Genitourinary Flashcards

1
Q

acute kidney injury (AKI) - definition, risk factors

note: good summary table on side 14 of PPT

A

sudden dec. in renal fx (GFR) which causes build up of nitrogenous waste (uric acid)

  • over hrs to days
  • severity based on inc. in BUN and Cr and reduction of urine output (oliguria)
  • can be pre-renal, intrinsic, or post-renal

risk factors:

  • age, heart and liver dz
  • exposure to nephrotoxins
  • surgery, sepsis, vol. depletion
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2
Q

important nephrotoxins

A
IV contrast dye
ACE-I and ARBs
Loop and thiazide diuretics
lithium
NSAIDs
statins
some ABX
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3
Q

acute kidney injury (AKI) - sxs, dx

A

sxs: vary depending on cause
- +/- oliguria
- change in urine color
- N/V, malaise, abd pain, itching

dx:

  • BUN/Cr ratio rises
  • image/biopsy may be done
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4
Q

acute kidney injury (AKI) - pre-renal causes and tx

A

Pre-renal (most common):

  • vol. depletion: dehydration, blood loss
  • dec. effective circulating vol: CHF, ascites, nephrotic syndrome
  • impaired renal blood flow: ACEIs, NSIADS, renal artery stenosis
  • systemic vasodilation: sepsis

Tx: treat cause, maintain euvolumia, check K+

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5
Q

acute kidney injury (AKI) - intrinsic causes (3)

A
  1. acute tubular necrosis
    - ischemia
    - endogenous nephrotoxins: rhabdomyolysis, hemolysis
    - exogenous nephrotoxins: amphotericin B, contrast dye
    - sepsis/infection
  2. interstitial nephritis
    - drugs: Penicillin, cephalosporins, sulfa, NSAIDs
  3. glomerularnephritis
    - IgA nephropathy
    - post strep (antibody against strep antigen that settled in kidney)
    - Good pastures (antibody against basement membranes of kidney and lung
    - HUS: hemolytic uremic syndrome (E. Coli)
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6
Q

acute kidney injury (AKI) - post-renal causes and tx

A

Post-renal (think obstruction; least common):

  • BPH
  • nephrolithiasis (bilateral)
  • bladder outlet syndrome

tx: catheterization or stent

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7
Q

acute tubular necrosis - causes, dx, tx

A

most common intrinsic cause of AKI

causes:

  • ischemia
  • endogenous nephrotoxins: rhabdomyolysis, hemolysis
  • exogenous nephrotoxins: amphotericin B, contrast dye
  • sepsis/infection

dx:

  • U/A: “muddy brown sediment” and granular casts
  • Labs: hyperkalemia, high phase, FeNa>1, BUN:Cr<20:1

tx:

  • remove toxin or tx cause to prevent further kidney injury!
  • loop diuretic, correct electrolytes
  • dialysis if needed
  • low protein diet
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8
Q

interstitial nephritis - causes (drugs), sxs, dx, tx

A

inflammation of renal tubules and interstitial
- intrinsic cause of AKI

causes:

  • DRUGS: Penicillin, cephalosporins, sulfa, NSAIDs
  • infection: strep, CMV
  • immune d/c: sarcoid, SLE (Lupus)

sxs: fever, maculopapular rash

dx:

  • U/A: WBC casts, eosinophils
  • CBC: peripheral blood eosinophils

Note: this is a hypersensitivity reaction to drug… why we see eosinophils

tx:

  • address underlying cause
  • urgent dialysis
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9
Q

glomerulonephritis - causes (many)

Note: only intrinsic cause list out on blueprint!

A

inflammatory lesions of glomerulus from immune complex deposition or development of antibodies against glomerulus
- intrinsic cause of AKI

causes:

  • IgA nephropathy (aka Berger dz): assoc. w/ URI sxs, gastroenteritis; hematuria
  • Post strep (immune complex deposition): occurs 2-6 wks post-impetigo and 1-3 wks post-strep pharyngitis; +ASO, inc. C3; steroids NOT helpful
  • Good pastures: autoantibodies against basement membrane; tx is plasma exchange
  • HUS (hemolytic uremic syndrome): uremia, low platelets, hemolytic anemia
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10
Q

glomerulonephritis - sxs, dx, tx

Note: only intrinsic cause list out on blueprint!

