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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
Q

Pathophysiology of simple hydrocele

A

Overproduction of fluid in tunica vaginalis

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26
Q

Pathophysiology of communicating hydrocele

A

Processus vaginalis fails to close , allowing peritoneal fluid to communicate freely with scrotal portion

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27
Q

Clinical presentation of hydrocele

A
  1. Scrotal enlargement with non-tender,smooth and cystic swelling
  2. No pain unless infection present
    3, Testis palpable but not in large hydrocele
  3. Lies anterior to and below testis and will transluminate
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28
Q

Differential diagnosis of hydrocele

A

Tetsicular torsion and strangulated hernias

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29
Q

Diagnosis of hydrocele

A

Ultrasound

Serum alpha-fetoprotein and human chorionic gonadopreotein excludes malignant teratomas or germ cell tumours

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30
Q

Treatment of hydrocele

A

Resolves on its own by 2 years of age

2. Therapeutic aspiration or surgical removal

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31
Q

What is a varicocele

A
  1. Abnormal dilatation of testicular veins in the pampiniform venomous plexus = venous reflux
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32
Q

What side of the testis is usually effected more commonly in varicoceles

A

Left

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33
Q

In what individuals are varicoceles common in

A

Boys over 10 (after puberty)

Associated with sub-fertility

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34
Q

Where is a varicocele palpated

A

Left tetsicular vein enters renal vein

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35
Q

Pathophysiology of a varicocele (what causes it)

A

Increased reflux from compression of renal vein

Lack of effective valves between testicular and renal veins

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36
Q

Clinical presentation of varicocele

A
  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
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37
Q

Differential diagnosis of varicocele

A
  1. Secondary to other pathological processes blocking testicular vein (kidney tumours or retroperitoneal tumours
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38
Q

Diagnosis of a varicocele

A
  1. Venography

2. Colour doppler ultrasound

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39
Q

Treatment of a varicocele

A

Surgery if there is pain, infertility or testicular atrophy

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40
Q

Define testicular torsion

A

Torsion of spermatic cord leads to occlusion of tetsicular blood vessels - ischaemia and infarct)

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41
Q

What cells are most susceptible to ischaemia

A

GERM CELLS

42
Q

When does surgery need to be performed to save testis after testicular torsion

A

Less than 6 hours after torsion happens

More than 24 hours after - 0% chance of keeping it

43
Q

What side of the tetsis is most commonly effected in a torsion

44
Q

What is belt-clapper deformity

A

Where testis is not fixed to scrotum completely - free movement and twisting

45
Q

Risk factors for testicular torsion

46
Q

Clinical Presentation for testicular torsion

A
  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
Q

Differential diagnosis of testicular torsion

A
  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
Q

When does torsion of testicular epididymal appendage occur

A
  1. Usually occurs in boys between 7 and 12 and causes less pain
49
Q

Clinical presentation of torsion of testicular epididymal appendage

A

Small blue nodule under scrotum

50
Q

What causes torsion of testicular or epididymal appendage

A

Surge in gonadotropins that single onset of puberty

51
Q

When does idiopathic scrotal oedema occur

A

Between 2 to 10 years

52
Q

How is idiopathic scrotal oedema differentiated from testicular epididymal appendage

A

Absence of pain and tenderness

53
Q

How is tetsicular torsion diagnosed

A
  1. DOPPLER ULTRASOUND - lack of blood flow to testis)
  2. Urinalysis - exclude infection and epididymis
  3. DO NOT DELAY SURGICAL EXPLORATION
54
Q

How is tetsicular torsion treated

A

Surgery

2. Orchidectomy (removal of tetsis) and bilateral fixation

55
Q

Define BPE

A

Benign prostatic enlargement - CLINCIAL DIAGNOSIS

56
Q

Define BPH

A

Benign prostatic hyperplasia - HISTOLOGICAL DIAGNOSIS

57
Q

Define BOO

A

Bladder outflow obstruction- URODYNAMIC DIAGNOSIS

58
Q

Define hydronephrosis

A

Dilatation of renal pelvis of the kidney - lead stop damage

59
Q

Define obstructive uropathy

A

Functional and anatomical obstruction of urine flow at any level of the urinary tract

60
Q

Define supravesical obstruction

A

Above bladder

61
Q

Define infravesical obstruction

A

Below bladder

62
Q

Normal function of the LUT

A

Convert continuous process of excretion to an intermittent process of elimination
Store urine insensibly
Void urine when convenient

63
Q

Role of detrusor muscles

A

Relax during storage
Contracts when voiding
Parasympathetic cholingeric control - S3,4,5

