Genitourinary Disorders Flashcards
(169 cards)
1
Q
How and where does the enlargement occur in BPH?
A
Periurethral enlargement from proximal to distal
2
Q
Etiologic risk factors for BPH?
A
gaining (age related changes in androgen levels)
genetics
race
diet
3
Q
What coverts DHT to T?
A
5a-reductase
4
Q
What is the function of DHT?
A
Supports prostate str and fx
5
Q
What imbalance occurs in BPH?
A
T:E imbalance. Quantitative decrease in T and relative increase in E
6
Q
What is the role of E in BPH? How does it work within its pathology?
A
E sensitizes prostatic cells to DHT.
More E = more sensitive
= increased growth
7
Q
What 2 cellular adaptations occur in BPH?
A
Hyperplasia of periurethral tissue
Hypertrophy of smooth muscle
8
Q
2 compensations during BPH?
A
bladder wall thickens
trabeculations & diverticula form
9
Q
2 complications from BPH and why do they occur?
A
calculi formation and infection due to urine stasis
10
Q
Consequential structural changes during BPH?
A
hydroureter (ureters distend w urine)
fishhook ureters (ureters loop downward)
hydronephrosis (distention of renal pelvis and calices with urine)
11
Q
5 Diagnostics for BPH?
A
DRE PSA BUN Creatinine Urinalysis
12
Q
What is PSA and what is it used for?
A
Prostate specific antigen
Normal component of prostatic fluid
Proportional to prostatic mass
13
Q
What additional diagnostic test is needed to calculate PSAD and PSAV?
A
US
14
Q
What kind of neoplasia occurs in prostate CA? (4)
A
Adenocarcinoma of peripheral origin, multi centric, beneath the capsule
15
Q
Where does extension occur in Prostate CA
Where does mets?
A
Bladder & seminal vesicle
Bone, liver, lungs
16
Q
Manifestations of Prostate CA and why?
A
Prostatitis r/t mets and invasion
Hip & back pain r/t bone mets
17
Q
1st line tx for prostate CA?
A
anti androgens (eg. estrogen)
18
Q
What does a radical prostatectomy include?
A
prostate and seminal vesicle
19
Q
What is inflamed in PID
A
reproductive tract beyond cervix (excluding vagina)
20
Q
What is affected in PID
A
uterus (endometritis)
tubes (salpingitis)
ovary (oophoritis)
21
Q
Etiologic factors (specific bacteria) for PID
A
POLYMICROBAL/PYOGENIC
chlamydia, gonococci, staphylococci, strepcocci, E-coli
22
Q
What untreated STIs can cause PID?
A
gonorrhoea or chlamydia
23
Q
When do the microbes enter the cervix in PID? Why is this time beneficial for their survival?
A
Menstruation
Menstrual slough is rich in nutrients
24
Q
Complications of PID (4)
A
Pelvic abscess
Peritonitis
Systemic Spread
Parametritis
25
Manifestations of PID (7)
```
abd pain
heavy purulent vaginal discharge
dyspareunia (pain during intercourse)
adnexal tenderness
fever
vaginal bleeding
leukocytosis
```
26
What will be elevated in PID
ESR and CRP
27
Tx PID
multiple broad spectrum Abx
28
What hormonal factors are risks for developing breast CA?
E admin for menopause, early menarche, late menopause, nulliparity
29
What hereditary genes contribute to breast CA?
BRCA1 gene on Chr 17
| BRCA2 gene on Chr 13
30
8 types breast CA?
```
ductal carcinoma in situ
infiltrating ductal carcinoma
infiltrating lobular carcinoma
inflammatory carcinoma
medullary carcinoma
mucinous carcinoma
tubular ductal carcinoma
Paget's disease
```
31
What stage in ductal carcinoma in situ? What does this mean? Is it invasive?
0.
If not treated, will become invasive
No
32
Most common breast CA?
infiltrating ductal carcinoma
33
Where do most malignancies occur in breast CA?
Tail of spence
34
Where does infiltrating ductal carcinoma mets to?
Axillary lymph nodes, liver, bone, brain
35
What is the mass like in infiltrating ductal carcinoma?
fixed
irregular
painless
36
Later manifestations of infiltrating ductal carcinoma?
nipple discharge, retraction and edema
37
What is the biopsy looking for in breast CA?
surface receptors for E and Progesterone.
38
If there are lots of surface receptors for E or P in breast CA biopsy, what does this mean?
