Gu Flashcards
What are the common causative bacteria of pyelonephritis?
E.coli (most common), klebsiella, proteus, enterococcus
What is the first line tx for pyelonephritis?
Ciprofloxacin/co-amixiclav
What additional medication other than antibiotics is needed for chronic pyelonephritis?
Blood pressure control
What is the first line antibiotic tx for epidiymo-orchitis?
doxycycline, cefixime, ciprofloxacin
What is the aetiology of epididymo-orchitis (for young vs older men)
- <35 years: STI
>35 years: gram negative enteric organisms
What can prostatitis be a symptom of?
UTI
What is the first line investigation for prostatitis? and results?
DRE: gland feels nodular, boggy, tender and hot
What are the normal causative organisms for prostatitis?
gram negative organisms: E.coli, enterobacter, serratia. Sometimes STIs such as Neisseria gonnorhoea and and chlamydia trachomatis
What is the first line Abx tx for prostatitis?
Quinolones
What are the two subtypes of urethritis? And what is there differing presentation?
gonnococcal and non gonococcal. Gonococcal presents with discharge, non gonococcal doesnt
What is the treatment for gonococcal urethritis?
quinolones
What is the treatment for non gonococcal urethritis?
ceftriaxone
what is the difference between nephritic and nephrotic syndrome?
- nephritic syndrome: haematuria, slight proteinuria, low urine volume, uraemia. Due to inflammation of the kidney
- nephrotic syndrome: proteinuria, hypoalbuminemia, oedema, hyperlipidemia. Due to increased glomerular permeability
What are causes for nephritic syndrome?
Can occur due to antigen getting trapped in kidney
- 1-3 weeks after a strep infection
- viral infection
- parasitic infection
- IgA nephropathy (following upper rep infection)
- ANCA associated nephritis
- Good Pastures syndrome (anti basement membrane antibodies)
- SLE
How does the liver compensate for the hypoalbuminaemia in nephrotic syndrome?
increased lipid synthesis
What are causes of nephrotic syndrome?
- primary renal disease
- minimal change disease
- membranous nephropathy
How does glomerular disease affect the GFR?
Decreases it
What is minimal change disease?
- cause of nephrotic disease
- loss of podocyte foot processes, vacuolation and appearance of the microvilli.
what is membranous nephropathy?
Thickening of the glomerular capillary wall. IgG deposited in subepithelial surface. Causes nephrotic syndrome
what do epididymal cysts present as (clinically and on dx)
- lumps that can be painful once large. Well defined
- Dx via scrotal ultrasound. Transluminate shows clear and milky fluid
What is a hydrocele?
abnormal collection of fluid in tunica vaginalis (serous membrane covering the testes)
What are the three types of hydrocele?
- simple: accumulation of fluid. Scrotal enlargement with non tender, smooth swelling. If congenital, can disappear in the first years life. Can also occur due to trauma, oedema elsewhere, etc.
- Communicating: persistence of the processes vaginalis (failure to close). Also peritoneal fluid to freely communicate
- non communicating: imbalance of secretion and resorption of fluid
Dx of hydrocele?
- ultrasound
- check beta HCG (teratoma) and alpha feroprotein
What are the possible complications of testicular torsion?
ischaemia, infarct and potential loss of testes due to ischaemia.
What is a variocele?
Abnormal dilation of testicular veins in the pampiform plexus.
how do varioceles present?
Scrotum feels like a ‘bag of worms’: hangs lower on one side
What side of the scrotum are varioceles more common on?
Left. Due to the angle of the left testicular vein entering left renal vein.
What are the possible complications of varioceles?
Infertility. the increased heat production can lead to reduced sperm quality
What are the three pathophysiology in erectile dysfunction?
- neurogenic (issue initiating due to nerve problems)
- arteriogenic ( failure to fill)
- venogenic (failure to store)
What is the normal physiology of an erection?
