GU Flashcards
what cells are found within the seminiferous tubules?
Germ cells/ Sertoli cells
what is the function of germ cells?
Allow the process of spermatogenesis
describe the steps of spermatogenesis?
spermatogonia - spermatocytes - spermatids - spermatozoon
what is the function of Sertoli cells?
They are the true epithelium of the seminiferous epithelium/ support germ cell development and secrete inhibin which enhances FSH biosynthesis and secretion
what are Peritubular Miotubular cells?
surround the seminiferous tubules and make up part of the smooth muscle
where our Leydig cells found?
Within the interstitium
what is a function of Leydig cells?
Secrete testosterone and other androgens as well as presenting macrophages
what is the blood supply to the testicles?
testicular arteries however it also has collateral blood supplies
describe the branching of the testicular arteries?
Arise from the abdominal aorta and descend through the inguinal canal
what blood supply supplies the scrotum and the rest of the external genitalia?
external Pudinal artery and branches of the internal Ilac artery
what is the venous drainage of the testicles?
Veins formed from the pump in the form of plexus in the scrotum/ the left testicle drains into the left renal vein the right testicle drains into the inferior VC
what tests are good for imaging the upper urinary tract?
CT with contrast or ultrasound scan
when our ultrasound scans most commonly used when imaging the urinary tract?
in accident and emergency for acute situations as they have a lower sensitivity than CT
what investigations are indicated for anyone with haematuria that is unexplained from a simple cause such as UTI?
Either CT or ultrasound and cystoscopy of the bladder
what type of CT is used when investigating human Tory or wanting to visualise the urinary tract?
CT urogram with IV contrast
when would you not want to use contrast?
If someone has severe kidney failure/ allergies/ or if wanting to view kidney stones
what does a reducible hernia mean?
When the contents of the area can be manipulated back into its original position during the defect from which it emerges
What does an irreducible hernia mean?
the hernia is compressed by the defect causing it to be irreducible
what is an obstructed hernia?
mainly refers to hernias containing bowel with the contents of the hernia compressed to the extent that the bowel lumen is no longer patents and causes bowel obstruction
what is a strangulated hernia?
The compression around the hernia prevents blood flow into the hernias content causing ischaemia and tissue pain
what is one of the most common causes of lump in the groin?
Inguinal hernia
Describe the path of the inguinal ligament
the inguinal ligament runs between the AAS IIS and the pubic tubercular/ this forms the inguinal canal/ inguinal canal allows for the passage of the spermatic cord and the round ligament as well as the ilioinguinal nerve
what is a direct inguinal hernia?
A hernia caused by a weakness in the posterior wall of the inguinal canal/ causes abdominal contents to enter the inguinal canal and go to the superficial ring but does not pass through the superficial ring
what is an indirect inguinal hernia?
the abdominal contents passes through both deep inguinal ring through the inguinal canal to the superficial ring
what is an easy way to distinguish a direct from an indirect hernia?
If you press on whether deep inguinal ring is and you can reduce the hernia then it means it is an indirect hernia
what are causes of inguinal hernias?
Increased intra-abdominal pressure/ weakness of the abdominal muscles/ chronic cough, constipation, heavy lifting, being elderly and obese also risk factors for hernias
how would you diagnose an inguinal hernia?
Diagnosis is usually clinical with examination but ultrasound scan can be used to aid diagnosis
what is a typical presentation of an inguinal hernia?
The development of a painless swelling in the groin over time (although can occur suddenly after heavy lifting)
what is the presentation of a symptomatic inguinal hernia?
Pain particularly on increasing intra-abdominal pressure/ change in bowel habits such as constipation/ pain or burning sensation in the groin/ scrotal swelling
what is the management of an asymptomatic hernia?
If it is small and not increasing in size then it can be left alone otherwise it should be treated on elective surgery
what is the management of asymptomatic inguinal hernia?
