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Male Parts Final Flashcards

1
Q

What are penile related conditions?

A
  1. Circumcision
  2. Penile disorders
  3. Penile cancer
  4. Scrotal masses
  5. Testicular cancer
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2
Q

What are the 2 jobs of the testes?

A
  1. Produce sperm (70-100 million per day)

2. Secrete hormones (testosterone)

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3
Q

What are characteristics of testicular masses?

A
  1. Often firm
  2. Solid
  3. Painless
  4. DO NOT transilluminate
  5. Usually malignant
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4
Q

What are characteristics of scrotal masses (and epididymis)?

A
  1. Painful
  2. transilluminate
  3. Usually bengin
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5
Q

What are the parts of the penis?

A
  1. Corpora cavernosa (erectile mechanism)
  2. Corpus spongiosum (contains urethra)
  3. Tunica Albuginea (surrounds erectile tissue)
  4. Fenulum, bulb (at base), corona, prepuce, glans
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6
Q

Circumcision is linked to reductions in which conditions?

A

UTIs, Rare penile cancer, HPV, HIV and others STIs

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7
Q

What are cons associated with circumcision?

A
  1. hemorrhage
  2. Infection
  3. Pain/trauma
  4. Diminished sensation
  5. Less mother/child bonding
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8
Q

What are the seminal vesicles an what is their role?

A
  1. Glandular structure that is an out-pocketing of the vas deferens at the base of the bladder
  2. Forms ejaculatory duct (thru prostate to urethra)
  3. Secretes 70% of fluid components of semen (energy/fluidity)
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9
Q

What does LH stimulate in the testis?

A

Leydig (interstitial) cells to produce testosterone

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10
Q

What do testosterone and FSH combine to stimulate?

A

Spermatogenesis

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11
Q

How long does it take to make a sperm?

A
  1. Spermatogenesis in the testis takes ~70 days

2. Maturation of sperm in the epididymis takes <2 weeks (motility, increased capacity to function)

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12
Q

What are questions about urination for men?

A

Frequency, dysuria, nocturia, urgency, hesitancy, incontinence, flow, urethral discharge

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13
Q

What are lesions from HPV like?

A
  1. Painless

2. enlarging, wart-like gorwths

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14
Q

What are lesions from leukoplakia like?

A
  1. Hyperkeratotic
  2. Scaly, white patches of penile epithelium
  3. Biopsy necessary
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15
Q

What are lesions from Bowen’s disease like?

A
  1. Precancerous intraepidermal
  2. Indurated erythematous plaques
  3. Ulcerated centers
  4. Development of pinkish/brownish papules covered with thickened horny layer
  5. Biopsy necessary
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16
Q

What are skin cancers that can show up on the penis?

A

Squamous cell carcinoma and melanoma

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17
Q

What is balanitis?

A
  1. Inflammation of the glans of the penis (11% of urology patients)
  2. Causes: uncircumcised with poor hygiene or over hygiene, diabetes, chem. irritants, CHF, cirrhosis, nephrosis, drug allergies, obesity
  3. Infections: candida, HPV, anaerobes, treponema, gardnerella, tichomonas
  4. Penile cancer
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18
Q

What are phimosis an paraphimosis?

A

Phimosis: foreskin can not be pulled back from tip of penis
Paraphimosis: Foreskin will not go back over the tip of the penis

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19
Q

What are hypospadius and epispadius?

A

Hypo: urethral opening on ventral surface of penis (more common)
Epi: Urethral opening on dorsal surface of penis

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20
Q

What causes hypo/epispadius?

A
  1. Exposure to PG hormone
  2. Finesteride
  3. Lack of testosterone in utero
  4. Inherited
  5. Often associated with hernias, cryptochidism
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21
Q

What is priapism?

A
  1. Non-erotic sustain, painful erection (acute onset)
  2. Glans remains soft (spongiosa not involved)
  3. Etiology: unknown, associated with leukemia, mets, local trauma, sickle cell, spinal cord trauma, circulatory disturbance
  4. Treat: ice, enema, pharma, spontaneous resolution
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22
Q

What is peyronie’s disease?