Nitrous oxide released neuronally. Leads to smooth muscle relaxation. Allows artery in flow and enlargement. Flows out when cAMP broken down by PDE-5 (venous channel opener). Involves pelvic plexus.
What type of medication is viagra?
PDE-5 inhibitor
What lobe is most affected in benign prostatic hyperplasia?
Median lobe
What scorring system is used for BPH?
I-PSS
What is the use of testosterone in BPH?
- Testosterone required for the cellular changes that occur: increased hyperplasia and decreased apoptosis
- testosterone is converted to its more potent form (DHT) by 5a-reductase
- binds to receptors in the prostate: increased secretions and divisions
What receptor mediates smooth muscle contraction of the prostate in BPH?
a-1 adrenoceptor
What is the order of treatment in BPH?
- watchful waiting
- A1- adrenoceptor antagonist: doxasine
- 5a reductase inhibitor
- Surgery
What are the histology of the majority of bladder carcinomas?
transitional cell carcinoma
How does TCC of the bladder present?
- painless haematuria (RED FLAG)
What is diagnostic for bladder carcinoma?
Flexible cytoscopy
What is the common spread of TCC of the bladder?
local –> pelvic structures –> lymphatic –> iliac and para-aortic nodes –> blood –> liver and lungs
What areas of the prostate are most affected in prostatic cancer?
Lateral nodes.
What type of cancer is prostatic (most often)
Adenocarcinoma
What hormone drives prostatic cancer development?
Androgen
What are the RF for testicular carcinoma?
undescended testis, HIV, FHx
Where might testicular cancer metastasise to, and what can this present as?
To the lung. Dyspnoea
What are the two types of testicular carcinoma and which is more common?
Seminoma and teratoma
What hormone indicates testicular cancer?
increase of beta HCG
Who is Wilhm’s cancer most prevalent in?
Children, as it is a nephroblastoma
Where do transitional cell carcinomas of the kidney arise from?
Renal pelvis
Where do renal cell carcinomas arise from?
Proximal renal tubular epithelium
What is a unusual feature of renal cell carcinoma?
Can secrete PTH, ACTH, EPO, renin
What is the gold standard dx for renal cell carcinoma?
IVU (intravenous pyelogram)
What is the tx for renal cell carcinoma?
Partial or radical nephrectomy. Not radio/chemosensitive. Can use high dose IL-2
What is the presentation of renal stones?
mainly asymptomatic. loin pain, LUTS, recurrent UTIs, haematuria, hypotension, decreased bowel sounds
What is the differentiating feature of renal colic to peritonitis?
- renal colic: can’t lie still
What is the most common composition of renal stones, and the aetiology?
- calcium oxalate
- calcium: hypercalcaemia, increased PTH, increased calcium gut absorption, excess bone absorption
- oxalate: high diet intake, low diet calcium, increased GI absorption due to disease
- calcium oxalate ppt can form in the basement membrane of loops of henle
What is gold standard dx for renal stones?
CT
What cells control GFR?
mesiangial cells: smooth muscle cells
What does the afferent arteriole detect and secrete?
Blood pressure and secretes renin
What does macula densa detect?
sodium levels
What is a nephron blood supply?
20% cardiac output. 1L/min
What is the normal GFR?
~125l/min
What is the presentation of AKI?
anuria (<100ml/24hrs)/oligouria. Large increase in serum creatinine levels (x1.5 base levels)
What are the three catergories of AKI injury?
- pre renal
- renal
- post renal
What are pre renal causes of AKI?
impaired perfusion of kidneys, GFR can’t be maintained. Volume depletion (D and V), hypotension, cardiac failure
What are renal causes of AKI?
damage to kidney apparatus impairs function. Glomerular disease, tubular injury, nephritis (NSAIDs), vascular disease
What are post renal causes of AKI?
obstruction of outflow
What are possible complications of AKI?
volume overload, metabolic acidosis, electrolyte disturbance
What are the 6 catergories of symptoms of CKD and why do they occur?
