GU Flashcards
testicular cancer
- common in 15- 35 men
- RF: undescended testicles
seminonam and nonseminoams
presentation: painless testicular mass
- mets signs ( brain mets, retroperitoneal mets)
labs;
nonseminomas- very high bHCG, AFP, LDH
seminomas: slight high bHCG, non-elevated, elevated LDH
imaging: scrotal sonogram
surveillance for mets and brain
tx: radical orchiectomy for every one
seminona- rad tx with chemo
nonseminona- no rad tx
chemo tx
px: excellent
prostate cancer
adenocarcinoma , AA,
fix
s/s: 2/3 asymptomatic when diagnosed
- rectal exam: hard and nodule
advanced dz: specific to mets ( does, nodes, rectum, and bladder)
labs: PSA> 4.0 good for monitoring and following pt with cancer
changed recs; over dx of cancer and tx
PSA can be high with other cancers
transrectal us/ guided bx
- do for anyone with positive DRE
Gleason score: evaluate tissue sample
tumor surveillance: CT abdomen/ pelvis, bone scan, MRI
tx: active surveillance
radical prostatectomy
rt and androgen therapy( luron, orchiectomy, anti-androgen)
cryotherapy
screening: Lots of disagreement
- need to screen in AA and fix
bladder cancer
linked to manufacture (leather, rubber, cig smoking, dyes)
transitional cells
- s/s: painless hematuria
labs: UA
studies; bx
tx: how much penetrattion of bladder wall
Transurethral resection with fulguration with chemo IP - Ta/ T1
invasive bladder: radical cystectomy with pelvic lymphadectomy chemo/t x
renal cell carcinoma
- occlusive thrombi in renal veina
- associated with paraneoplastic syndrome
- diagnosed on incidental scan
s/s: flank pain with hematuria
dx: CT scan and met work up
labs: check LFTs, CBC, CMP
tx: radial partial nephrectomy with met ( lung, bones, and brain --> poor px
wilms tumor
2-3 y/o
tumors in the kidneys
palpable ab mass, and pain, and hematuria
cannot bx- spill tumor cell and increase stage
tx; surgical resection, nephrectomy, chemotherapy, rad tx
px: depends on histology
acute renal failure
- sudden rise in BUN/Cr
- build up of nitrogenous waste
s/s: uremic ( nausea/ itching)
labs: BUN/Cr
causes: pre renal azotemia, intrinsic renal ( failure, post renal azoetmia
major cause: pre-renal azotemia
- volume deplete
- septic
- no blood flow to kidneys
tx: tx the cause
monitor K
post renal azotemia-
bilat obstruciotn
acute tubular necrosis
- damage of renal of tubules
- muddy sediment, granular case
cause: MI, sepsis,nephrotoxic, IV constrast
tx: tx the cause, low protein diets, dialysis
- can repair itself
interstitial nephritis
inflame of renal tubules
causes:
drugs
s/s : fever, rash, arthalgias
labs: WBC casts and eosinophils
tx: remove cause
steroids
dialysis
-pts get better
glomerulonephritis
inflame of glomerulus from immune complex deposition
Immune complex- strep in kids
- tea colored urine
- puffy on eyes and scrotum
- positive ASO titer
IGA nephropathy- starts with URI or H. flu and have hematuria
lupus nephritis- auto ab production
+ ANA and ANCA
Good Pasteur syndrome: assoc with pulmonary hemorrhage
tx: plasmapheritis
Vasculitis: effects small and medium sized vessels
- assoc with granuloma formation airway, lung skin,
Rhinitis
Vascular: hemolytic uremic syndrome
-uremia, low plts, hemolytic anemia
s/s: hematuria, HTN, edema, tea colored urine with RBC casts
dx: renal bx
tx: steroids except for post strep pt
Good pasteur- plasmapheresis
chronic renal failure
destruction of nephrons least to progressive decline
causes: HTN and DM
dx: HTN, high BUN/ Cr, SOB
UA: proteinuria, U/s shows small echogenic kidneys
tx: renal diet, dialysis
and or transplant
ACE or ARB to delay progression
nephrotic syndrome
increased permeability of glomeulr capillary walls ) glomeulr becomes a sieve) proteinuria, hypoalbuimnaea and edema causes: primary minimal change dz membranous nephropathy
dx: proteinuria > 3 gm
oval fat body( Maltese cross)
management: low ptn diet, restrict salt, tx of hyperlipidemia, anemia
diuretics and ACE inhibitors
polycystic kidney disease