A

sxs:

  • related to underlying cause
  • hematuria, HTN and edema (periorbital and scrotal edema), flank pain

dx:
- U/A: tea or coca-cola colored urine w/ red cell casts

tx:

  • treat underlying cause
  • high dose corticosteroids (except if post-strep)
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11
Q

AKI - what medical calculation can help you determine cause?

A

FeNa

FeUrea - can be used on patients on diuretics

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12
Q

chronic renal failure - definition, sxs

A

destruction of nephrons leading to progressive decline in kidney fx

  • common (1 in 9 adults)
  • often with other chronic diseases
  • most people die of other cause (CVD) and not ESRD

sxs:

  • HTN (#1 sx)
  • uremic syndrome
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13
Q

uremic syndrome

A

build-up of metabolic wastes w/ advanced chronic kidney dz

sxs:

  • urinary changes
  • fatigue, dec. appetite, pruritus, edema, SOB
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14
Q

chronic renal failure - dx, tx, prevention

A

Dx:

  • renal fx: inc. BUN/Cr, inc. Cr, dec. GFR (< 60 for 3+ mo)
  • hyper K, metabolic acidosis, proteinuria, etc.

tx:

  • diet: protein restriction, also salt, water, potassium, and phosphate restriction
  • dialysis or transplant

Prevent:
- treat HTN: ACE-I or ARB

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15
Q

chronic renal failure - stages

A

based on GFR

1: normal, but evidence of kidney dz; GFR 90+
2: mild; GFR 60-89
3: moderate: GFR 30-59
4: severe; GFR 15-29
5: failure (ESRD); GFR<15 (on hemodyalysis)

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16
Q

hydronephrosis - definition and cuases

A

distention of renal calyces and pelvis of kidney(s) by urine

  • is the result of urinary blockage anywhere along urinary tract
  • will see dec. GFR if bilateral

causes:

  • BPH
  • VUR
  • nephrolithiasis (esp. at ureteropelvic jx)
  • pregnancy
  • large fibroids
  • neurogenic bladder
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17
Q

hydronephrosis - sxs, dx, tx

A

sxs:
- pain, sxs related to cause

dx: U/S
- can also use IV urogram or CT

tx: treat cause!
- catheter for BPH
- anticholinergics for neurogenic bladder
- emergent stenting or nephrostomy for infection

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18
Q

nephrotic syndrome - definition, causes, sxs

A

increased permeability of glomerular capillary walls that allows passage of large amounts of protein into urine
- proteinuria + hypoalbuminemia + edema

Primary causes:

  • minimal change dz
  • focal glomerulosclerosis
  • membranous nephropathy
  • menbranous proliferative nephropathy (MPGN)

Secondary causes:

  • DM
  • amyloidosis

sxs:

  • edema: periorbital and scrotal (also feet and ankles)
  • pleural effusion: SOB
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19
Q

nephrotic syndrome - dx, management

A

Dx:

  • proteinuria > 3g/day
  • oval fat bodies: lipid passed into urine, as well (maltese crosses are signs of oval fat bodies under microscope)

Manage:

  • diet: low protein, salt restriction
  • tx hyperlipidemia and hypercoaguability
  • diuretics (thiazide, loop) and ACE-I
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20
Q

polycystic kidney disease - definition, sxs, dx

A

genetic, cystic d/o of the kidneys often resulting in massive enlargement
- MOST common hereditary dz in US

sxs:

  • present in 30-40’s; ESRD by age 60
  • hematuria + abd/flank pain + 2ndary HTN
  • large, palpable kidneys
  • frequent UTIs and nephrolithiasis

dx:
- U/S for screening
- CT or MRI give anatomic details

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21
Q

polycystic kidney disease - complications, management

A

complications:

  • pain from cyst and rupture
  • renal infection
  • nephrolithiasis
  • HTN: must tx aggressively!
  • cerebral aneurysms
  • MVP (mitral valve prolapse)
  • cysts in other locations

Management:

  • treat complications
  • aspirate cysts
  • treat HTN aggressively
  • VASOPRESSIN receptor antagonist delays ESRD
  • renal transplant
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22
Q

renal artery stenosis

A

narrowing of 1 or both renal arteries

sxs:

  • HTN onset <20 or >50 y/o
  • HTN resistant to meds
  • renal bruits

dx:

  • U/S: screening
  • renal arteriography: gold standard

tx:

  • renal artery angioplasty +/- stent
  • antihypertensives
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23
Q

renal vein thrombosis - definition, causes, sxs, dx, tx

A

acute or chronic thrombosis of renal vein

causes:

  • Kids: severe dehydration
  • Adults: infection, ascending thrombosis of vena cava, clotting d/o

sxs:

  • flank pain
  • palpable kidney
  • nephrotic syndrome if bilateral

dx:

  • renal U/S
  • renal venography

tx:

  • eliminate cause
  • anticoagulation or thrombolytic therapy
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24
Q

Acid-Base Basics

A

acid-base balance is coordinated by lungs and kidneys to keep optimal pH

  • goal pH: 7.35-7.45
  • lungs regulate pCO2
  • kidneys regulate HCO3-

Note: when one system fails, the other tries to compensate to bring back balance

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25
acidosis
results when pH is too low (<7.35) - pCO2 is HIGH (>40) - HCO3 is LOW (<24) Note: think of CO2 as Hydrogen
26
alkalosis
results when pH is too high (>7.45) - HCO3- is HIGH (>24) - pCO2 is LOW (<40)
27
acid-base question: approach
1. identify if you have an acidic or basic state - acidic: pH<7.35 - basic: pH>7.35 2. identify if it is metabolic (HCO3-) or respiratory (pCO2) underlying the cause 3. Consider underlying cause and correct
28
metabolic acidosis (w/ elevated anion gap) - causes
low pH, low HCO3- anion gap > 16 causes: MUDPILERS ``` M: methanol U: uremia D: DKA P: propylene glycol, acetaminophen, I: iron, isoniazid (due to seizures), inborn errors of metabolism L: lactic acidosis E: ethanol (due to lactic acidosis), ethylene glycol R: rhabdomyolysis S: salicylates/ASA/Aspirin ```
29
anion gap
positive ions minus negative ions anion gap = Na+ - (HCO3- + Cl-) normal: 8-16 mEqu
30
metabolic acidosis (w/ normal anion gap) - causes
low pH, low HCO3- anion gap b/t 8-16 causes: - dec. bicarb with diarrhea
31
metabolic acidosis - what is compensation
increased ventilation to blow off CO2 | - can get Kussmaul breathing
32
metabolic alkalosis - causes, compensation, other s/sx, tx
high pH, high HCO3- causes: loss of H+ or excess HCO3- - vomiting, suction gastric contents - diuretics - overcorrect metabolic acidosis compensation: decreased ventilation (inc. pCO2) other s/sx: - hypocalcemia: paresthesias, confusion, coma - hypokalemia: polyuria, polydipsia, weakness tx: fix underlying cause, IV fluids
33
respiratory acidosis - causes, compensation, tx
low pH, high CO2 causes: anything that dec. respirations (COPD, narcotics OD) compensation: inc. reabsorption of HCO3- by kidneys tx: - fix underlying cause, assist ventilation, naloxone (if all else fails)
34
respiratory alkalosis - causes, s/sx, compensation, tx
high pH, low CO2 causes: anything that inc. respirations and blows off too much CO2 - hysterical hyperventilation - salicylate intoxication - pulmonary embolism s/sx: rapid breathing, lightheadedness compensation: inc. elimination of HCO3- by kidneys tx: underlying cause
35
