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Year 2 > Genitourinary: Part 4 > Flashcards

Genitourinary: Part 4 Flashcards

1
Q

Is ARPKD more common than ADPKD

A

It is RARER

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2
Q

What causes ARPKD

A

PKHD1 mutation on q arm of chromosome 6

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3
Q

Clinical presentation of ARPKD

A
  1. Presents in infancy
  2. Alongside congenital hepatic fibrosis
  3. Enlarged polycystic kidneys
  4. 30% develop kidney failure
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4
Q

Differential diagnosis of ARPKD

A
  1. ADPKD
  2. Multicystic dysplasia
  3. Hydronephrosis
  4. Renal vein thrombosis
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5
Q

Diagnosis of ARPKD

A
  1. ULTRASOUND
  2. CT and MRI
  3. Genetic testing
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6
Q

How is ARPKD treated

A
  1. Genetic counselling
  2. Laparoscopic removal of cysts to help with pain relief
  3. RAMIPRIL
  4. Treat stones an give analgesia
  5. Renal replacement therapy for ESRF
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7
Q

How do we diagnose non-malignant scrotal disease

A

If we can prove testicular lump is NOT cancer:

  1. Can you get above it
  2. Can you separate it from the testis
  3. Cystic or solid
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8
Q

What is the scrotal disease if you cannot get above the lump

A
  1. Inguinoscrotal hernia or proximally extending hydrocele
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9
Q

What is the scrotal disease if separate and cystic

A

Epididymal cyst

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10
Q

What is the scrotal disease if separate and solid

A

Epididymitis or varicocele

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11
Q

What is the scrotal disease if testicular and cystic

A

Hydrocele

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12
Q

What is the scortal disease if testicular and solid

A

Tumour

Haematocele

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13
Q

Characteristics of an epididymal cyst

A
  1. Smooth
  2. Extratesticular
  3. Spherical cyst in head of epididymis
  4. Contains clear and milky fluid
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14
Q

Clinical presentation of epididymal cyst

A
  1. Many an bilateral
  2. Small cysts = asymptomatic
  3. Well defined and transluminate since fluid-filled
  4. Testis is palpable quite separately from cyst (unlike hydrocele where testes is palpable within fluid filled swelling)
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15
Q

Differential diagnosis of epididymal cyst

A
  1. Spermatocele
  2. Hydrocele - collections of fluid surrounding entire testicles
  3. Varicocele - dilated veins that increases with abdo pressure
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16
Q

What is spermatocele

A
  1. Fluid-filled sperm filled cyst in epididymis

2. No way to differentiate between cyst of epididymis and spermatocele

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17
Q

How can we differentiate spermatocele from epididymal cyst

A

Sperms are present in milky fluid aspiration

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18
Q

How is epididymal cyst diagnosed

A

ULTRASOUND

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19
Q

How is epididymal cyst treated

A
  1. Not needed

2. Surgical excision if painful

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20
Q

What is hydrocele

A
  1. Abnormal collection of fluid within the tunica vaginalis
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21
Q

Where are primary hydroceles found

A

Younger men

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22
Q

What is primary hydrocele associated with

A

Patent processus vaginalis which resolves during 1st year of life

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23
Q

In what individuals are secondary hydroceles found

A
  1. Older boys and men
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24
Q

