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Year 2 > Genitourinary: Part 7 > Flashcards

Genitourinary: Part 7 Flashcards

1
Q

Define EPIDIDMO-ORCHITIS

A

Acute epididymo-orchitis is a clinical syndrome of pain, swelling and inflammation of the epididymis that can extend into the testes

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2
Q

What spread causes epididymo-orchitis

A

extension of infection from the urethra or bladder

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3
Q

Under 35 causes of epididymo-orchitis

A
  1. Chlamydia trachomatis

2. Neisseria gonorrhoea

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4
Q

Over 35 causes of epididymo-orchitis

A
  1. UTI (KEEPS):
  2. Mumps
  3. Trauma
  4. Catheter
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5
Q

Risk factors for epididymo-orchitis

A
  1. Previous infection
  2. Indwelling catheter
  3. Structura;/functional abnormality of urinary tract
  4. Anal intercourse
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6
Q

Clinical presentation of epididymo-orchitis

A
  1. Subacute onset of unilateral scrotal pain and swelling
  2. Urethritis or urethral discharge in STD
  3. Sweats/fever
  4. Tenderness and palpable swelling of the epididymis and testicles
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7
Q

Differential diagnosis of epididymo-orchitis

A
  1. Testicular torsion - urological emergency (SURGICAL EXPLORATION)

NEEDS TO BE RULED OUT:

  1. Short pain duration (sudden)
  2. Associated nausea/abdo pain
  3. High-riding/bell-clapper testis
  4. Hydrocele, trauma, abscess formation
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8
Q

Diagnostics of epididymo-orchitis

A
  1. NAAT (Nucleic acid amplification test):
    If intracellular gram-NEGATIVE DIPLOCOCCI are present - Gonorrhoea
  2. Mid-stream urine dipstick for UTI symptoms
  3. Ultrasound to rule out abscesses
  4. STD screening
  5. Urethral smear and swab
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9
Q

How is Chlamydia treated

A
  1. ORAL DOXYCYCLINE 7 days
    OR
    STAT AZITHROMYCIN
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10
Q

How is Gonorrhoea treated

A
  1. IM CEFTRIAXONE + STAT ORAL AZITHROMYCIN
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11
Q

How is UTI treated

A
  1. ORAL CIPROFLOXACIN for 2-4 weeks
  2. NSAIDs
  3. ABSTAIN
  4. Partner notification and testing
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12
Q

What is the most common STD

A

Chlamydia

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13
Q

What causes Chlamydia Trachomatis

A

GRAM-NEGATIVE bacterium

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14
Q

What causes Neisseria gonorrhoea

A

gram-NEGATIVE diplococcus bacterium

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15
Q

In what parts of the body does chlamydia and gonorrhoea effect

A
  1. Urethra
  2. Endocervical canal
  3. Rectum
  4. Pharynx
  5. Conjunctiva
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16
Q

In neonates, what part of the body is effected by chlamydia and gonorrhoea

A
  1. Conjunctiva

2. Atypical pneumonia

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17
Q

Primary site of CT and GC in males

A

Urethra

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18
Q

Clinical presentation of CT and GT

A

Dysuria

Urethral discharge

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19
Q

Incubation for CT and GC

A

CT: 7-21 days
GC: 2-5 days

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20
Q

Percentage of people who are asymptomatic

A
  1. CT: 50%

2. GC - 10%

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21
Q

Transmission rate female to male in CT and GC

A

CT: 70%
GC: 60-80% (20% if single encounter)

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22
Q

Complication with CT

A

Epididymo-orchitis

Reactive arthritis

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23
Q

primary site of CT and GC in females

A

Cervix

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24
Q

Non-specific symptoms of CT and GC in females

A
  1. Dysuria
  2. Menstrual irregularity
  3. Discharge
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25
Q

Percentage of CT and GC who are asymptomatic

A

CT: Over 70%
GC: 50%

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26
Q

Incubation time for GC in women

A

10 days

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27
Q

Complications for GC and CT in females

A
  1. PELVIC INFLAMMATORY DISEASE
  2. NEONATAL TRANSMISSION
  3. FITZ HUGH CURTIS syndrome
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28
Q