hyponatremia - 1st step, s/sx
serum sodium <135 - can be due to excess total body water s/sx: N/V, weakness, HA, dec. DTRs, delirium, coma Must 1st determine volume status (hypo-, eu-, hyper volemic)
36
hyponatremia (hypovolemic): causes, sx, results of UA, tx
water and Na+ are lost; causes ADH to be released (for water retention) causes: vomiting, diarrhea, diuretic use, Addisons dz sx: dehydrated UA: urine Na is LOW tx: volume replacement to suppress ADH
37
hyponatremia (euvolemic): causes, sx, results of UA, tx
causes: SIADH (kidney conserves too much H2O), hypothyroidism, psychogenic polydipsia sx: NO vol. overload UA: urine sodium is HIGH Tx: water restrict, correct cause
38
hyponatremia (hypervolemic): causes, sx, results of UA, tx
inc. extracellular water compared to Na+ causes: cirrhosis, CHF, nephrotic syndrome, renal failure sx: edema, vol. OL UA: urine Na LOW tx: water restrict, diuretics
39
hyponatremia (hypertonic) - definition, cause, tx/correction
hypertonic: excess extracellular solute creates gradient so water moves out of cells cause: hyperglycemia (most common) tx: hypertonic saline - BE CAREFUL - do not correct Na too rapidly = Central Pontine Myelinolysis
40
hypernatremia
serum Na >145 - can be due to low total body water causes: - impaired thirst mechanism, lack of access to water - diabetes insipidus s/sx: dehydration, hyperthermia, delirium, coma tx: volume replace and rehydrate - BE CAREFUL - do not dec Na too rapidly = cerebral edema (neuro impairment)
41
SIADH
syndrome of inappropriate secretion of ADH - leading to water retention causes: MANY (CVA, trauma, infections, cancers, pneumonia, drugs and meds) s/sx: hyponatremia dx: diagnosis of exclusion tx: fluid restrict, furosemide, tx cause
42
hypokalemia: causes, s/sx, EKG changes, tx
serum K < 3.5 (severe: <2.5) causes: - diarrhea (most common) - vomiting, diuretics s/sx: weakness, fatigue, muscle - may cause arrhythmias EKG: flattened or inverted T waves, U waves, frequent PVCs Tx: oral or IV replacement - monitor EKG Recall: hypo K means hypo Mag
43
hyperkalemia: causes, s/sx, EKG changes, tx
serum K >5 (sever: >6.5) causes: - end stage renal dz (#1) - kidneys can't excrete - drugs: spirinolactone (K sparing diuretics), NSAIDs, ACE, ARBs - burns, rhabdo - lab erros s/sx: muscle wekaness, hyperreflexia, flaccid paralysis - life threatening arrhythmias (V-Fib --> death) EKG: peaked T-waves, widened QRS, sine waves, death tx: repeat lab - stabilize heart: calcium gluconate - drive K+ back into cells (insulin, albuterol, sodium bicarb) - excrete K: kayexalate (stool), furosemide (urine) hemodialysis
44
hypocalcemia: causes, s/sx, EKG changes, tx | - recall: bound to albumin so much check ionized Ca to be sure not result of low albumin
serum Ca++ <8.5 - lowers neuromuscular and CV excitation thresholds (more sensitive to stimulation) causes: - chronic kidney dz (#1) - hypoparathyroidism, hypoalbuminemia, vit D deficiency s/sx: - muscle cramping, inc. DTRs - Chvostek sign: facial muscles contract when facial nerve tapped - Trousseau sign: carpal spasm when BP cuff inflate for 3 min EKG: prolonged QT --> ventricular arrhythmias tx: oral of IV Ca++; replace Mg as needed
45
hypercalcemia
serum Ca++ > 10.5 - increases neuromuscular and CV excitation thresholds (less sensitive to stimulation) causes: - hyperparathyroidism (anything that makes high PTH) s/sx: anorexia, constipation, polyuria, dehydration (only if >12) EKG: shortened QT intervals Tx: IV fluids, loop diuretics
46
hypomagnesemia: which patients, causes, s/sx, EKG tx