hereditary dz ( 30s and 40s)
clinical features: cross hematuria, abd flank pain,
complications: cysts rupture, stones, HTN, Cerebral aneurysms, aspirate cyst
tx: agressive HTN tx,
renal transplant
rental artery stenosis
HTN 50
abd exam: renal bruit
if you give ACE–> creatine goes up
dx: renal arteriography
tx: renal artery angioplasty with stunting
renal vein thrombosis
causes: children - severe dehydration
adults: infection, ascending thrombus of v. cava
sxs: flank pain and palpable kindness
dx: renal us, renal venography
tx: eliminate cause, anticoagulant or thrombolytic
hypnatremia
-affect CNS
- low sodium
- total body watery and total body sodium
-
SIADH
- brain produces ADH despite normal plasma volume
- causes: trauma, strok, small cell lung ca
labs: Urine:
tx: fluid restrict, and tx the cause
hypernatremia
Na> 145 mEq/L
Causes: impaired thirst, lack of access to water, lactulose and mannitol
s/s: dehydraiton, hyperthermia, delirium
tx: volume replacement and dehydration
Decrease serum sodium by no more than 1 meQ/:
too fast–> neuro edema
diabetes insipidus
problem wth ADH
central DI: head injury
nephrogentic- kindney not listening to ADH
dx: water deprivation test (
tx: volume replacement for everyone
central: desmopression
nephrogenic ID: treat underlying cause
hypokalemia
-sxs in mm
-
hyperkalemia
K > 5, > 6.5 severe
when severe
V.fib–> death
causes: renal disease, hypoaldosterism, drugs ( NSAiDs, ACE, and ARBs), burns, rehab,
s/s: mm weakness, hyperreflexia, flaccid paralysis
ekg: peaked T waves
tx; confirm that lab result i real
-treat cause
- stabilize heart- calcium gluconat
- dive K back into cells
insulin+ glucose
albuterol
sodium bicarb
excrete- kayelate
hypocalcemia
hypercalcemia
> 10.5
less sensitive to stimulation
cause: hyperparthathyrid, renal cell carcinoma, MM
s/s: anorexia, diagnostic, polyuria
EKG: shortened QT interval
tx: IV fluids and loop diuretics
hypomagnemia
Acid -base basics
body wants a ph of 7.4
CO2 and bicarb maintain this
if bicarb drops- ph goes how
if ph high -high bicarb or low CO2
when ph is too low=acidosis
pCo2 is high and HC03 is low
When ph is too high = alkalosis
HCo3 is high and Pco2 is low
respiratory: alteration in pc02
metabolic - alteration in Hc bicarb ( kidneys)
when on system fails–> other system kick in
metabolic acidosis
ph is low, bicarb issue
too much H ion then positive ion gap
- MUDPILES- rise in H ion methanol uremia DKA glycol Isoniazid lactic acidosis ethanol salicylates
compensation: increased ventilation ( kassuma)
tx: fix underlying cause
metabolic alkalosis
high bicarb and high ph
causes: due to loss of H or too much bicarb
vomiting , aggressive suction of gastric content
compensation; dec ventilation to increase pC02
s/sx; associated with low CA and low K
tx: fix underlying cause and associated metabolic problems
IV fluids
respiratory acidosis
low ph, high Co2
- causes: COPD, narcotic overdose
compensation: reabsorption of bicarb by kidneys
tx; fix underlying cause
naloxone
resp alkalosis
low co2 and high ph
cause: hysterical hyperventilaion, salicylate intoxication, PE
sx: rapid breathing, lightheadedness, perioral paresthia
compensation; incr eliminate of bicarb by kidney
tx: tx underling cause
kidney stones
calcium 85% , struviet ( infection) uric acid, cystine
s/s: M >F
inc calcium, diets in oxalate ( chocolate, tea, coffee), diets high in purine
sever pain- radiation got the flank or labia
dx; spiral CT scan
and do KUB
UA/ culture
tx: meds, pain control- tordal , flomax
if stone 10 mm
hydronephrosis
-distension of renal calices
causes by urinary blockage - kidney stone -pregnancy - s/s: pain
dx; UA, check BUN/ Cr
tx: tx causes
catheter, anticholingerica
infeciotn- needing emergent stunting or nephrostomy
incontinence
requires evluaiotn
women> men
stress: incr ab press
tx: kegel, estrogen, surgery
urge: overative bladder ( irritable bladder)
- oxcybutin and petrol LA
bowel training
overflow: outlet obstruction ( big BPH)