A
  1. Plaques/strands of dense fibrous tissue surrounding the corpus cavrnosum
  2. Results in deformity and painful erection, impotence
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23
Q

What are signs and symptoms of peyroni’es disease?

A
  1. hardened tissue
  2. Pain during erection
  3. Curvature with erection
  4. Distortion (indentation, shortening)
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24
Q

What causes peyronie’s disease?

A
  1. Idiopathic
  2. Trauma (surgery, injury)
  3. Inherited HLA-B27 (SLE, scleroderma)
  4. Diabetics
  5. 30% of patients will develop fibrotic tissue in other areas of the body
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25
Q

How is peyronie’s disease diagnosed and treated?

A
  1. Exam with vasoactive injection to cause erection
  2. Treatment: watch and wait (often resolves in 1-2 years), non-surgical Ca2+ channel blockers, collagenase, cortisone or surgery
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26
Q

What are symptoms of penile cancer?

A
  1. Penile growths or sores
  2. Abnormal penile discharge
  3. Bleeding
  4. Glans and foreskin most common site
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27
Q

What are risk factors for penile cancer?

A
  1. Intact/non-circumcised foreskin (it bascially does not happen in circumcised men)
  2. HPV infection (certain strains)
  3. smoking
  4. Age: majority are over 50
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28
Q

What are treatment options for penile cancer?

A
  1. Surgery (excision laser, circumcision, penectomy, nodal dissection)
  2. Radiation
  3. Chemotherapy (topical/oral)
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29
Q

What are the different types of scrotal masses?

A
  1. Hydrocele
  2. Varicocele
  3. Inguinal Hernia
  4. Epididymitis
  5. Orchitis
  6. Testicular cancer
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30
Q

What are characteristics of scrotal masses?

A
  1. Painless OR painful lump or swelling
  2. Solid or cystic
  3. Can develop at any age
  4. Malignant or benign
  5. Evaluate with US
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31
Q

What causes scrotal masses?

A
  1. Cysts
  2. Infections
  3. Inflammation
  4. Hernias
  5. Tumors (malignant most often within the testicle)
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32
Q

What should you know about Cryptochidism (undescended testicles)

A
  1. Can be abdominal, pubo-scrotal, femoral or perineal
  2. Arrests or changes direction at some point in its path of descent
  3. Risk higher with preterm infant (30%)
  4. Associated with risk for testicular cancer, infertility, torsion
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33
Q

What are signs and symptoms of testicular torsion?

A
  1. Sudden severe pain, swelling and erythema
  2. Lower abdominal pain with N/V
  3. WORSE with lifting of the testicle
  4. Most common in males 10-16
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34
Q

Why is testicular torsion a medical emergency?

A

Preservation of the testicle is doubtful after 24 hours (after 48 hours orchiectomy)

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35
Q

What is hydrocele?

A

A collection of fluid in the sheath (tunica) that holds the testicle caused by excess fluid prodcution or decreased fluid absorption

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36
Q

What are signs and symptoms of hydrocele?

A
  1. Often painless
  2. Swollen, soft
  3. Uni/bilateral mass that will transilluminate
  4. Most often in older men
  5. Causes: trauma, radiation therapy, inflammation, congenital
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37
Q

What is a varicocele? (“bag of worms”)

A

Blood backs up in the veins leading from the testicle due to valve dysfunction

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38
Q

What are signs and symptoms of varicocele?

A
  1. Benign painless scrotal swelling
  2. More common on left side (left spermatic vein empties into the left renal vein, right into the inferior vena cava)
  3. Testicles may feel heavy, achy, may show atrophy with visibly enlarged veins
  4. Better with lying down
  5. Infertility
  6. WILL NOT transilluminate
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39
Q

Who gets varicoceles?