serum mag <1.5 patients: hospitalized, ICU causes: - chronic ETOH - chronic diarrhea - hypo PTH - hyperaldosteronism - diuretics, malnutrition s/sx: - can lead to hypo K and hypo Ca++ EKG: long QT leading to arrhythmia (TORSADES) Tx: oral, IM, IV Mag - monitor EKG
47
hypermagnesemia: what population does this occur in
rare - except in CKD patients
48
nephrolithiasis: definition, risk factors, s/sx
saturation of urine w stone-forming salts causes precipitation of crystals risk factors: - male, 3rd or 4th decade - drugs: antacids, carbonic anhydrase inhibitors, loop diuretics, vit. C - hyperparathyroidism - diets high in oxalate-rich foods (leafy veggies, nuts, tea/coffee) - diets high in purines s/sx: - SEVERE flank pain (radiates to abdomen or groin) - hematuria, frequency, urgency, N/V
49
nephrolithiasis: dx, tx, prevention
Dx: - imaging: spiral CT (gold standard); KUB (x-ray) helps to track stones - U/A (culture), CBC, electrolytes Tx: - PAIN CONTROL: NSAIDs are best) - Management depends on stone size and location - <5mm: passable; 5-10mm (likely to pass), >10mm: admit for stent, nephrostomy, lithotripsy Prevention: - inc. FLUIDS, diet changes, tx underlying cause
50
nephrolithiasis: types of stones
calcium: most common (85%) - radio-opaque struvite: 15% - assoc. w/ infections, staghorn - urine pH<7.2 - ABX do not penetrate staghorn, so inc. risk of urosepsis (may ned surgery) uric acid: 8% - radiolucent (not seen on KUB) - urine pH<5.5 cystine: <1% - hereditary condition
51
urinary incontinence: definition, general categories of causes
NOT normal with aging - women>men can be caused by issues within and outside urinary tract
52
urinary incontinence: causes outside urinary tract
``` Outside: DIAPPERS (r/o first) D: delirium I: infection A: atrophic urethritis P: pharmaceuticals (alpha and beta blockers, diuretics, alcohol, anti-psych, narcotics) P: psychiatric illness E: excessive urinary output (hyperglycemia, CHF) R: restricted mobility S: stool impaction ```
53
urinary incontinence: 4 types of pathology within urinary tract
1. Urge: "gotta go now" - caused by overactive bladder - most common in elderly - tx: bladder training is 1st choice; Oxybutinin 2. Stress: due to inc. abdominal pressure / dysfx of urethral sphincter - adult women - leak w/ cough, sneeze, valsalva - tx: Kegels 3. Overflow: due to outlet obstruction --> distention --> overflow - leakage from BPH - dx using post-void residual (large) - tx: relieve obstruction w/ cath or foley 4. Functional: urine system is normal, but cannot get to bathroom in time (immobility, cognitive problem)
54
benign prostatic hyperplasia (BPH): pathophysiology, s/sx
increase in # of cells in prostate which surrounds urethra pathophys: - dihydrotestosterone causes hyperplasia and age increases sensitivity to DHT - >90% of men over 80 s/sx: - obstructive sxs: hesitancy, weak flow - irritative sxs: frequency, urgency nocturia - DRE: smooth, enlarged prostate
55
BPH: dx and tx
Dx: R/O other cases (UA, PSA, creatinine, post void residual, flow rate, cystoscopy) Tx: 1. watchful wait if very minor 2. alpha blockers (tamulosin, doxazosin, terazosin): relaxes smooth muscle 3. 5alpha reductase inhibitors (finasteride, dutasteride): block formation of DHT - NOTE: these reduce PSA by 50% 4. Surgery: - TURP, TUIP, TUNA, TUMT, prostatectomay
56
erectile dysfunction: definition, causes, dx, management
inability to attain or maintain erection - >50% men 40-70 y/o causes: - medical conditions: DM, HTN, androgen deficiency, CAD, high chol - surgery: complications of tx for prostate cancer - drugs: alpha and beta blockers, diuretics, tobacco, ETOH dx: good H&P; labs to r/o contributing conditions tx: 1. treat underlying cause / limit risk factors 2. vasoactive therapy: oral PDE-5 inhibitors (sildenafil / Viagra); - Note: NEVER with nitro (severe hypotention)