The tumor is dependent on hormones for support
39
Serum marker for breast CA?
CEA (carcinoembryonic antigen)
protein needed for cell adhesion
also for Colorectal CA
40
Why would we treat a hormone dependent tumor with more of the hormone?
High doses of hormones will decrease number of receptors on tumor
41
If E/P receptors high in breast CA, what is a tx?
tamoxifen (antiestrogen, non steroidal)
42
Lumpectomy
removal of tumor and surrounding tissue
43
Quadrantectomy
removal of quadrant
44
Mastectomy
entire breast
45
What determines the prognosis of breast CA?
not the breast tissue involved, but lymph node involvement
46
Why is ovarian CA the most lethal CA? (4)
no screen
difficult to dx
silent advancement
mets at dx
47
Et/risks for ovarian CA?
age, increased ovulatory age (age of oocytes, first menses - menopause), autosomal dominant, familial history, nullipatiry, infertility, dysmenorrhea
48
What familial history is pertinent in ovarian CA?
breast/ovarian CA of 1st/2nd degree relatives
49
What kind of malignancy is ovarian CA usually?what other kinds of tumors are possible?
epithelial
germ cell, stromal
50
Where does extension in ovarian CA happen?
tubes, uterus, ligaments, other ovary
51
Where does seeding occur in ovarian CA?
mesentery, bowel, liver
52
How does mets occur in ovarian CA?
via lymph/blood
53
Early manifestations of ovarian CA?
nonspecific GI disturbances
54
Uterine CA is also known as
Endometrial CA
55
Why is obesity a risk for uterine CA?
adipose tissue stores and synthesizes E & hyperestrogenism is a risk factor for this CA
56
Risk factors for uterine CA?
obesity, hyperestrogenism, age, pelvic radiation, DM, HTN
57
Every month, what normal cellular adaptation happens in the uterus? How does this become abnormal in uterine CA?
hyperplasia of endometrium
| ++ E = hyperplasia -> dysplasia -> anaplasia
58
What kind of neoplasia is uterine CA?
adenocarcinoma
59
Type 1 uterine CA
E dependent, from hyperestrogenism
60
Type 2 uterine CA
non E dependent
associated c atrophy of endometrium (those with atrophied endometriums who get uterine CA will get type 2)
poor prognosis
61
Et/risks for cervical CA
HPV infection, early age sex, multiple partners, unprotected sex, smoking, hx of STDs
62
What strains of HPV cause genital warts? Which ones cause cervical CA?
6 & 11
| 16 & 18
63
What kind of cell origin is cervical CA?
squamous cell origin
64
3 stages cervical CA (not CIN)
dysplasia
carcinoma in situ
invasive CA
65
CIN levels
CIN1: preCA, mild dysplasia
CIN2: PreCA, moderate dysplasia
CIN3: severe dysplasia, carcinoma in situ
66
What scope is done to dx cervical CA?
colposcopy
67
What 2 factors can contribute to menstrual pattern changes?
lack of ovulation
| disturbances of hormone patterns
68
What is amenorrhea?
No menstruation
69
What is primary amenorrhea?
no menstruation if over 15 years or 13 years if the woman has no secondary sex characteristic
70
What is secondary amenorrhea?
cessation of menses for at least 6 months when normal cycles were present
71
What causes primary amenorrhea? (4)
gonadal dysgenesis, congenital mullerian genesis, testicular feminization, hypothalamic-pituitary ovarian axis
72
What causes secondary amenorrhea? (8)
```
ovarian, pituitary or hypothalamic dysfunction
intrauterine adhesions
infections (syphilis or TB)
pituitary tumor
anorexia
++ physical activity
```
73
How can menstruation be induced in the treatment of amenorrhea?
cyclic P and E
74
What is dysmenorrhea?
Pain and discomfort with menstruation
75
Primary dysmenorrhea is
menstrual pain not associated pathologically, after menarche, systemic symptoms
76
secondary dysmenorrhea
caused by organic conditions such as endometriosis, uterine fibrosis, adenomyosis, IUDs, PID
77
Tx of dysmenorrhea
symptom control, prostaglandin synthetase inhibitors, ovulation suppression (oral contraceptives)
78
What is the significance of prostaglandins in dysmenorrhea?
++ PG = painful uterine contractions and arteriolar vasospasm
79
What is Menorrhagia?
Prolonged/excessive bleeding at time of regular flow
80
What causes menorrhagia?