A
  1. Age 15-25 MC
  2. Infertile men in 40%
  3. Risks: pelvic floor stress, vascular damage, heretidary tumors
  4. Incidence is 10-25%
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40
Q

How are varicoceles diagnosed and treated?

A
  1. Diagnosis with ultrasound or vengram (dye with x-ray)
  2. Treat: scrotal support, surgical ligation, embolization, laparoscopy
  3. Some recur (5-20%) and 2-5% develop into hydrocele
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41
Q

What is an inguinal hernia?

A

Protrusion of abdominal contents (usually the small bowle) thru a weak point of the abdominal wall (usually where the vas deferens passes)

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42
Q

What are signs and symptoms of inguinal hernias?

A
  1. Bulge in the groin area that may extend into the scrotum

2. Treat with surgical repair

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43
Q

What is epididymitis?

A

Infection in the tubular coil (epididymis) that is often a complication of gonorrhea/chalmydia or caused by enterobacteriae or pseudomonas.

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44
Q

What are signs and symptoms of epididymitis?

A
  1. Pain is generally severe and insidious

2. Fever and swelling common

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45
Q

What often causes orchitis?

A

Bacterial infection or the mumps virus (25-30% mumps infections will progress)

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46
Q

What are signs and symptoms of orchitis?

A

Pain and swelling with a feeling of heaviness

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47
Q

Why is orchitis bad news?

A
  1. Spermatogenesis is irreversibly damaged in 30% of mumps cases
  2. Can caused permanent damage to testicles resulting in: diminished size, inadequate hormone production and infertilty
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48
Q

What are stats related to testicular cancer?

A
  1. Most common cancer in men 15-34 (young)
  2. Accounts for 1% of all cancers in men
  3. 7000-8000 new cases and 400 deaths per year
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49
Q

What are risk factors for testicular cancer?

A
  1. Cryptorchidism (treatment reduces risk)
  2. Genetic: Klinefelter’s, Chromosome 12 abnormality
  3. Caucasian: 4-5x increased incidence
  4. Family history (2%)
  5. HIV
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50
Q

What does injury or vasectomy do to testicular cancer risk?

A

It does not change it

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51
Q

What are symptoms of testicular cancer?

A
  1. Unilateral enlargement or change in way it feels
  2. Painless lump or swelling or collections of fluid
  3. Dull ache in back, groin or lower abdomen
  4. Gynecomatia and/or mastalgia
  5. Testicular discomfort/pain or feeling of heaviness
  6. There may be no symptoms, or only those related to metastasis
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52
Q

What cancers can metastasize to the testicles?

A
  1. Testicular lymphoma (more common than testicular cancer)
  2. Prostate
  3. Lung
  4. Skin
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53
Q

What are survival rates for testicular cancer?

A
  1. Confined to one testicle (stage 1): 98%
  2. Metastasis to nodes (stage 2): 97%
  3. Mets above diaphragm or to visceral organs (stage 3)” 72%
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54
Q

How is testicular cancer diagnosed?

A
  1. Physical exam: firm, non-tender mass that does not transilluminate, fluid collection, regional LAD
  2. Imaging: US, CXR, Adb CT
  3. Blood tests: none
  4. Biopsy
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55
Q

What are treatments for testicular cancer?

A
  1. Radical inguinal orchiectomy
  2. Retroperitoneal lymph node dissection with metastatic disease
  3. Testicular prosthesis available
  4. Sperm banking before treatment
  5. Radiation
  6. Chemotherapy
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56
Q

How do prostate related complaints present?

A
  1. Pain, discomfort

2. Urinary and sexual problems

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57
Q

What is prostatitis and how is it diagnosed?

A
  1. Inflammation of the prostate
  2. It is responsible for 25% of all young to middle aged men going to the doctor for GU concerns
  3. Symptoms often mimic those of other urinary tract prostate disorders
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58
Q

What are symptoms of prostatitis?

