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Bloc D - Renal > Jan16 M2-LUTS > Flashcards

Jan16 M2-LUTS Flashcards

1
Q

what type of cells in the pelvis

A

transitional

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2
Q

two ways to control continence and how controlled

A 
bladder neck (internal sphincter): by ANS
external sphincter, skeletal muscle
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3
Q

normal things bladder should do to store urine (2) (when don’t want to pee)

A

low detrusor pressure (SS activity to relax the SM) + PSS inhibition

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4
Q

what affects bladder compliance (common ones)

A

neurological problem, diabetes (neuropathy), fibrosis , prolonged obstruction

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5
Q

what can cause obstruction

A

enlarged prostate for a long time (high R downstream)

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6
Q

external sphincter what type of control and what nerve

A

somatic. pudendal nerve

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7
Q

2 types of fibers in the external sphincter (or distal or rhabdo sphincter) + fct

A

slow-twitch: (type I) maintain skm resting tone

fast-twitch: (type IIa) rapid response to sudden rises in intra-abd coughing

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8
Q

why females more prone to incontinence (3)

A
  • post menopause atrophy in submucosa (harder to fight P)
  • shorter urethra (less downstream P)
  • misalignement from anatomical changes (bladder prolapse, cystocele)
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9
Q

CNS actions when you want to pee (what part of the brain starts it all and what it acts on)

A
  • pontine micturition center. inhibits guarding relaxation

- sacral micturition center (S2 to S4)

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10
Q

2 brain centers for micturition: 3 things they do

A
  • relax skm of external sphincter
  • rise in detrusor P
  • open bladder neck (ANS)
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11
Q

two types of LUTS

A

irritative and obstructive

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12
Q

irritative LUTS

A 
dysuria
incontinence
urgency
frequency
hematuria
nocturia
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13
Q

obstructive LUTS

A 
frequency
hesitancy
intermittency
incomplete emptying
weak stream
retention
straining
terminal dribbling
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14
Q

intermittency def

A

must force abd muscles but intermittently bc get tired

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15
Q

straining def

A

have to force

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16
Q

terminal dribbling def

A

urine falls slowly in drops of a thin stream

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17
Q

main reason for obstruction

A

prostate enlargement

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18
Q

main risk factors for LUTS

A

age, obesity, diabetes, ETOH intake, phys activity

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19
Q

main meds that affect voiding

A

anticholinergics: relax bladder SM
CCB: relax bladder SM
alpha blockers: decrease outlet resistance
alpha agonist: increase outlet R

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20
Q

3 other meds that relax the bladder and increase outlet resistance

A
  • narcotis
  • antipsychotics
  • antihistamines
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21
Q

overactive bladder def and caues

A

SS too weak. fail to act as a low P storage

causes: neurogenic or myopathic

22
Q

LUTS in overactive bladder

A

urgency, frequency, incontinence maybe

23
Q

management of overactive bladder

A
  • anticholinergic
  • catheterization
  • cystostomy, surgical bladder augmentation
24
Q

4 voiding dysfunctions ex

A
  • overactive bladder
  • obstruction (BPH)
  • urinary incontinence
  • urinary retention
25
Q

retention causes

A
  • bladder prob (neuro, pharmaco, myopathic)

- outlet prob (prostate obstruction, stricture, neck contracture, neuro (sphincter))

26
Q

incontinence causes

A
  • bladder prob (neuro, myopathic, retention with overflow incontinence)
  • outlet prob (sphincter prob, stress incontinence = anato)
27
Q

BPH def

A

benign prostatic hyperplasia

28
Q

hyperplasia of what cells in BPH

A 
glandular tissue (epithelial cells)
prostate stroma (SM)
29
Q

how prostate develops

A

testosterone (T) converted to dihydrotestosterone (DHT) by 5-alpha reductase. DHT is a more potent androgen, acts for prostate dev

30
Q

how BPH leads to LUTS (2)

A
  • pressure on urethra from prostate bulk

- higher SM tone in prostate and urethra

31
Q

how detrusor reacts to BPH over time

A

becomes hypertrophic

32
Q

4 prostate zones

A

transitional, central, peripheral, fibromuscular stroma

33
Q

prostate zones with BPH and with cancer

A

BPH in transitional

peripheral: cancer

34
Q

rectal exam to check what and why

A

for prostate CANCER (peripheral zone in front of the rectum)

35
Q

2 scores to evaluate for LUTS

A 
IPSS score (international prostate symptom score)
AUA (Am Urol ASsoc Symptom score)
36
Q

most common cause of LUTS

A

UTI

37
Q

ddx for LUTS and how to differentiate

A

UTI, neuro, BPH, cancer, stricture, diabetic neuropathy, etc. LAB TESTS + history

38
Q

PSA meaning and shows what (test)

A

blood prostate specific antigen. shows prostate enlargement or cancer or infection

39
Q

high sensitivity testing for prostate cancer

A

DRE AND PSA

40
Q

complications of BPH

A

UTI, overflow incontinence, urinary retention, renal fialure

41
Q

hematuria workup and how to check for the cause

A
  • imaging of upper urinary tract

- cystoscopy for lower urinary tract

42
Q

BPH and PSA

A

PSA high

43
Q

principle in diagnosing BPH and how to do it

A

by elimination. rule out renal failure by physical exam. DRE to rule out cancer. (stones, other cancer)

44
Q

labs to do in LUTS

A

UA, urine culture, PSA, uroflow scan

45
Q

BPH = dx by exclusion. what to rule out b4 BPH

A

UTI, prostate infection, cancer, prostate cancer, neuro voiding problem

46
Q

non-pharma vs pharma options in BPH

A

non-pharma: timed voiding, double voiding

pharma: alpha blockers, 5 alpha reductase inhibitors, anticholinergics

47
Q

alpha blockers act on what

A

alpha-1 adrenergic receptors in prostatic SM and in the bladder neck

48
Q

alpha receptors type in the prostate, bladder, vasculature and CNS

A

prostate: alpha 1a
bladder: alpha 1d
vasculature: alpha 1a and alpha 1b
CNS: alpha 1b

49
Q

2 drugs (alpha 1 a blockers)

A

tamsulosin

silodosin

50
Q

2 5-alpha-reductase inhibitors and what type

A

finasteride (type2)

dutasteride (type 1 and 2 inhibitor)

51
Q

surgeries in BPH + most common

A

TURP (most common), TUIP (incision rather than resection)

52
Q

criteria for referring LUTS to a urologist

A
  • intense symptoms
  • young patients
  • meds side effects too bad
  • BPH complications
  • complex presentation

Bloc D - Renal (32 decks)

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