What is pelvic inflammatory disease

A

Infection spreads up to the fallopian tube leading to inflammation and scarring

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29
Q

Complications of pelvic inflammatory disease

A

Tubular factor infertility

  1. Ectopic pregnancy
  2. Chronic pelvic pain
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30
Q

Symptoms in neonates with CT and GC

A

Conjunctivitis

Pneumonia

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31
Q

What is Fitz hugh syndrome

A

Peri-hepatitis but no decline in liver function

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32
Q

Cons of NAAT with first void urine

A

Lower sensitivity

33
Q

How is gonorrhoea in females tested

A
  1. Near patient test
  2. Culture mid-stream urine
  3. Antibiotic sensitivity testing
  4. NAAT
34
Q

What is the near patient test

A
  1. Microscopy of gram stained smears of genital secretions - GRAM-NEGATIVE DIPLOCOCCI

Sample from urethra in males + endocervix in females

35
Q

How to treat chlamydia in pregnant women

A
  1. ERYTHROMYCIN for 14 days or AZITHROMYCIN STAT
36
Q

Parasympathetic control of LUT

A

S3,4,5

37
Q

Sympathetic control of LUT

A

T10, L1 and L2

38
Q

What causes sphincter weakness incontinence

A
  1. Sphincter weakness

2. Small leak of urine when intra-abdominal pressure rises (laughing, coughing and standing up)

39
Q

Causes of sphincter weakness (stress incontinence)

A
  1. Women secondary to birth trauma
  2. Men: Post-prostatectomy
  3. Neurogenic or congenital
40
Q

Treatment of incontinence in females and males

A
  1. Pelvic floor excursuses
  2. DULOXETINE
  3. Surgery: Sling or artificial sphincter
  4. Males - artificial sphincter or male sling
41
Q

What is DULOXETINE

A

Antidepressant

42
Q

What is urge incontinence

A

Strong desire to void and unable to hold urine

43
Q

What causes urge incontinence

A

Detrusor overactivity - rise in detrusor pressure on filling associated with urgency (most often in women)

Bladder hypersensitivity due to UTI, stones or tumour

44
Q

How is urge incontinence treated

A
  1. Bladder exercises: gradually increasing the interval between voids
  2. Behavioural therapy: controlling caffeine, alcohol and frequency volume charts
  3. Drugs
  4. Bladder augmentation
45
Q

What drugs are given for urge incontinence

A
  1. Anticholingeric agents
  2. Beta 3 agonist
  3. Botox of bladder
46
Q

Name an anticholinergic agent

A

OXYBUTYNIN - decreases detrusor excitability

47
Q

Name a beta 3 agonist

A

MIRABEGRON - activates beta 3 receptor on bladder, allowing detrusor relaxation

48
Q

Why do we give botox to th bladder

A

Stops release of ACh from pre-synaptic terminal and paralyses the bladder

49
Q

Surgical name for bladder augmentation

A

Detrusor myectomy

Cystoplasty

50
Q

What is a cystoplasty

A

Adding bowel to bladder to increase SA
Gives increased bladder capacity and reduced detrusor overactivity

May have to self-catheterise due to muscle loss

51
Q

Role of the periaqudecutal grey

A
  1. Co-ordination

2. Completion of voiding

52
Q

What is the guarding reflex

A

A spinal reflex where proximal part of sphincter senses urine and sends impulses to spinal cord to tell onus’s nucleus to store urine

53
Q

What is spastic spinal cord injury

A

Reflexes work but not controlled by brain

54
Q

Clinical features of spastic spinal cord injury

A
  1. Supra-conical (high part of spinal cord) lesions
  2. Loss of co-ordination and completion of voiding
  3. Reflex bladder contractions
  4. Poorly sustained bladder contraction
  5. Kidney failure potentially
55
Q