A
  1. Very symptomatic (acute) to asymptomatic (chronic)
  2. Tender/swollen prostate
  3. Fever, chills (acute)
  4. Dysuria, nocturia, urgency, hesitancy, frequency, hemturia
  5. Pelvic/abdominal, LBP, joint muscle PAIN
  6. Painful ejaculations
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59
Q

What are risk factors for prostatitis?

A
  1. Medical procedures (catheterization)
  2. Unprotected vaginal/anal intercourse
  3. Abnormal urinary tract
  4. Recent cystitis
  5. Enlarged prostate (BPH)
  6. diabetes
  7. Immunocompromised
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60
Q

What is the clinical presentation of acute bacterial prostatitis?

A
  1. SUDDEN onset of chills, fever, LBP, body aches, dysuria, frequency, urgency, nocturia, perineal pain
  2. Cause: overgrowth of bacteria (E. coli) or STI
  3. ER referral, treat with antibiotics
  4. Tender, swollen indurated prostate with purulent prostatic secretions
  5. Accompanied by bacteriuria
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61
Q

What is the clinical presentation of chronic prostatitis?

A
  1. Encompasses a variety of syndromes
  2. Pathogenesis: variable but there are 2 groups: chronic bacterial (infectious) and chronic non-bacterial
  3. Suprapubic pain, LBP, dysuria, nocturia, intermittent, waxing/waning pattern
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62
Q

What should you know about chronic bacterial (infectious) prostatitis?

A
  1. Often follows acute prostatitis
  2. Insidious onset, associated with recurrent UTIs, syptoms less severe, intermittent
  3. Causes: chlamydia, ureaplasma
  4. May be associated with underlying prostate defect
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63
Q

What should you know about chronic non-bacterial prostatitis?

A
  1. Most common form, similar to bacterial type without fever and bacterial infection
  2. Unknown pathogenesis
  3. WBC in urine and prostatic secretions without identifiable cause
  4. Diagnosis of exclusion
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64
Q

How is prostatitis diagnosed?

A
  1. Prostatic stripping (massage) and culture the discharge
  2. WBCs in expressed prostatic secretions (EPS) are not diagnostic of bacterial prostatitis (not specific)
  3. pH of prostatic fluid rises when infection is present from 6.5 to >8.0
  4. PSA levels often elevated (collect before DRE)
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65
Q

How will findings of a DRE lead to a diagnosis of prostatitis?

A
  1. Symptomatic patient
  2. Enlarged, soft/boggy gland
  3. Moderately to severely tender to palpation
  4. Prostatic stones may be present and cause recurrent infections
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66
Q

How can lab findings differentiate the type of prostatitis?

A
  1. ACUTE: WBCs and bacteria in urine/prostatic fluid with acute onset and systemic symptoms
  2. CHRONIC BACTERIAL: WBCs and bacterial in urine/prostatic fluid with insidious onset
  3. CHRONIC NON-BACTERIAL: May see WBCs in urine/prostatic fluid. No evidence of infection
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67
Q

How is prostatitis treated?

A
  1. Acute: Antibiotics (repeat if does not resolve)
  2. Chronic: Antibiotics, NSAIDs for symptoms, sitz baths
  3. Non-infectious: NSAIDs to reduce inflammation, relax tissue and decrease congestion
  4. Look for underlying causes if recurrent…
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68
Q

What is prostadynia (chronic pelvic pain syndrome: CPPS)?

A
  1. Prostatits symptoms without inflammation or bacterial infection
  2. Pain in the pelvis or perineum that can extend to the penis, testes, rectum
  3. May cause voiding or sexual dysfunction
  4. Unknown cause (muscle spasms? nerve entrapements?)
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69
Q

What can be helpful is reducing symptoms of prostadynia?

A

Finesteride (for BPH)

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70
Q

What causes pudendal nerve entrapment?

A
  1. Impact trauma
  2. Surgery
  3. congenital malformations
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71
Q

What are symptoms of pudendal nerve entrapment?