57
priapism: causes, tx
painful, persistent erection lasting > 4 hours - can lead to permanent penile necrosis! causes: 1. medical conditions: sickle cell dz, leukemia, multiple myeloma 2. medications: anti-psychotics, sildenafil (rare) 3. illicit drugs: cocaine, ecstasy tx: - terbutaline, if fails... - aspiration of corpus cavernosum
58
peyronie's: definition, cause, tx
fibrotic plaque of tunica albuginea leading to penile curvature cause: unclear, repeat trauma (occurs in men >40) tx: - intra-plaque injection of Verapamil or interferon - Surgery to remove plaque (NO guarantee of normal fx)
59
foreskin conditions - 3 main ones
balanitis phimosis paraphimosis
60
balanitis: definition, cause, tx
swelling of foreskin and glans penis causes: - poor hygiene - more likely if uncircumcised - can be fungal in DM tx: - kids: none (hygiene) - adults: topical steroids or antifungals
61
phimosis: definition, cause, tx
foreskin unable to be retracted over glans penis cause: - kids: physiologic (no intervention) - adults: chronic low grade infection (Lichen sclerosis) tx: - betamethazone cream - stretch foreskin - circumcision
62
paraphimosis: definition, cause, tx
foreskin trapped in retracted position - edema, compromised blood supply - can cause necrosis > EMERGENCY cause: - long-term foley tx: - manual reduction - emergent dorsal slit
63
hypospadias: definition and tx
congenital abnormality when urethral meatus is ventral and proximal to normal position tx: repair b/f 18 months note: if hypospadias + bilateral cryptorchidism = think sex hormone abnormality
64
chordee: definition and tx
congenital abnormality resulting in ventral penile curvature, often associated with hypospadias tx: surery 6-18 months
65
vesicoureteral reflux (VUR): definition, population, dx, tx, complication
congenital abnormality when urine passes retrograde from bladder to kidneys during voiding - results from incompetent vesicoureteral sphincter population: child with recurrent UTIs dx: IVP (intravenous pyelogram), renal U/S, radionuclide cystogram, voiding cystourethrogram tx: - tx HTN (ACE-I) - ABX for frequent urine cx - surgery for severe reflux complication: - renal nephropathy: scarring associated w/ intra-renal reflux of infected urine - can lead to HTN
66
cryptorchidism: definition, risks, PE, tx
congenital abnormality when testicle fails to descend from abdomen into scrotum - normally, descent at 7 mo gestation but can get caught in inguinal ring risks: premature, low birth weight, MOC exposure to estrogens in 1st trimester, FH PE: - empty hemiscrotum/absence of scrotal rugae - must confirm not just retracted (pulled up into pubic area but can be "milked" into scrotum) - resolves by puberty w/o tx tx: - hCG IM daily for 3 days (25% will descend) - surgical correction by 1 y/o (inc. in testicular cancer and infertility if not)
67
hydrocele: definition, tx
accumulation of serous fluid in membranes around testicle (not fluid in scrotum) - benign and painless - must transilluminate testicles - no tx required
68
varicocele
varicosities in scrotum that feel like "bag of worms" - may be achy - increases with valsalva; dec. when supine - rarely tx unless effecting fertility
69
testicular torsion: definition, clinical features, s/sx
testis rotates on spermatic cord causing vascular occlusion clinical: - 10-20 y/o males - bell clapper deformity (testes not anchored) s/sx: - SUDDEN, SEVERE testicular pain, N/V - neg. Phren's sign: NO relief w/ elevation - neg. cremasteric reflex: NO retraction of ipsilateral testis when medial tight is stroked