Surgery either open or laparoscopic if anything is strangulated or obstructed then emergency surgery is required
what structures are found beneath the inguinal ligament?
femoral artery femoral vein femoral nerve femoral canal
where would a femoral hernia usually occur?
The femoral canal – abdominal contents protrudes through it
why are femoral hernias particularly problematic?
They are at high risk of strangulation and obstruction as it is bordered by the lacuna ligament
what are risk factors associated with femoral hernias?
Elderly women who have had childbirth
what is the presentation of a femoral hernia?
Swelling can be in the groin like an inguinal hernia however it is usually closer to the upper thigh/ can cause hip pain as well as pain at the site of herniation
what other benefits of laparoscopic surgery, and what are its cons?
Involves less pain, less scarring, shorter recovery times but more expensive than open surgery
what other most common causes of uro sepsis?
UTI / obstruction in urinary flow causing urinary stasis
Were the most common locations for an obstructed kidney?
pelvicureteric junction vericoureteric junctionn ureter
what investigations do you need to perform in urosepsis?
sepsis six and gaining IV access/ taking blood cultures urine cultures/ finding out if there is any obstructive cause using CT (no contrast)
what is the management of urosepsis?
starting empirical antibiotics until cultures come back/ if there is obstruction then a ureteric stent can be placed or a nephrostomy until obstruction is removed
what do you need to ensure in the management of over 65’s?
That you ensure gram-negative pseudomonas is covered using penicillin or cephalosporins with gentamicin
what is a femoral aneurysm?
usually classes in a classes ileo femoral aneurysm which can either be on the Ilac or femoral artery
what is the most common cause of of femoral aneurysm?
Atherosclerosis
how does atherosclerosis lead to aneurysm?
Information associated with the atherosclerosis leads to the destruction and thinning of a vascular wall making it weaker/ specifically in the tunica media is weekend and this leads to dilation of the vessels forming an aneurysm
what is the presentation of A femoral aneurysm?
usually asymptomatic until there is embolisation or rupture however sometimes a pulsatile mass may be felt at the groin
what is an easy way to distinguish between an aneurysm and a hernia?
They may feel very similar but there aneurysm you would hear bruit and vascular flow
patient presents with acute groin pain and signs of tachycardia what should be one of your initial diagnoses?
ruptured femoral aneurysm
apart from groin pain what other symptoms can a ruptured femoral aneurysm cause?
Weakness of the leg swelling and numbness due to compression of nerves and obstructions nearby / those of acute limb ischaemia / pain paraesthesia paralysis pulse list nurse pallor perishing with cold
if you suspect a ruptured femoral artery what investigations should you perform?
Duplex ultrasound scan looking at proximal and distal arteries/ CT angiography is then used/ bloods for shock
what is blue toe syndrome?
tissue ischaemia secondary to cholesterol or greater in bottle embolus/ can occur if a clot forms due to an aneurysm and then dislodges
what is the management of a femoral aneurysm?
it is indicated if symptomatic or if larger than 3 cm , rapidly expanding, coexisting AAA, any complications present -give surgery
what is testicular torsion?
and emergency caused by the twisting of testicles on the spermatic cord/ leads to constriction of the vascular supply/ causes rapid ischaemia and necrosis
what is the presentation of testicular torsion?
sudden onset of severe scrotal pain/ associated nausea and vomiting/ no relief of pain upon elevation of scrotum
what can cause testicular torsion?
Trauma or inflammatory/infective causes
what symptoms would indicate that infection/inflammation has caused testicular torsion
fever dysuria frequency pain discharge
what features in the history of testicular torsion would support your diagnosis( apart from symptoms)?
history of intermittent or acute on and off pain
how would testicular torsion present in a patient with undescended testes?
sudden abdominal pain
what features might you find on examination of testicular torsion?
Severe tenderness/ test is higher than the unaffected testes
what physical features may be present in a delayed presentation of testicular torsion?
