(alfacalcidol)
Anaemia - ferrous sulphate/EPO
Cramps - quinine sulphate
57
Q

At what GFR should dialysis be considered?

A

GFR<8-10

58
Q

How is dialysis set up?

A

Create AV fistula in the arm, or graft/catheter if not possible
This will provide a strong access point for dialysis

59
Q

How does haemodialysis work?

A

Blood is passed over a semi-permeable membrane, outside of the body, against dialysis fluid in the opposite direction

60
Q

How does peritoneal dialysis work?

A

Uses the peritoneum as a semi-permeable membrane - add osmotic agents to the fluid to promote ultra-filtration

61
Q

What are the absolute contraindications for renal transplant?

A

Active infection, cancer, severe comorbidity

62
Q

What is glomerulonephritis?

A

Inflammation of the glomeruli and nephrons causing:

  1. Restricted blood flow so BP increases
  2. Damage to filtration mechanism, so proteinuria and haematuria
  3. AKI
63
Q

Name 4 types of glomerulonephritis

A

Nephrotic syndrome
IgA nephropathy
HSP
SLE

64
Q

What is nephrotic syndrome?

A

A triad of:

  1. Proteinuria
  2. Hypoalbuminaemia
  3. Oedema
65
Q

What is the pathophysiology behind nephrotic syndrome?

A

Damage to the podocyte causes heavy protein loss.

This is primary or secondary to hepatitis, diabetes, SLE or paraneoplastic

66
Q

How do loop diuretics work, and when are they used?

A

Block the Na/K/2Cl cotransporters in the loop of henle –> reduce water reabsorption

Uses - pulmonary/peripheral oedema, severe hypercalcaemia

Eg. furosemide, bumetanide

67
Q

How do thiazide diuretics work, and when are they used?

A

Block the Na/Cl transporter in the DCT –> reduce water reabsorption

Uses - hypertension, heart failure

Eg. bendroflumethiazide

68
Q

How do potassium-sparing diuretics work and when are they used?

A

Spironolactone - aldosterone antagonists (slow onset)

Amiloride - blocks Na channels in collecting tubules (fast onset)

Uses - alongside other diuretics to control K+ wasting

69
Q

How do osmotic diuretics work and when are they used?

A

Remain in lumen and hold water in by osmotic effect

Uses - haemolysis, rhabdomyolysis, reduction in intra-ocular and ICP

Eg. Mannitol

70
Q

What is the most common cancer of the bladder?

A

Transitional cell carcinoma (can also arise n the ureter or renal pelvis)

71
Q

How does a TCC present?

A

Painless haematuria, frequency, urgency, recurrent UTIs

72
Q

How is TCC diagnosed?

A

Cystoscopy with biopsy

73
Q

What is a KUB and what is it used for?

A

Kidneys, ureters, bladder x-ray

Uses - Investigation of bowel obstruction, gallstones and renal stones

74
Q

What is cystoscopy used for?

A 
Bladder cancer
Haematuria
Frequent UTIs
Chronic pelvic pain
Urinary blockage
Urinary incontinence
75
Q

What is the causative agent for chancroid ?

A

Haemophilius ducreyi

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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