70
testicular torsion: Ddx, imaging, tx
Ddx: - epididymitis (less acute, + Phren's sign, + cremasteric reflex) Image: - doppler U/S shows dec. arterial flow Tx: - SURGICAL EMERGENCY! - surgery in 4-6 hrs to save testicle - manual detorsion: in to out (open book)
71
epididymitis: definition, pathogens, s/sx, dx, tx
infection of epididymis - most common cause of adult scrotal pain pathogens: - < 35 y/o sexually active = GC/CT - not sexually active (young or older): E. Coli (uropathogens) s/sx: - gradual, severe, unilateral scrotal pain - scrotal inflammation, redness - urethral D/C and irritative voiding sx possible - + Phren's sign - + Cremasteric reflex Dx: doppler U/S to r/o torsion - labs: U/A, GC/CT, CBC tx: 1. bed rest, scrotal elevation, tight briefs, NSAIDS 2. if E. Coli: Ofloxacin or Levofloxin ABX 3. If STD: Ceftriaxone IM + Doxycycline for 10 days (cover for both GC and CT) - treat partner!
72
orchitis: defintion, s/sx, tx, complications, prevention
inflammation of one or both testes - associated with MUMPS - can also be spread of epididymitis s/sx: - 1 week after onset of parotitis - marked pain and swelling in 1 or both testes (large, tender, indurated) - N/V, fever, urinary sxs tx: - bed rest, scrotal support, ice, analgesics - ABX if due to epididymitis complications: - 1/2 develop testicular atrophy; 20% infertile - abscess and chronic epididymitis prevention: vaccine (MMR)!!
73
urethritis: causes, s/sx, dx, tx, complications
inflammation of urethra - usually infectious cause (GC/CT) s/sx: - urethral d/c (purulent), dysuria - may be asymptomatic dx: urine or urethral swab for gram stain or PCR tx: MUST treat BOTH GC and CT - ceftriaxone IM + azithromycin (PO) - ceftriaxone IM + doxycycline x 7 days complications: - men: epididymitis, disseminated GC infection, reactive arthritis - women: PID, ectopic preg, infertility
74
cystitis: pathogen, s/sx, dx, tx (in pregnancy)
infection of bladder - ascending infection, more common in women pathogen: E. Coli s/sx: dysuria, frequency, urgency, hematuria - low back pain, public pain, malaise Dx: - clean catch U/A (w/ cx) - urologic w/up if recurrent tx: ABX for 3-7 days - TMP/SMX, quinolones (cipro and levaquin), nitrofurantoin (only active in urinary tract) Note: nitrofurantoin in pregnancy!
75
pyelonephritis: pathogen, s/sx, dx, tx
renal inflammation pathogens: E/ Coli (most common) s/sx: - irritative voiding sx - fever, chills, flank pain and CVA tenderness, N/V - can develop sepsis! dx: - U/A: nitrites, WBC, RBC, WBC casts - urine cx - CBC: leukocytosis - imaging: only if obstruction suspected tx: - Uncomplicated: oral ABX x 14 days (Cipro or quinolone) - Admit: elderly, pregnant, etc. - IV ampicillin + aminoglycoside
76
prostatitis - 4 types
inflammation of prostate 1. acute bacteria prostatitis 2. chronic bacterial prostatitis 3. non-bacterial prostatitis (chronic pelvic pain syndrome) 4. prostatodynia - condition of normal prostate with no abnormal labs - thought to be due to musculature or spasm
77
acute bacterial prostatitis: pathogen, s/sx, what to avoid, dx. tx
pathogen: E. Coli s/sx: - perianal pain - toxic appearing, fever, chills, body aches DO NOT DO DRE - can become septic! dx: - fever, +U/A, + urine cx, DO NOT DO prostatic secretions tx: - 4-6 WEEKS TMP/SMX or fluoroquinolone - analgesia, fluids, rest
78
chronic bacterial prostatitis: pathogen, s/sx, what to avoid, dx. tx