What is flaccid spinal cord injury

A
  1. Conus lesions (lower spinal cord) - decentralised bladder
56
Q

What three things are lost in flaccid spinal cord injury

A
  1. Reflex bladder contration
  2. Guarding reflex
  3. Rece[tive relxation
57
Q

Features of flaccid spinal cord injury

A
  1. Areflexic bladder
  2. Stress incontinence
  3. Risk of poor compliance
  4. Puts kidneys at risk
58
Q

What is spastic paralysis

A
  1. Conus functioning but not controlled by brain
  2. Reflex bladder - involuntary urination
  3. Reflex bowel - involuntary defecation
59
Q

What is flaccid paralysis

A
  1. Conus destroyed or non-functional
  2. Areflexic bladder - fills til overflows
  3. Areflexic bowel - fills til overflows
60
Q

Three goals of flaccid and spastic injuries

A
  1. Prevent autonomic dysreflexia
  2. Maintain bladder safety
  3. Symptom control
  4. TAMSULOSIN or sphincterectomy
  5. Cystoplasty
  6. Permenant catheterisation
61
Q

What causes autonomic dysreflexia

A
  1. Over-distention of bladder in lesions above T6

Overstimulation of sympathetic nervous system below the levelk of lesion in response to stimulus

62
Q

Symptoms of autonomic dysreflexia

A

headache
Severe hypertension
Flushing

63
Q

Why do we want to maintain bladder safety

A

Puts kidneys at risk

64
Q

Risk factors for bladder injuries

A
  1. Raised bladder pressure
  2. Vesico-ureteric reflux
  3. Chronic infection (stones)
65
Q

How do we control symptoms in flaccid and spastic issues

A

Suppress reflexes by converting bladder to flaccid type and empty regularly

ORAL TAMSULOSIN or sphincterectomy

66
Q

How do we treat sepsis

A
  1. Give high flow oxygen via non-rebreathe bag
  2. Take blood cultures
  3. Give IV antibiotics
  4. Start IV fluid resuscitation
  5. Check lactate
  6. Monitor hourly urine output and consider catheterisation
  7. WITHIN 1 HOUR
67
Q

Why is Saline given to patients

A

Replace fluids and increase BP if low - normal composition to ECF

68
Q

What is onctained in each litre of normal saline

A
  1. Around 150mmol of Na
  2. Around 150 mol of Cl
  3. Around 300mmol of osmotically active ions
  4. NO K+
69
Q

What type of drug is Sildenafil

A

Phosphodiesterase (TYPE V) inhibitors

70
Q

When is Sildenafil given

A
  1. Erectile dysfunction

2. Primary pulmonary hypertension

71
Q

Pharmacology of Sildenafil

A
  1. Selective for phosphodiesterase type 5 which is found in smooth muscle of corpus cavernous of penis and lung arteries
    Causes vasodilatation by inhibiting PDE5 which breaks down Cyclic GMP - increased Cyclic GMP causes smooth muscle relaxation
72
Q

Adverse effects of Slidenafil

A
  1. Flushing, headache, dizziness, HYPOTENSION, tachycardia and palpitations
  2. Increased risk of MI and stroke

AVOID where vasodilatation is dangerous

73
Q

What drugs contraindicate slidenafil

A
  1. Drugs that increase NOX - severe vasodilatation and Cv collapse
74
Q

How does OXYBUTYNIN work (anti-muscarnic)

A
  1. Inhibits acetylcholine, blocking muscarinic receptors and promoting bladder relaxation to increase capacity

SELECTIVE for M3

75
Q

Adverse effects of Oxybutynin

A
  1. Dry mouth
  2. Tachycardia
  3. COnstipation
  4. Blurred vision
  5. Contraindicated in UTI
76
Q

Why can’t oxybytynin be used in glaucoma

A

Causes rise in intraocular pressure and in patients with arrhythmias and those at risk of urinary retention

77
Q

How does Bicalutamide work

A
  1. Anti androgen - decreases body’s response to androgens - prostate cancer
78
Q

Contraindications for bicalutamide

A

GI disturbance and liver injury

Year 2 (155 decks)

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