Erythema and oedema and reactive hydrocele
how would you diagnose testicular torsion?
any indication of testicular torsion means that the patient should be rushed for all exploratory laparoscopy surgery do not waste time with ultrasound and Doppler’s
what is the management of testicular torsion?
aim to treat within 4 to 6 hours/ immediate urological consultation for emergency scrotal exploration/ than surgery of all Kiddo plexi however if there is no reperfusion orchidectomy
what is epididymitis?
Inflammation of the epididimis
what are the most common agents which cause epididymitis?
Chlamydia nessieria gonorrhoea Mycoplasma genitalium
What is the presentation of epididymitis?
unilateral pain and swelling/ erythema and tender enlargement of the epididymis / systemic features may be present
what is an important differential to exclude in epididymitis?
Testicular torsion - consider if there is a sudden and severe onset with initial examination showing no evidence of inflammation or infection
what conditions usually accompany epididymitis?
Epididymoorchitis or urethritis
how would you investigate Epididymitis?
Urine dipstick/ first void urine sample for N AAT (chlamydia and gonorrhoea) urethral swab for Gram stain if there is accompanying urethritis
what is the management of epididymitis?
Once the cultures come back, with antibiotics stop and discontinue amiodarone if used
patient presents with a hot swollen erythema to Hemi Scruton the testicle and the epidermis is very tender to touch there is discharge and some symptoms of El UTS he reported having had a fever in party days what is most likely diagnosis?
epididimoorchitis
what is Epididimoorchitis?
an infection of both the epididymitis and the testicle
what pathogen is usually because epididymal orchitis?
E. coli or STIs
how would you investigate epididymoorchitis?
full STI screen with urine dipstick and urine cultures
what antibiotics would you give to cover E. coli?
Ciprofloxacin
how long should you give antibiotics to cover epididymo orchitis?
10 – 14 days
a patient presents with L UTS dysuria and urinary frequency perineal or genital pain some signs of urinary obstruction – urinary stream diminished or slowing stream as well as a low-grade fever what is the most likely diagnosis?
prostatitis
as well as pain in the perineal or genital regions where else can prostatitis cause pain?
Scrotum testes suprapubic lower back
what is the most common cause for prostatitis?
E coli or STIs if untreated and ascend
what findings would be present on DRE in a patient with prostatitis?
Intensely tender prostate gland which may also feel abnormally soft and boggy
what investigations need to be performed in prostatitis?
urinalysis urine cultures blood cultures- in febrile patients with acute symptoms PSA may be performed- raised
what is the management of prostatitis?
Antibiotic therapy – quinolone PO, if signs of sepsis then gave Paran Terrell antibiotics of broad-spectrum penicillin cephalosporins all quinolone with gentamicin
What is the name of the pathogen that causes chlamydia?
Chlamydia trachomitis
what are the symptoms of chlamydia in women?
85% of women are asymptomatic/ post coital or inter menstrual bleeding/ odourless vaginal discharge/ dysuria/ pelvic pain
what are symptoms of chlamydia which goes untreated in females?
Complications of untreated STI’s can lead to pelvic inflammatory disease as it assigns into the urogenital tract causing fever myalgia nausea and vomiting pelvic or abdominal pain
what are the symptoms of chlamydia in a male?
Dysuria clear white urethral discharge
what are the symptoms of untreated chlamydia in males?
can cause epididymitis prostatitis epididimoorchitis and some systemic symptoms
how do you test for chlamydia?
First pass urine test swabs from high vagina or urethra and NAHT testing
what is the management of chlamydia?
If there is a high index of suspicion you don’t have to wait until test results to begin antibiotics/ doxycycline is used for seven days (azithromycin is another option)
what is involved in a full STI screen?
First pass urine/ high vagina charcoal swab endocervical charcoal swab endocervical NAHT test/ swab or urethral in males
what pathogen causes gonorrhoea?
Gram-negative diplo coccus Neisseria gonorrhoea
what is the presentation of gonorrhoea in a male?