recurrent infection of prostate Pathogen: usually gram neg rods (E. Coli) s/sx: milder than acute, not systemic - irritative voiding - low back and perineal pain - DRE: boggy and tender dx: - no fever, neg. U/A, positive urine cx, prostatic secretions w/ inc. WBCs Tx (>50% relapse): - TMP/SMZ, quinolones x 6-12 WEEKS - NSAIDs, alpha-blockers, sitz baths
79
nonbacterial prostatitis (CPPS: chronic pelvic pain syndrome): definition, s/sx, dx, tx
sxs of chronic prostatitis w/o infection s/sx: - chronic pelvic pain (wax and wane) - can be inflammatory or non inflammatory - cause unknown / dx of exclusion - NO hx of acute bacterial prostatitis dx: - no fever, neg. U/A, neg. urine cx, may have WBC in prostatic secretions if inflammatory tx: - ABX usually tried but do not help - alpha blockers, NSAIDs, benzos??
80
testicular carcinoma: risks, population, tumor type, s/sx, dx, tx, prognosis
risks: - cryptorchidism (40%!) - FH or personal hx - males 15-35 y/o (most common neoplasm) tumor type: most are germ cell tumors (nonseminomas and seninomas) - bHCG and LDH elevated in both - AFP elevated in nonseminomas s/sx: - PAINLESS testicular mass - usually does not MET (to lungs and brain if it does) dx: - scrotal U/S - CT (abd, pelvis, chest) and MRI (brain) for mets tx: - radical orchiectomy - radiation w/ seminomas - no radiation w/ nonseminomas prognosis: excellent (90-95% cure rate)
81
prostate cancer: risks, tumor type, s/sx, PE, mets
risks: age, AA, FH tumor type: adenocarcinomas (95%) s/sx: - many asymptomatic - pain, obstructive urinary sxs, erectile dysfunction PE: - DRE: indurated, hard prostate gland; may feel nodules Mets: bone (axial skeleton - low back)
82
Prostate specific antigen (PSA)
Good for staging, trending dx, detecting recurrence NOT for screening - only if FH Not: PSA is reduced by 50% by 5 alpha reductase inhibitors (used to tx BPH)
83
prostate cancer: dx, prognosis, tumor surveillance, tx
Dx: trans-rectal U/S-guided biopsy Gleason score: - evaluates tissue sample - higher score = cells less differentiated/irregular = poorer prognosis tumor surveillance: - CT abd and pelvis - bone scan - MRI Tx: many options - prostatectomy - radiation - cryotherapy - hormone therapy / androgen deprivation (LHRH agonists, antiandrogen meds, orchiectomy) - chemotherapy (if hormone therapy failed)
84
bladder cancer: risks, s/sx,
risks: - smoking (#1) - industrial dyes, solvents - male, > 40y/o s/sx: - PAINLESS hematuria (bladder cancer until proven otherwise) - may have irritative voiding sxs dx: - cystoscopy w/ biopsy tx: depends on penetration of bladder wall - Ta, T1: does not invade wall - transurethral resection +/- intravesical chemo - >T2: invades wall - radical cystectomy + pelvic lymphadenactomy +/- chemo and radiation
85
renal cell carcinoma: risk factors, s/sx, paraneoplastic syndrome, dx, tx
NOT common Risks: - smoking, male, obesity, HTN Note: risk of producing occlusive thrombi in renal vein and IVC!! s/sx: - hematuria - flank pain or mass 20% will have paraneoplastic syndromes (tumor produces ectopic hormones) - hypercalcemia - erythrocytosis - HTN - anemia dx: - imaging: CT w/ eval for mets (CXR, bone scan) - labs: U/A, studies for paraneoplastic syndromes tx: - if localized, radical or partial nephrectomy - if mets: palliative care
86
Wilms tumor (aka nephroblastoma): definition, population, s/sx, dx, tx, prognosis
cells meant to form kidney fail to develop properly - peak incidence 2-3 y/o - 5% childhood cancers s/sx: - PALPABLE ABDOMINAL MASS (60%) - abdominal pain - hematuria - N/V, anorexia, fever Dx: - imaging - biopsy is not done b/c could spill tumor cells tx: - surgical resection, nephrectomy, chemo, radiation prognosis: 85% curable