What diseases cause secondary hydrocele

A
  1. Testis tumour
  2. Trauma
  3. Infection
  4. TB
  5. Testicular torsion
  6. Generalised oedema
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25
Pathophysiology of simple hydrocele
Overproduction of fluid in tunica vaginalis
26
Pathophysiology of communicating hydrocele
Processus vaginalis fails to close , allowing peritoneal fluid to communicate freely with scrotal portion
27
Clinical presentation of hydrocele
1. Scrotal enlargement with non-tender,smooth and cystic swelling 2. No pain unless infection present 3, Testis palpable but not in large hydrocele 4. Lies anterior to and below testis and will transluminate
28
Differential diagnosis of hydrocele
Tetsicular torsion and strangulated hernias
29
Diagnosis of hydrocele
Ultrasound | Serum alpha-fetoprotein and human chorionic gonadopreotein excludes malignant teratomas or germ cell tumours
30
Treatment of hydrocele
Resolves on its own by 2 years of age | 2. Therapeutic aspiration or surgical removal
31
What is a varicocele
1. Abnormal dilatation of testicular veins in the pampiniform venomous plexus = venous reflux
32
What side of the testis is usually effected more commonly in varicoceles
Left
33
In what individuals are varicoceles common in
Boys over 10 (after puberty) Associated with sub-fertility
34
Where is a varicocele palpated
Left tetsicular vein enters renal vein
35
Pathophysiology of a varicocele (what causes it)
Increased reflux from compression of renal vein Lack of effective valves between testicular and renal veins
36
Clinical presentation of varicocele
1. Distended scrotal blood vessels that feel like a bag of worms 2. Patients have dull ache or scrotal heaviness 3. Scrotum hangs lower on the side of varicocele
37
Differential diagnosis of varicocele
1. Secondary to other pathological processes blocking testicular vein (kidney tumours or retroperitoneal tumours
38
Diagnosis of a varicocele
1. Venography | 2. Colour doppler ultrasound
39
Treatment of a varicocele
Surgery if there is pain, infertility or testicular atrophy
40
Define testicular torsion
Torsion of spermatic cord leads to occlusion of tetsicular blood vessels - ischaemia and infarct)
41
What cells are most susceptible to ischaemia
GERM CELLS
42
When does surgery need to be performed to save testis after testicular torsion
Less than 6 hours after torsion happens More than 24 hours after - 0% chance of keeping it
43
What side of the tetsis is most commonly effected in a torsion
LEFT
44
What is belt-clapper deformity
Where testis is not fixed to scrotum completely - free movement and twisting
45
Risk factors for testicular torsion
Genetic
46
Clinical Presentation for testicular torsion
1. Presenting with abdo pain - testes should be checked 2. Sudden onset of pain in one testis - makes walking uncomfortable 3. Pain comes on during sport or physical activity 4. Pain in abdo, nausea and vomiting are common 5. Inflammation of one testis - very tender, hot and swollen 6. Testis may lie high or transversely WITH INTERMITTENT TORSION - pain may have passed on presentation - but was severe and lie is horizontal then prophylactic fixing may be wise
47
Differential diagnosis of testicular torsion
1. EPIDIDYMO-ORCHITIS: But usually patient tends to be older and there may be symptoms of UTI and more gradual onset of pain 2. Tumour, trauma and an acute hydrocele 3. Torsion of testicular or epididymal appendage (remnant of mullein duct) 4. Idiopathic scrotal oedema
48
When does torsion of testicular epididymal appendage occur
1. Usually occurs in boys between 7 and 12 and causes less pain
49
Clinical presentation of torsion of testicular epididymal appendage
Small blue nodule under scrotum
50
What causes torsion of testicular or epididymal appendage
Surge in gonadotropins that single onset of puberty
51
When does idiopathic scrotal oedema occur
Between 2 to 10 years
52
How is idiopathic scrotal oedema differentiated from testicular epididymal appendage
Absence of pain and tenderness
53
How is tetsicular torsion diagnosed
1. DOPPLER ULTRASOUND - lack of blood flow to testis) 2. Urinalysis - exclude infection and epididymis 3. DO NOT DELAY SURGICAL EXPLORATION
54
How is tetsicular torsion treated
Surgery | 2. Orchidectomy (removal of tetsis) and bilateral fixation
55
Define BPE
Benign prostatic enlargement - CLINCIAL DIAGNOSIS
56
Define BPH
Benign prostatic hyperplasia - HISTOLOGICAL DIAGNOSIS
57
Define BOO
Bladder outflow obstruction- URODYNAMIC DIAGNOSIS
58
Define hydronephrosis
Dilatation of renal pelvis of the kidney - lead stop damage
59
Define obstructive uropathy
Functional and anatomical obstruction of urine flow at any level of the urinary tract
60
Define supravesical obstruction
Above bladder
61
Define infravesical obstruction
Below bladder
62
Normal function of the LUT