EARLY IN LIFE
endocrine imbalance
LATER IN LIFE
inflammatory disturbances, tumors in uterus, hormonal imbalance
81
What is metorrhagia?
Vaginal bleeding between regular menstrual periods
82
What kind of renal CA occurs in children?
Wilms Tumor
83
Why is Wilms tumor called an embryonic kidney tumor?
Composed of elements that resemble normal fetal tissue
84
What congenital abnormalities are associated with Wilms tumor?
Anirida, hemihypertrophy
85
What gene mutation is associated with Wilms tumor?
WT1 gene on Chr 11 encoding for factor needed for kidney development
86
What does Wilms tumor look like?
solitary mass, encapsulated, distends kidney
87
Manifestations of Wilms tumor?
asymptomatic abdominal mass, HTN, abd pain, vomiting
88
What Renal CA affects adults?
Renal Cell Carcinoma
89
Risk factors for Renal Cell Carcinoma
smoking, kidney CA, obesity, exposure, chronic renal insufficiency, acquired cystic kidney disease
90
5 Kinds of Renal Cell Carcinoma and the most common?
```
Clear cell carcinoma (most common)
Papillary tumors
Chromophoric tumors
oncocytomas
collecting duct tumors
```
91
What features of clear cell carcinoma?
clear cytoplasm
Chr 3 deletion
proximal epithelial cell origin
92
Symptoms of Renal Cell Carcinoma indicate...
| What are they...
Advanced disease
Hematuria and flank pain, presence of palpable flank mass
93
What MO is associated with bladder CA
S. Maematobium parasite
94
What 2 kinds tumors bladder CA
High grade invasive and low grade invasive
95
Risks for bladder CA
carcinogens excreted in urine (dyes), smoking, UTIs, stones
96
What is a the neoplasm derived from in bladder CA?
Transitional epithelial cells lining bladder
97
3 hematuria associated with bladder CA?
painless, gross, microscopic
98
What diagnostics are done for high risk patients bladder CA
periodic urine cytology, cystoscopy, biopsy, US, CT
99
What tx bladder CA
endoscopic resection, diathermy
100
What 4 defences does the UT have?
mucin layer (secreted by bladder cells prevents contact with urine), washout, prostatic fluid (antimicrobial), women = periurethral flora (microbial antagonism)
101
What bacteria usually causes lower UTI and pyelonephritis?
E coli
102
Pyelonephritis is the inflammation of...
The upper UTI including the renal pelvis and parenchyma
103
What risks associated with pyelonephritis?
suppressed immunity, catheterization, urinary reflux, DM
104
Chronic for pyelonephritis, 3 points
recurrent inflammation = obstr/reflux
renal damage = renal failure
fibrosis and scar tissue
105
Pyuria in pyelonephritis is
pus in urine
106
what is a serious manifestation in chronic pyelonephritis?
Severe HTN
107
5 Categories of glomerular disease
```
Nephrotic syndromes
Nephritic syndromes
Sediment disorders
Chronic glomerulonephritis
Rapidly progressive glomerulonephritis
```
108
Characteristics of nephrotic syndromes
increase perm of G = increased filtrate and abnormal urine composition
fluid and protein loss
109
Characteristic of nephritic syndromes
decreased permeability of G, fluid and NW retention = azotemia
110
Patients with glomerular disease can often present with both...
nephritic and nephrotic syndromes
111
Sediment disorder characteristics
hematuria and or proteinuria
112
Acute post infectious glomerulonephritis is an example of what glomerular disease?
Rapidly progressive glomerulonephritis
113
What precedes Acute post infectious glomerulonephritis?
An A beta hemolytic strep infection
dermal or pharyngeal
114
Who does Acute post infectious glomerulonephritis affect mostly?
children
| adults - 30% will develop RF
115
Patho Acute post infectious glomerulonephritis
T3HS
IC traps in G = GF impeded
Hypercellularity (leukoytes, endothelial cells, mesangeal cells)
glomerular enlargement d/t inflm
116
What are some initial and late mnfts of Acute post infectious glomerulonephritis
initially = oliguria d/t impaired filtration d/t IC imbedding
then = proteinuria and hematuria d/t later inflammatory damage
Increased BUN and Creatinine
HTN & edema
117
Where do renal calculi occur?
Anywhere in the UT
118
What 3 factors can contribute to the formation of renal calculi?
Structural changes
Increased [blood/urine]
dietary & metabolic factors
119
What usually inhibits crystallization for renal calculi formation?