64
Q

Role of distal sphincter

A
  1. Contracts when storage
  2. Relaxes when voiding
  3. SYMPATHETIC CONTAL - T10,L1,L2
65
Q

Four ways we can classify urine storage symptoms

A
  1. Urgency
  2. Nocturne (>30% volume added)
  3. Frequency
  4. Overlfow incontinence
66
Q

7 ways we can classify urinary voiding issues

A
  1. Poor intermittent stream
  2. hesitancy
  3. Incomplete emptying
  4. Post-micturition dribbling
  5. Straining
  6. Haematuria red flag
  7. Dysuria red flag
67
Q

What is PSA

A

Glycoprotein expressed by normal and neoplastic prostate tissue

68
Q

Where is pSA produced

A

Prostate in semen

69
Q

Is pSA present in blood

70
Q

When is PSA raised

A
  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
Q

What PSa level confers risk of LUTS progression

A

Greater than 1.4 ng/ml

72
Q

What flow rate suggests bladder outflow obstruction due to BPH

A

Max flow rate less than 10

73
Q

When do we look at max flow rate

A

When more than 150ml has been voided

74
Q

What is the frequency volume chart

A

Measures volume voided and time over MINIMUM 3 days

Calculates whether polyuric or nocturic

75
Q

Define acute urinary retention

A

Sudden onset of painful inability to pass urine with over 500ml in bladder

Palpable

76
Q

Causes of acute urinary retention

A 
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
Q

How is acute urinary retention examined

A
  1. Abdo, protstate (DRE) and perineal sensation to check for caudal equine syndrome
78
Q

Diagnostics for urinary retention

A

Normal renal biochemistry

  1. Renal ULTRASOUND
  2. PSA test
79
Q

Treatment for urinary retention

A
  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
Q

Consequence of chronic urine retention

A

Increased risk of infection

2

81
Q

When is chronic urine retention low pressure

A

Detrusor failure

82
Q

When is chronic urine retention high pressure

A

Interactive obstructive uropathy

83
Q

What causes chronic urine retention

A
  1. Prostatic enlargement due to BPH
  2. Pelvic malignancy or rectal surgery
  3. Diabetes
84
Q

Clinical presentation of chronic urine retention

A
  1. Overflow incontinence - leaking urine during the day/wetting bed
  2. Loss of appetite, constipation, distended abdomen, UTI
85
Q

How to manage chronic urine retention

A

Pain, urinary infection or renal impairment

86
Q

What kind of urinary tract obstructions are there (4)

A
  1. Partial
  2. Complete
  3. Unilateral
  4. Bilateral
87
Q

Luminal causes of urinary tract obstruction

A
  1. Stones
  2. Blood
  3. Clot
  4. Sloughed papilla
  5. Tumour
88
Q

Mural causes of urinary tract obstruction

A
  1. Congenital or acquired stricture, neuromuscular dysfunction or schistomiasis
89
Q

Extra-mural causes of urinary tract obstruction

A
  1. Abdo or pelvis mass/tmour, retroperitoneal fibrosis, BPH, prostate cancer
  2. Pregnancy
  3. Inflammation (peritonitis or diverticulitis)
90
Q

Clinical presentation of acute upper tract obstruction

A

Loin pain radiating to groin

91
Q

Clinical presentation of acute lower tract obstruction

A

Flank pain, renal failure, infection and polyuria as urinary conc is lower

92
Q

Clinical presentation of acute lower tract obstruction

A

Suprapubic pain, bladder outflow obstruction

Distended, palpable bladder

93
Q

Clinical presentation of chronic lower tract obstruction

A
  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
Q

Diagnostics of urinary obstructions

A
  1. FBC
  2. Mid-stream urinary sample
  3. ULTRAOSUND
95
Q

FBC results for urinary obstruction

A

U and Es for creatinine (raised

96
Q

What would ultrasound show in urinary obstruction

A

Hydronephrosis - arrange for CT after

97
Q

Treatment for upper tract obstruction

A
  1. Nephrostomy
  2. Alpha-1 antagonist
  3. 5-alpha reductase inhibitor
98
Q

What is a nephrostomy

A

Artificial opening created between kidney and skin allows for urinary diversion directly from upper tract

99
Q

Treatment for lower tract obstruction

A
  1. Urethral catheter
  2. Suprapubic catheter
  3. TURP (Transurethral resection of prostate)
100
Q

Pros of suprapubic catheter

A

Less risk of UTI and urethral damage

less likely to be colonised by bacteria

101
Q

Cons of suprapubic catheter

A
  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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