Convert continuous process of excretion to an intermittent process of elimination Store urine insensibly Void urine when convenient
63
Role of detrusor muscles
Relax during storage Contracts when voiding Parasympathetic cholingeric control - S3,4,5
64
Role of distal sphincter
1. Contracts when storage 2. Relaxes when voiding 3. SYMPATHETIC CONTAL - T10,L1,L2
65
Four ways we can classify urine storage symptoms
1. Urgency 2. Nocturne (>30% volume added) 3. Frequency 4. Overlfow incontinence
66
7 ways we can classify urinary voiding issues
1. Poor intermittent stream 2. hesitancy 3. Incomplete emptying 4. Post-micturition dribbling 5. Straining 6. Haematuria red flag 7. Dysuria red flag
67
What is PSA
Glycoprotein expressed by normal and neoplastic prostate tissue
68
Where is pSA produced
Prostate in semen
69
Is pSA present in blood
Yes
70
When is PSA raised
1. BPH 2. Prostate cancer 3. Perianal trauma from surgery 4. BMI > 25 5. Taller men 6. Prostatitis 7. Black africans 8. Ejaculation 9. UTI s
71
What PSa level confers risk of LUTS progression
Greater than 1.4 ng/ml
72
What flow rate suggests bladder outflow obstruction due to BPH
Max flow rate less than 10
73
When do we look at max flow rate
When more than 150ml has been voided
74
What is the frequency volume chart
Measures volume voided and time over MINIMUM 3 days Calculates whether polyuric or nocturic
75
Define acute urinary retention
Sudden onset of painful inability to pass urine with over 500ml in bladder Palpable
76
Causes of acute urinary retention
``` 1. Prostatic obstruction 2> urethral strictures 3. Anticholinergics 4. Alcohol 5. Constipation 6. Post-op 7. Infection 8. Neurological (spinal compression - cauda equina syndrome) ```
77
How is acute urinary retention examined
1. Abdo, protstate (DRE) and perineal sensation to check for caudal equine syndrome
78
Diagnostics for urinary retention
Normal renal biochemistry 2. Renal ULTRASOUND 3. PSA test
79
Treatment for urinary retention
1. Catheter 2. TAMULOSIN (alpha-1 blocker) - relaxes smooth muscle in bladder neck 3. 5-alpha reductase inhibitor - FINASTERIDE which reduces testosterone conversion to dihydrotestosterone = reduction in prostate size
80
Consequence of chronic urine retention
Increased risk of infection | 2
81
When is chronic urine retention low pressure
Detrusor failure
82
When is chronic urine retention high pressure
Interactive obstructive uropathy
83
What causes chronic urine retention
1. Prostatic enlargement due to BPH 2. Pelvic malignancy or rectal surgery 3. Diabetes
84
Clinical presentation of chronic urine retention
1. Overflow incontinence - leaking urine during the day/wetting bed 2. Loss of appetite, constipation, distended abdomen, UTI
85
How to manage chronic urine retention
Pain, urinary infection or renal impairment
86
What kind of urinary tract obstructions are there (4)
1. Partial 2. Complete 3. Unilateral 4. Bilateral
87
Luminal causes of urinary tract obstruction
1. Stones 2. Blood 3. Clot 4. Sloughed papilla 5. Tumour
88
Mural causes of urinary tract obstruction
1. Congenital or acquired stricture, neuromuscular dysfunction or schistomiasis
89
Extra-mural causes of urinary tract obstruction
1. Abdo or pelvis mass/tmour, retroperitoneal fibrosis, BPH, prostate cancer 2. Pregnancy 3. Inflammation (peritonitis or diverticulitis)
90
Clinical presentation of acute upper tract obstruction
Loin pain radiating to groin
91
Clinical presentation of acute lower tract obstruction
Flank pain, renal failure, infection and polyuria as urinary conc is lower
92
Clinical presentation of acute lower tract obstruction
Suprapubic pain, bladder outflow obstruction Distended, palpable bladder
93
Clinical presentation of chronic lower tract obstruction
1. Urinary frequency, hesitancy, poor stream, terminal dribbling and overflow incontinence 2. Distended, palpable bladder (+/- large prostate on rectal exam) 3. Complications are UTI and urinary retention
94
Diagnostics of urinary obstructions
1. FBC 2. Mid-stream urinary sample 3. ULTRAOSUND
95
FBC results for urinary obstruction
U and Es for creatinine (raised
96
What would ultrasound show in urinary obstruction
Hydronephrosis - arrange for CT after
97
Treatment for upper tract obstruction
1. Nephrostomy 2. Alpha-1 antagonist 3. 5-alpha reductase inhibitor
98
What is a nephrostomy
Artificial opening created between kidney and skin allows for urinary diversion directly from upper tract
99
Treatment for lower tract obstruction
1. Urethral catheter 2. Suprapubic catheter 3. TURP (Transurethral resection of prostate)
100
Pros of suprapubic catheter
Less risk of UTI and urethral damage less likely to be colonised by bacteria
101
Cons of suprapubic catheter
1. Urethral erosion image to urethral sphincter 2. Small risk of bowel injury during insertion 3. Requires general anaesthetic

Year 2 (155 decks)

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