functional- unable to urinate on own
bening prostatic hyperplasia
enlargement of prostate due to inc. number of cells
- s/s; obstructive sxs; hesistany, slow, weak, dribbling
irritative sxs; frequency
on DRE: smooth, firm, elastic enlargement in move over 50 y/o
dx: UA, check PSA, cr
, cystoscopy, flow rates
tx; depends on symptoms
alpha blockers: tamsulosin, doxaxoin- relaxes smooth muscle
- finasterid, dutasterid- blocks formation of DHT
surgery; TURP, TUIP, TNA
prostatectomy
erectile dysfunction
not able to attain or maintain a rigid penile erection
- check UA, tesosteroi, FSH, thyroid panel,
psychogenic: check for erections at night
management: treat underlying cause
viagra- careful who have CAD or h/o MI
don’t give with Nitro
vacuums erection device, penile prosthesis
priapism: erection > 4 hours
medical causes: SC, leukemia, illicit drugs
meds: terbutaline
Peyronies dz- penis becomes curved
tx: intraplaque injection of verapamil or interferon
cause: repetive trauma
balanitis
swollen foreskin d/t hygiene
tx: children: no tx
Adults: abx cream, steroid cream, anti fungal
phimosis
foreskin is unable to br retracted
tx; betamethazoe
stretch the fore skin
circumcision
paraphiosis- emergency
-edema- compromised blood —> surgery
congenital abn
hypospaids- urethera meatus is ventral and proximal to normal positive
- repat before kid is 18 month old
chord- ventral penile curvature
- surgery
veisicoureteral reflux: urine passess retrograde from bladder to kidneys
lead to:
reflux nephropathy: renal scarring assoc with infrarenal reflux
child with recurrent UTi
test: IVD, renal us,
tx: Tx HTN, Ace, abx
cryptorchidism
testes don’t descent from abdomen
- s/s: empty hemiscrotitum on right
tx; hCG 1500 X 3 days
if not,must tx surgically
incr risk for testicual cancer and infertility
scrotal masses
hydrocele: fluid in membranes around the testicle
- transillumination
- no tx required
varicocele: varicose veins in scrotum
- may feel achy
- rarely treated unless indicted by infertility
sprematocel- retention cuts of the head of the epididmysis
no tx
testicular torsion
testicel rotate on spermatic cord causing occlusion
s/s: sudden, severe tesitcular pain, n/v
- Preh’s sign- no relief with elevation of testicle
- cremaster reflex
- no retraction of ipsilateral testis when medial thigh is stocked
imaging u/s
tx: surgical emergency
( 4-6 hours)
- need to detorse it ( in to out)
epididmyitis
most common cause of adults scrotal pain
- caused by STI or E. col
s/s: gradual sever, scrotal pain
dx; must do doppler u/s
labs; UA, GC/ chlamydia
CBC
tx: abx if infection, bed rest, scrotal election/ tight fitting briefs, NSAIDs
if STI- ceftriaxome
orchitis
seen with mumps
-s/s: develop 1 week after parrots
marked pain and swelling in one or both testicles
n/v, fever, urinary sxs,
tx; bed rest, scrotal support, ice
abx d/t epidimytis
complication: testicular
urethritis
STI,
s/s: d/c
labs; check urine
tx: cefrixone and doxycycline
treat partner
cystitis
common in women,
enterococcus
s/s: dysruai, flank pain
labs; UA and culture
tx; abx X 3-7 days, longer if elderly, DM, pregnant, men
Bactrim, microbic, quinones
pyelonephritis
fever/ chills, sepsis, vomiting, flank pain
labs: WBC casta
urine culture
blood cultures
imaging; u/s r/o hydronephrosis
Ct scan
tx; admit
ampicillin and aminoglycoides
prostatitis
acute bacterial- gram neg rods, sick perineal, lower back pain no DRE dx: CBC, UA, tranrectal uS
tx: bacterium or quinolone
analgesis, fluids, rest
if septic–> admit
chronic: recurrent infection of prostate
- gram neg rods
s/s: vary, milder
h/o UTI or sexual dysfunction
dx; UA : norma, expressed prostatic secretions ( manage prostate and milk out pus)
two glass test
tx: bacterium, quinolone X 6-12 weeks, alpha blocker
chronic nonbacterial prostates
- no bacteria
same sxs
- no bacterial on prostate secretions
tx; alph blocker, NSAiDS
try bacterium 4- 6 weeks
asymptomatic-
WBC on prostate fluids
feel fine
no tx