Thick green yellow discharge muco purulent/ dysuria + urethral pruritus (sx of urethritis)/ and if it ascends can cause symptoms of prostatitis and epididimoorchitis
what are the symptoms of gonorrhoea in females?
Yellow green vaginal discharge pelvic pain fever pain on urination and intermenstrual bleeding
What would be the rectal presentation of gonorrhoea?
rectal pruritus muco purulent discharge usually with bowel movements/ rectal pain and sometimes rectal bleeding
what is a common complication of untreated gonorrhoea?
PID
What is disseminated gonococcal infections?
where skin and siyovium the manifestations occur as well as systemic features
what is the management of gonorrhoea?
Ceftriaxone and azithromycin
what is the pathogen which causes syphilis?
Trepenema pallidum
How is syphilis spread?
Contact with a syphilitic lesion on the genitals or mucous membrane it can also be passed on congenitally
what is the presentation of syphilis and which is the main symptom to be aware of?
Solitary painless genital ulcer! In the anogenital or cervical area mouth ulcers may also be present and regional lymphadenopathy are all features of primary infection
what does a painful lesions suggestive of syphilis indicate?
Coinfection with genital herpes
what do multiple alterations in primary syphilis indicate?
Coinfection of HIV
when does secondary syphilis occur?
4 to 8 weeks after primary syphilis
what is the presentation of secondary syphilis ?
Systemic features /arthralgia/generalised lymphadenopathy/symmetrical maculopapular rash on palms and soles of feet also on trunk and scalp which may ulcerate/mucosal ulceration causing snail track pulses ulceration on genitals/patchy alopecia
what is neuro syphilis?
Uncommon to have in primary or secondary syphilis however specific organ involvement of the brain can cause headaches meningismus hearing loss and seizures
what are some areas of specific organ involvement which can occur in secondary syphilis?
Neurological/ ophthalmological - iritis uveitis and choridoretinitis / vasculitis - causing nephrotic syndrome or hepatitis
what is the definition of latent syphilis?
A patient is seropositive with the absence of any clinical features
how do you diagnose syphilis?
swab testing and PCR from lesion and additional serological testing / if anyone is presenting with neurological symptoms than a CSF PCR should be performed
What is management syphilis?
IM benzylpenicillin unless is neurological involvement in which case give IV
what is trichomoniasis?
Infection caused by protozoan parasitic infection called trichomonal vaginalis
what is the presentation of trichomonas in women??
Usually asymptomatic but can cause: itching burning redness or soreness of the genitals/ discomfort urinating/ changing vaginal discharge- pain or increased volume which can be clear white yellow or green/ unusual fishy smell/ discomfort during sex
what is the presentation of trichomonas in men?
usually is asymptomatic: Itching or irritation inside the penis burning after urinating or ejaculating/ discharge/ soreness and swelling and redness of the head of the penis or the foreskin
how do you diagnose trichomonas?
swabbing either the penis or the vagina and looking for the parasite under the microscope
How do you manage trichomonas?
metronidazole
What is the presentation of Thrush in women?
white dial discharge – cottage cheese appearance/ no unusual smell/ itching and irritation around the vagina and vulva/ soreness and stinging during sex or when you Pee
what is a presentation of Thrush in men?
irritation or burning and redness around the head of the penis and under the foreskin/ white discharge like cottage cheese/ unpleasant smell/ difficulty pulling back the foreskin
what are some signs of severe vulvovaginal candidiasis?
erythema which can extend to the labia majora and perineum/ vaginal for showing or oedema/ excoriation of the vulva
is thrush an STI?
Technically no but can still be spread from sexual partners
what investigations are necessary in thrush?
high vaginal carbon swab/ can be a swab taken from patient
what is the management of thrush?
pessary- clotramiozloe or fluconazole - PO/ if younger than 15 prescribed topical cream only/ if there are only vulval symptoms then prescribed topical only - top clotramidazole
what should you check in a patient who has recurrent or severe infections of thrush?
HbA1c and offer STI screening