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1
Q

1) Hormone Review

A 
Hypothalamus → GnRH → Anterior Pituitary gland →         -------LH        &       FSH
          ↓                    ↓
   Leydig Cell            ↓
          ↓		     ↓
Testosterone → Sperm
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2
Q

b) Penile Disorders

i) Balanitis:

A

Inflammation of glans penis

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3
Q

b) Penile Disorders

Phimosis

A

Constriction of the orifice of the prepuce so as to prevent the foreskin from being drawn back to uncover the glans penis.

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4
Q

b) Penile Disorders

iii) Paraphimosis:

A

Cannot retract the foreskin → becomes inflamed

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5
Q

b) Penile Disorders

iv) Prosthitis:

A

Inflammation of the retracted foreskin of the penis; usually caused by bacterial infection

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6
Q

b) Penile Disorders

v) Hypospadias:

A

Urethral opening on the ventral surface. More common

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7
Q

b) Penile Disorders

vi) Epispadias:

A

Urethral opening on the dorsal surface. Not as common

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8
Q

b) Penile Disorders

vii) Priapism:

A

Nonerotic sustained painful erection with acute onset

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9
Q

b) Penile Disorders

viii) Peyronie’s Disease:

A

Plaque’s/strands of dense fibrous tissue surrounding the corpus cavernosum  Curved deformity & painful erection; impotence

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10
Q

ix) Penile Cancer:

A
  • Occurs almost entirely in uncircumcised; rarely in circumcised.
  • Low risk with HPV
  • Prostate Cancer is 100 x’s more likely than penile cancer.
  • Age = > 50 y.o.
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11
Q

c) Penile Lesions

i) Condyloma:

A

HPV; painless, enlarging warts

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12
Q

c) Penile Lesions

ii) Squamous Cell Cancers:

A

Skin cancer, melanoma

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13
Q

c) Penile Lesions

iii) Leukoplakia:

A

Hyperkeratotic, scaly white patches of penile epithelium

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14
Q

c) Penile Lesions

iv) Bowen’s Disease:

A

An intraepidermal (pre)cancerous indurated erythematous plaque; pink or brown papules covered with thickened horny layer.

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15
Q

When is a biopsy needed for a Penile lesion?

A

• Biopsy is needed for Bowen’s Disease and Leukoplakia

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16
Q

i) Male Sexual Dysfunction:

• Causes:

A

o Physical: Drugs, blood flow abnormality, Nerve or hormonal (andropause, testosterone)

o Psychological: Depression, Stress, Performance Anxiety, Misinformation about sexuality

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17
Q

i) Male Sexual Dysfunction:

•• Risk Factors:

A

o > 40 y.o.
o Decreased libido
o Ejaculatory disturbances
o Erectile dysfunction (most common)

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18
Q

ii) Cryptorchidism:

A

Enters into the inguinal canal to the abdomen

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19
Q

iii) Ectopia:

A

Undescended testis goes either inguinal or perineal.

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20
Q

iv) Inguinal Hernia:

A

• Protrusion of abdominal contents (usually the small bowel) through a weak point of the abdominal wall (usually where the vas deferens passes through).

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21
Q

Inguinal Hernia

Signs and Symptoms

A

o Bulge in groin area that may extend into the scrotum.

o Painful or uncomfortable

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22
Q

Testicular Torsion?

What is it and is it emergent?

A 
•	Signs & Symptoms:
o	Sudden severe pain
o	Swollen
o	Erythema
o	Lower abdominal pain, N/V
o	Worse with lifting of the testicle
  • EMERGENT MEDICAL REFERRAL TO ER
  • DDX: Epididymitis
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23
Q

vi) Hydrocele:

A

• Collection of fluid in the sheath that holds the testicles

Cause: excess fluid production or decreased fluid absorption

Can develop rapidly due to: Trauma, radiation therapy, Inflammation, congenital

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24
Q

Hydrocele Signs and Symptoms

A

• Signs & Symptoms:

o Often painless
o Swollen
o Soft uni or bilateral mass

o —–>WILL transilluminate
o Most often in older men

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25
Hydrocel DDX
• DDX: Varicocele
26
Varicocele:
• Benign painless scrotal swelling of blood that backs up in the veins leading from the testicles due to valve dysfunction
27
Varocelle Signs and Symptoms
• Signs & Symptoms: ``` o Age 15-25 y.o. o More common on the left side o May feel heavy o Better with lying down o Achy o Testicular atrophy o Infertility o Visibly enlarged vein, o Will NOT transilluminate ```
28
Varicocele: DDX
* Can reoccur 5-20 % | * DDX: Hydrocele
29
Epididymitis
viii) Epididymitis: • Infection in the tubular coil (complication of Chlamydia/gonorrhea) ``` o Enterobacteria or pseudomonas • Signs & Symptoms: o Generally severe and insidious pain o Fever o Swelling • Treatment: Antibiotics ```
30
ix) Orchitis:
• Inflammation of the testes o Often d/t bacterial infection or the mumps virus. • May be concurrent with prostatitis or epididymitis • Signs & Symptoms: o Pain o Swelling o Heaviness • Can cause permanent damage
31
x) Testicular masses:
• Signs & Symptoms: o Firm o Solid o Painless o Does NOT transilluminate • Usually MALIGNANT
32
xi) Scrotal Masses (spermatocord, and epididymis): • Causes of Scrotal Masses o
``` Cysts o Infection o Inflammation o Hernia (undescended testes) o Tumors (often malignant within testes) ```
33
• Testicular Cancer | o Risk Factors:
```  Cryptorchidism: Treatment reduces risk  Genetic  Klinefelter’s Syndrome  Chromosome 12 abnormality  Caucasian—4-5 x’s increase incidence  Family History (2%)  HIV ``` o
34
Testicular Cancer Signs and Symptoms
NO increased risk with injury or vasectomy o Signs & Symptoms:  Unilateral enlargement or change in way it feels  Painless lump or swelling or collection of fluid  Dull ache in back, groin or lower abdomen  Gynecomastia &/or mastalgia  Testicular discomfort/pain or feeling of heaviness  Occasionally, initial symptoms are related to metastasis in the lungs, pelvis, abdomen or brain o NOTE: There may be no signs and/or symptoms
35
Stage 1 Kidney Damage:
kidney damage with normal GFR (90 or above)
36
Stage 2 Kidney damage
Kidney damage with mild decrease of GFR ( 60-89)
37
Stage 3 Kidney Disease
Moderate decrease in GFR (30-59) CKD at this stage = anemia & bone problems
38
Stage 4 Kindey disease
Severe reduction in GFR (15-29) Dialysis or Transplant
39
Stage 5 kidney Failure
Kidney failure GFR 15>) Dialysis or transplant
40
Labs UA Leukocyte Esterase
- Pyuria | * *** UTI
41
Labs UA Ketones
Diabetes
42
Labs UA Nitrites
UTI
43
Labs UA Bilirubin
Hepatitis ** Billary Obstruction
44
Labs UA Ueobillogen
Liver disease
45
Labs UA Protein
* Small amounts of Albumin --> Microalbuminia Increased amount of Albumin (Worse kidney function) --> Proteinuria
46
Protein Albumin: Creatine Ratio
More sensitive test ***** Requires positive 2nd test after 1-2 weeks to confirm
47
Proteinuria Cuases:
severe Golmeeunephritis
48
Hematuria:
Is cancer until proven otherwise
49
Hematuria: Cancer associated with SITT is positive
S - stones I- Infection T- trauma T- Tumor Repeat in 2 weeks if positive
50
Hormones product by kidney
- BUN | - Creatine
51
Kidney disease Treatment: Diet and Lifestyle changes
Decrease: * Protien (unable to process d/t KD) * Cholesterol * Smoking (STOP) * Sodium (may increase BP) * Potassium (Unable to remove d/t KD
52
Kidney Stones Treatment:
Diet : * Low purine diet * Low oxalate diet for Renal Stone prevention
53
Kidney Stone Prevention: Calcium Oxalate Stones
* Increase fluid intake * Longevity diet - vegetarian, low animal protein * Low NA /High K * Low oxalate
54
Kidney Stone prevention Supplements
* Calcium * Magnesium * Vit. B6 * Vit. C
55
Uric Acid Stones Prevention
* increased fluid intake * low purine diet * Maintain alakaline urine (above pH 6) _ Alkaline fruits, veggies and their juices - Sodium Bicarbonate 3-4 times daily
56
Uric Acid stone Treatment:
usually require a procedure to remove or break up the stones as well as to prevent their reacurrcne
57
Renal Cancer General Charectersitcs
Males 2X greater incidence (African American) Usually b/t age 50-70 Most solid kidneys tumors (>90%) Malignant
58
Risk Factors for Renal Cancer
``` Smoking Obesity HTN Unopposed estrogen Therapy Occupational exposure Renal dialysis Renal transplantation ( aossictaed with immunosuppression) ```
59
Renal Cancer Symtoms:
Many go undetected due to lack of symptoms and are detected by unrelated problems
60
Kidneys tutors can cause symptoms by the following:
compressing stretching invading structures near or within a kidney
61
Renal Cancer/Kidney Cancer
HTN 20% Hematuria 40% Supraclavicular adneopathy Symptoms aosscoated with Mets Paraneoplasic syndrome
62
Paraneeoplasic Syndrome symptoms
weight loss Loss of appetite Fever Night sweats HTN
63
Urinary Tract Infection Pyelonephritis
1) Infection/inflammtion of kidney/renal pelvis 2) Gram Negative = most common Infection secondary to ascending LOWER UTI
64
Pyelonephritis Signs/Symptoms
Fever > 102 F CVA tenderness and flank pain Chills Tachycardia N/V
65
Epithelial cell casts
acute tubular necrosis
66
RBC casts
glomerulonephritis
67
WBC casts
pyelonehritis
68
Hyaline/mucoprotein casts:
chronic renal disease,
69
Granular casts
Severe Renal Disease
70
Waxy casts
severe renal disease
71
Fatty casts
nephrotic syndrome
72
Kidney Produce Hormones
􀀋 Erythropoietin (EPO): stimulates bone marrow to make RBCs (important role in the brain's response to neuronal injury, involved in the wound healing process and as performance enhancer (ESA) 􀀋 Renin: regulates blood pressure (activates the renin-­‐angiotensin system by cleaving angiotensinogen, produced by the liver, to yield angiotensin I, which is further converted into angiotensin II by ACE. Angiotensin II then constricts blood vessels, increases the secretion of ADH and aldosterone, and stimulates the hypothalamus to activate the thirst reflex, each leading to an increase in blood pressure) 􀀋 Calcitriol: active form of vitamin D, helps regulate calcium (uptake from the gut, dec. transfer from blood to urine, released from bone)
73
Waste removal
􀀋 200qts of blood ~ 2qts of waste products & extra water = daily urine output
74
Filtering
Filtering occurs in nephrons.
75
What reabsorbed in the blood?
Sodium, phosphorus, and potassium are removed & reabsorbed into blood.
76
What a good renal function and bad?
Two healthy kidneys = 100% renal function. 􀀋 One functioning kidney or small decline in function typically does not cause clinical problems. 􀀋 Renal function
77
What recommend as a BP to prevent kidney disease?
The National Heart, Lung, and Blood Institute (NHLBI), recommends BP
78
Stress incontinence (most common) =
involuntary leakage from effort, exertion, or sneezing or coughing.  usually related to poor sphincter function and/or increased urethral mobility.
79
Urge incontinence =
 involuntary leakage accompanied/proceeded by urgency.  usually related to detrusor overactivity/instability, BPH
80
Mixed incontinence =
 features of both  more common in women >65
81
Overflow incontinence =
associated with overdistention/filling, e.g. detrusor paralysis or bladder outflow obstruction.
82
Interstitial Cystitis  AKA: painful bladder syndrome Prvelence
Prevalence  Women = 90% vs. Men = 10%  More common in Caucasian  Average age = 40
83
Oral Drugs |  Pentosan polysulfate sodium (Elmiron)
May repair defects in the lining of the bladder.
84
Aspirin and ibuprofen
First line of defense against mild discomfort.
85
Tricyclic antidepressants (amitriptyline)
Reduces pain, increases bladder capacity, decreases frequency
86
IC Diet
IC: Diet  There is no scientific evidence linking diet to IC  Alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, & acidic foods may contribute to bladder pain & inflammation.  Symptoms may worsen after eating or drinking products containing artificial sweeteners.
87
IC Decrease 3
Decrease/eliminate big 3: alcohol, caffeine, spicy foods
88
Bladder cancer |  Usually in
in the bladder lining transitional epithelial cells (called transitional cell carcinoma; TCC). carcinomas caused by Schistosoma haematobium  Primary symptom is hematuria.
89
Bladder Cancer is more common in
industrialized communities and In 2-3 X in MEN
90
Highest incidence of bladder cancer occurs in | industrialized countries
 Lowest in Asia, South America; ~about 70% lower than US and increases with age
91
Causes of bladder cancer
Smoking Fat burner Aristolochia fangchi (botanical for weight-loss) Infection Schistosome haematobium Male Saturated fat Caucasian
92
Bladder cancer rate
Superficial 85% live for 5 year Invasive - live for 2 years after diagnosis
93
Renal cales 2X ancer
3% of all cancer Common in african americans Males 2x greater to get it Age 50-70 Also called renal carcinoma 90% of solid (kidney) tumour are malignant
94
Risk factor of renal cancer
Smoking Obesity Hypertension Unopposed estrogen therapy occupational exposure Cystic kidney Phenacetin containing algesics Renal transplantation: With associated immunosuppression  80-fold increase in the risk

Gu Final (1 decks)

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