A
  1. Pain in penis, scrotum, perineum or anorectal area
  2. Prostatits like pain and voiding/sexual dysfunction (Hallmark)
  3. Aggravated by sitting, relieved by standing/lying down
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72
Q

Where can the pudendal nerve become entrapped? (PNE)

A
  1. At ischial spine between sacrotuberous and sacrospinus ligaments
  2. Ensheathed by ligamentous expansions that form a perineural compartment
  3. At pudendal canal by falciform process of the sacrotuberous ligament
  4. Thickened obturator fascia
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73
Q

How is pudendal nerve entrapment diagnosed?

A
  1. Must R/O prostatits (urology referral)

2. Treat with acupuncture, chiro, PT, meds, decompression surgery

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74
Q

is BPH common?

A 
Yes (increased incidence in african americans)
25% by age 40
50% by age 60
75% bu age 70
90% by age 80
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75
Q

Why does the prostate enlarge?

A
  1. Condition of aging

2. Decreased testosterone and increase estrogen

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76
Q

What part of the prostate enlarges in BPH?

A

nearly always the transitional zone beginning around the prostatic urethra and extending peripherally

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77
Q

20% of BPH patients have symptoms. What are they?

A
  1. Difficulty initiating urine stream
  2. Interruption of stream
  3. Frequency
  4. Urgency
  5. Nocturia
78
Q

What causes increases in PSA levels?

A
  1. BPH
  2. Prostate cancer
  3. Recent ejaculation (~2 days)
  4. Prostatitis
    This should lead you to think that PSA levels are helpful mostly with comparison to previous levels
79
Q

What is the normal consistency of the prostate?

A

Rubbery, walnut sized (4cm), symmetrical and absent of any nodules or polyps

80
Q

What produces prostate specific antigen?

A

Cells of the prostate capsule and periurethral glands

81
Q

What are normal levels of PSA?

A

0-4.0 = normal
4-10 - slightly elevated
10-20 = moderately elevated
20-35 = highly elevated

82
Q

Who needs a referral for a transrectal ultrasound (TRUS)?

A
  1. PSA levels 4-10 with abnormal DRE
  2. PSA >10 regardless of DRE
    Consider “velocity” (how quickly it rises)
  3. Palpable nodule on DRE, regardless of PSA
83
Q

What is conventional treatment for increased BPH?

A
  1. Watchful waiting
  2. Meds: 5-alpha-reductase inhbitors (finasteride) or alpha blockers
  3. Surgery: for those with more serious compilcaitions
84
Q

What is the mechanism of finasteride?

A

Inhibits peripheral conversion of testosterone to DHT which blocks the growth effects of DHT

85
Q

What are conservative care options for increased BPH?

A
  1. Reduce hyperplasia by inhibiting conversion of T to DHT
  2. Prevent estrogen from binding to estrogen receptors
  3. Saw Palmetto!! (160mg BID)
86
Q

What are supplements and botanicals for BPH? (best for mild/moderate symptoms?)

A
  1. Amino acids
  2. Beta-sitosterol
  3. Zinc picolinate
  4. Pygeum
  5. Nettles (urtica diocia)
87
Q

How many men suffer from male sexual dysfuction?

A

~50% of men over 40
Decreased libido
Ejaculatory disturbances
Erectile dysfunction (MC)

88
Q

How much does testosterone decline in adult men

A

~2-3% per year between 40 and 70

89
Q

What are symptoms of androgen decline in aging men (ADAM)?

A
  1. Mood dysfunction
  2. Sexual dysfunction (libido, erectile)
  3. Osteoporosis
  4. Muscle atrophy
  5. Cognitive changes
90
Q

What are factors to consider in ADAM?

A
  1. Stress (physical and psychological)
  2. Obesity
  3. Diabetes
  4. Pituitary tumors
  5. Drugs
91
Q

How many men will get prostate cancer?

A

1 in 6 (220,900 cases in 2003)

92
Q

What hormone feeds prostate cancer (carcinoma) growth?

