Lecture 23 - Revision Flashcards
Read the first SAQ1 text and investigations:
Answer 1a:
Parathyroid glands do be big since they are secreting excess PTH
At high serum calcium they should not be making PTH
SAQ1 Question 1B:
PTH acts at bone to stimulate osteoclast activity increasing bone resorption to increase Ca2+ levels
PTH acts at the kidneys to increase the excretion of phosphate and resorption of calcium in the DCT via calcium channels
SAQ 1:
1C
Increased PTH cause increased loss of phosphate in kidney
SAQ 1
1D
Primary hyperparathyroidism
Parathyroid adenoma results in high calcium levels leading to stones forming
What is the saying to remember the signs/symtpoms of Hypercalcaemia?
Bones, thrones, groans, stones and psychic moans
What are the features of of Hypercalcaemia (bones, stones, thrones, groans and psychic moans)?
Bone pain
Fragility fractures
Renal calculi
Polyuria
Constipation
Confusion
Fatigue
Abdo pain
Pancreatitis
In primary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?
Ca2+ high
PTH high
Phosphate low
In secondary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?
PTH high
Ca2+ low
Phosphate low
In tertiary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?
When secondary parathyroid is unctreaeed
Low phosphate
PTH high
Ca2+ high
SAQ 2
2A
STAGE 2
(Creatinine has doubled)
SAQ 2
2b
240ml/8 = 30
30/64 = 0.47ml/h/kg
Stage 1 AKI
SAQ 2
2C
Signs and symptoms of uraemia:
Confusion
Nausea
Itchy
Muscle weakness
Bone pain
Heart palpitation
Anxiety
SAQ 2
2D
As well a uraemia, what other complications can an AKI develop to?
Fluid overload
Acidosis (can’t filter blood so H+ build up)
Hyperkalaemia
SAQ 2
2e
Look at CT:
Right hydronephrosis + hydroureter
SAQ 3:
3a
Renal cell carcinoma
SAQ 3
3B
Which part of the tubule is the renal cell carcinoma most likely to have arisen from?
Proximal Covulted Tubule
PCT is mst common location for RCC
SAQ 3
3c
Common risk factors for RCC
Obesity
Hypertension
Smoking
Dialysis
How can small and larger RCC be treated?
Small = partial nephrectommy
Larger = radical nephrectomy (remove kidney, perinephric fat, adrenal gland and ureter)
What increases the risk of developing squamous cell carcinoma of the bladder (rare)?
Anything that stimulates chronic inflammation of the bladder:
Neurogenic bladder
Renal stones
Schistosomiasis
What part of the prostate does prostate cancer usually arise?
What about BPH?
Prostate cancer = peripheral zone
BPH = central transitional zone
Why do patients with prostate cancer have lower back pain?
Most commonly metastasises to bone like the spine
How would you treat a small renal cancer?
Large renal cancer treatment?
Small = partial nephrectomy
Large = radical nephrectomy
Why can patients with metastatic renal cell carcinoma perestn with Hypercalcaemia?
Can produce PTH related peptides which inc osteoclast activity increasing bone resorption
Also increases kidneys resorption of Ca2+ and excretion of PO4(3-)
What are some signs and symptoms of Hypercalcaemia?
Bones, thrones, groans, stones and psychic moans
Confusion
Abdominal pain
Vomiting
Depression
Polyuria
Bone pain and fragility fractures
Constipation