3 kidney proteins
120
4 types of kidney stones
Calcium (oxalate+phosphate)
Magnesium ammonium phosphate (struvite)
Uric Acid (urate)
Cystine
121
What quality of pain occurs with renal calculi?
Renal colic
122
When does non colicky pain occur with renal calculi?
staghorn calculi
123
IVP is what and for which condition?
intravenous pyelogram
| renal calculi
124
renal calculi
Passed spontaneously
125
What 3 drugs are given for renal calculi?
Morphine
Dimenhydrinate
Buscopam (antispasmodics)
126
Sx for renal calculi?
Lithotripsy
127
Stress incontinence (3)
change in urethro-vesicular angle (d/t pelvic distention/childbirth)
weak sphincter
Increased intrabdominal pressure (coughing/laughing)
128
Overflow incontinence (2)
intravesicular pressure > urethral pressure
| retention and bladder distension
129
Overactive bladder (2)
Hyperactive detrusor muscle
| Neurogenic/myogenic problem
130
Why are alpha adrenergic agonists used for urinary incontinence?
They cause contraction of the urethral sphincter (fortify and strengthen)
131
2 major problems in ARF
fluid/electrolyte imbalance
| azotemia
132
How much urine must be produced each day to avoid azotemia?
400 mL/day
133
What is oliguria?
100-400 mL/day
134
What is anuria?
135
Main etiologic factors for ARF?
hypotension/hypovolemia
136
Pre Renal ARF presents with
oliguria and ischemia
137
Infrarenal ARF 3 stages
Initiating phase = precipitating event -> manifestations
Maintenance phase = Decreased GFR, oliguria
Recovery phase = tissue repair and gradual increased in GFR
138
Why are you monitoring closely when administering fluids to those in ARF
Kidneys cannot make adjustment
139
3 stages CRF
Diminished renal reserve
Renal insufficiency
Renal failure
140
Diminished renal reserve
GFR
141
Renal Insufficiency
GFR 20-50% of normal
142
Renal Failure
GFR
143
End stage CRF
GFR
144
How can STDs be transmitted?
Via genitalia, mouth, rectum, skin, placenta
145
Why are females at a higher risk for contracting STDs?
Higher SA = higher probability of transmission
146
What are the viral STDs
Herpes, warts, AIDS
147
What are the bacterial STDs
syphilis, chlamydia, gonorrhoea, chancroid
148
What predisposes someone at a higher risk of contracting a STD
multiple partners, unsafe practices, drug abuse, underserved medically, prior STDs, noncompliant STD tx
149
What virus causes genital herpes
HSVT2
150
What kind of virus is herpes simplex two
A neurotrophic microbe = replicates in neurons
151
Does genital herpes always present with symptoms?
No. Can be subclinical
152
What causes genital warts?
HPV 6 & 11
153
What topical drugs are available for genital warts?
Antimitotic and cytotoxic
154
What causes syphilis? What kind of organism is it?
Treponema pallidum
Spirochetes
Long gen time
155
How is syphilis spread?
Contact with lesions and through placenta
156
How does the syphilis microbe replicate?
Replicates and distributes systemically
157
Complications of syphilis?
Blindness, paralysis, heart disease, death
158
At which stages can syphilis be eradicated?
primary and secondary
159
What happens in the primary stage of syphilis?
Painless chancre at exposure site
Healing 3-12 weeks
Regional lymphadenopathy
160
What happens in the secondary stage of syphilis?
Maculopapular rash to palms/soles
Patches on mucous meds/flat papule
Generalized lymphadenopathy
Fever, malaise
161
Why is long acting penicillin used for syphilis?
long generation time
162
What causes chlamydia?
Chlamydia trachomatis
163
Male symptoms chlamydia
white clear DC, mild dysuria, testicular pain
164
Female symptoms chlamydia
mucopurulent vaginal DC, dysuria, bleeding, pelvic pain d/t PID
165
Tx for chlamydia
Doxycycline or azithromycin
166
What bacteria causes gonorrhoea?
Neisseria gonorrhoeae (Gm -, diplococcus)
167
Local symptoms of gonorrhoea M/F
```
Female= purulent vaginal DC, dysuria, late = pelvic pain
Male= urethral DC, dysuria
```
168
Systemic manifestations of gonorrhoea
bacteremia/septicemia, pharyngeal infection, conjunctivitis, arthritis-dermatitis syndrome
169
Tx gonorrhoea
```
1st line: cepholasporins
2nd: increase dose + another class of Abx
```