A

Testosterone

93
Q

What are risk factors for prostate cancer?

A
  1. age >50
  2. Race, ethnicity: African Americans 70% more likely and 2x more likely to die
  3. Family history
  4. Diet: high fat, sedentary, obese
  5. Vasectomy (may increase risk)
  6. Smoking
94
Q

Why do hispanic and african american men often present with more advanced prostate cancer?

A

Likely related to cultural differences that mean fewer screenings

95
Q

How do prostate tumors often arise and progress

A

Start peripherally and feel like a pebble, thus fewer incidences of urinary obstruction

96
Q

Where does prostate cancer metastasize to?

A

lymph nodes, seminal vesicles, spine, rectum, bladder

97
Q

15-20% of prostate carcinomas are discovered with ____?

A

TURP: TransUrethral Resection of Prostate: done for BPH not cancer

98
Q

What are signs and symptoms of prostate cancer?

A
  1. Blood in urine or semen
  2. Pain/stiffness in back,hips, upper thighs or pelvis
  3. If BPH as well: nocturia, inability to urinate, painful ejaculation, pain or burning urination, weak or interrupted flow
99
Q

How is prostate cancer detected?

A
  1. DRE
  2. PSA
  3. TRUS and biopsy
  4. PAP (prostatic acid phosphatase)
  5. Gleason score
  6. CT scan, bone scan (mets)
100
Q

What would a PSA velocity have to be to be concerning?

A

> 0.75 in 1 year = high risk

101
Q

Your patient has a PSA level >20 which makes you think….

A

That their cancer has metastasized beyond the prostate

102
Q

What is the Gleason score and how is it used?

A 
1. Evaluates 2 tissue samples from different areas of the tumor
Scores:
2-4 = well differentiated
>6 = potentially indolent
5-7 moderately differentiated
8-10 = poorly differentiated
>10 = aggressive tumor
103
Q

What are tumor characteristics that help stage prostate cancer?

A
  1. size
  2. Cell character
  3. Extent of metastasis
104
Q

What numbers indicate low risk for prostate cancer?

A

PSA <10
Gleason <6
Stage T1c, T2a

105
Q

What numbers indicate intermediate risk for prostate cancer?

A

PSA: 10-20
Gleason: 7
Stage T2b

106
Q

What numbers indicate high risk for prostate cancer?

A

PSA >20
Gleason 8-10
Stage T2c

107
Q

Which hormones are produced by the kindeys?

A
  1. Erythropoietin (EPO): stimulates bone marrow to make RBCs
  2. Renin: Regulates blood pressure
  3. Calcitriol: Active form of vitamin D (helps regulate calcium)
108
Q

At what point in decreased renal function is treatment necessary?

A

<10-15%: dialysis/transplant

109
Q

What are the most common causes of kidney disease?

A
  1. Diabetes (increased blood glucose cannot be metabolized or excreted)
  2. HTN: damages renal micorvasculature
110
Q

What are less common causes of kidney disease?

A
  1. Glomerular disease
  2. Autoimmune disease (IgA nephropathy, SLE, Goodpasture’s)
  3. Infection (post-strep, HIV, bacterial endocarditis)
  4. Sclerotic diseases (SLE, DM, focal glomerulosclerosis)
  5. Other (membranous neuropathy)
  6. Posions and Trauma (NSAIDs)
111
Q

What are signs and symptoms of kidney disease?

A
  1. Proteinuria
  2. Hematuria
  3. Peripheral edema
  4. Hypoporteinemia and anemia
  5. Decreased glomerular filtration rate (GFR)
  6. Hypertention
112
Q

How is kidney disease diagnosed?

A
  1. ID causative systemic disease
  2. US
  3. Biopsy
113
Q

What should you think if you have intermittent suprapubic/lower abdominal pain? What about constant?

A

Intermittent: obstruction
Constant: Infection

114
Q

What are symptoms of obstructive voiding?