- anaemia –> decreased EPO production
- CNS (confusion, coma) –> advanced uraemia can cause decreased cerebral function, fits. Carpal tunnel syndrome due to amyloidosis
- CVS (HTN): BP not properly controlled
- Renal (nocturia, polyuria, haematuria)
- Bone (osteomalacia, bone pain, hyperparathyroidism): renal phosphate retention, impaired production o 1,25 dihydroxyvitamin D –> decreased calcium. Increased PTH, skeletal decalcification
- skin (Pruitus)
What is the treatment for CKD?
- renoprotective: control BP <120/80
- ACE-I and ARB can reduce proteinuria.
- dialysis and kidney replacement
What is the aetiology of CKD?
polycystic kidney disease, HTN, DM, glomerular disease, urinary tract obstruction
What is the pathophysiology of autosomal dominant polycystic kidney disease?
Polycystin mutation. Integral membrane protein that regulates tubular and vascular kidney development. Cysts develop, increase with age, renal enlargement and destruction
What co-morbiditie is there with AD Polycystic renal disease?
SAH due to berry aneurysms
what is the pathophysiology of autosomal recessive polycystic kidney disease?
Dilation and elongation of renal collecting ducts. Develops fibrosis and tubular atrophy and leads to end stage kidney disease.
What often exists with AR polycystic kidney disease?
liver disease
What scoring system is used for prostate cancer?
Gleason’s pattern scale. Looks at how much tissue looks normal and how much diseased
Why might urine appear foamy?
Kidney disease
What is GFR measured in?
ml/min/1.73m2
how was diabetes lead to CKD?
glycation of glomerular endothelium, and efferent arteriole
What arteriole in the kidney does HTN damage?
afferent
What are the systemic effects of uraemia?
pruitus, yellow/grey complexion, nausea, reduced appetite, weakness
What electrolyte imbalance commonly occurs due to CKD?
potassium
What are the four intra renal catergories of AKI?
glomerular, tubular (necrosis in most cases), interstitial, vascular
what is diagnostic for nephritic syndrome?
renal biopsy
What are four physiological consequences of nephrotic syndrome?
- loss of Abs due to proteinuria, reduce immunity
- increased liveractivity due to hypoalbuminae leads to increased coagulation factors, increased cholesterol synthesis and increased albumin production
What is the criteria of proteinuria for nephrotic syndrome?
> 3.5 g/24hrs
what is the most common cause of nephrotic syndrome in children vs adults?
- children: minimal change disease
- adults: membranous glomerulonephritis
What cardiac compx do many polycystitic kidney patients have
ventricular hypertrophy
What size of renal stones are left to pass spontaneously?
<5mm
What is hydronephrosis?
Dilation of the renal pelvis
What is the first line and gold standard dx for kidney cancer?
- 1st line: USS
- gold standard: renal biopsy
What is a common metastasis site of prostate cancer and the compx?
Bone, and sclerotic bone lesions
What is the dx for prostate cancer?
USS and biopsy
What is the classic triad for pylonephritis?
loin pain, fever, pyuria
What is the acronym for remembering common caustive bacteria for cystitis?
KEEPS
what factors are related to a low GFR?
High serum creatinine, older age, being Caucasian and high protein diet
What is the treatment for hyperkalaemia?
calcium gluconate
What drugs should immediately be stopped in AKI?
diuretics, ACEi, metformin and NSAIDs (DAMN)
What is tamsulosin? What is it’s s/e?
- used for BPH (alpha blocker)
- s/e: postural hypotension
If someone is in AKI, what electrolyte should be carefully monitored?
Potassium. Unable to excrete it: can lead to hyperkalemia
Where do thiazide diuretics work?
DCT
What is the MoA of tamsulosin?
a1 adrenoceptor antagonist.
How does postural hypotension occur as a s/e of tamsulosin?
via dilation of venous capacitance
where are germinoma’s commonly found, and what can be presenting feature?
- in the brain
- positive pregnancy test