A
  1. Hesitancy
  2. Decreased stream force
  3. Intermittancy
  4. Post-void dribbling
115
Q

What should be on your DDx for obstructive voiding symptoms?

A
  1. BPH
  2. Urethral stricture (narrowing)
  3. Stone
  4. Neurogenic bladder disorder
  5. Carcinoma
116
Q

Whhat is analyzed in a urinalysis?

A
  1. Color (clear)
  2. pH (4-8)
  3. Specific gravity (1.005-1.030)
  4. Leukocyte esterase (negative
  5. Ketones (negative)
  6. Nitrite (negative
  7. Protein, blood, glucose, bilirubin, urobilinogen (negaitve)
117
Q

What is indicated by proteinuria?

A
  1. Clinical marker for underlying kidney disease
  2. Albumin first then larger amounts and proteins
  3. most sensitive: protein/albumin:creatinine ratio
118
Q

What is indicated by severe proteinura? (>3.5g/24hours)

A

Glomerulonephritis

119
Q

What ddoes hmaturia indicate?

A

Bleeding in the GU tract (kidneys, ureters, prostate, bladder, urethra)

120
Q

What iis jogger’s hematuria?

A

Hematuria from repeated jarring of the bladder during jogging, long distance running, horse back riding, sports…etc

121
Q

Hematuria indicates ___until proven otherwise

A

Cancer

122
Q

What can hematuria during different phases of urination mean?

A
  1. Onset: urethra, prostate
  2. Throughout: bladder, ureter, kidneys
  3. End: bladder or prostate
123
Q

What does SITT stand for?

A 
Causes of hematuria
Stone
Infection
Trauma
Tumor
124
Q

What are the different types of casts and the conditions they are associated with?

A
  1. Epithelial: acute tubular NECROSIS, interstitial nephritis, eclampsia
  2. RBC: GLOMERULONEPHRITIS, collision sports
  3. WBC: glomerulonephritis, PYELONEPHRITIS, interstitial nephritis
  4. Hyaline/mucoprotein: normal, CHRONIC RENAL DISEASE, glomerulonephritis
  5. Granular/waxy: severe renal disease
  6. Fatty: NEPHROTIC SYNDROME, hypothuroidism
125
Q

What are good kidney function tests? What should you know about them?

A
  1. Serum nitrogen and creatinine
  2. Not sensitive indicators of early kidney function (~50% functional loss)
  3. Once elevated they are sensitive markers for disease progression
126
Q

What are possible causes of elevated blood urea nitrogen? (BUN)

A
  1. Dehydration
  2. Heart Failure
  3. GI hemorrhage
  4. Large protein meal
  5. Ketoacidosis (DM)
127
Q

What is the process of BUN creation? normal levels?

A
  1. Blood carries protein to cells and cell use it and create urea (waste) which is returned to blood
  2. Urea eliminated in urine; stays in blood in kidney disease
  3. Normal BUN: 7-20 dl/mg
128
Q

What are normal creatinine clearance levels? different for genders

A

Male: 15-25 mg/kg/24 hours
Female: 10-20 mg/kg/24 hours
Declines 1 mL/min/year after age 40

129
Q

What causes elevation of creatinine?

A
  1. Ketoacidosis

2. Drugs (aspirin, cimetidine, trimethoprim, cefoxitin, flucytosine)

130
Q

What causes reduced creatinine clearance?

A
  1. Advanced age (less protein)
  2. Cachexia
  3. Liver disease
  4. Shock
  5. Nephrotoxicity
  6. Acute/chronic GN
  7. HTN nephrosclerosis
  8. Polycystic kidneys
131
Q

What are normal creatinine levels in the blood?

A

0.6-1.2 mg/dL

132
Q

What is a intravenous pyelogram and what can it detect?

A
  1. X-ray of kidneys, ureters and bladder with iodine contrast agent
  2. Detects: stones, enlarged prostate, tumors
133
Q

What is the imaging of choice for growths or blockages to urine flow?

A

Ultrasound, CT and MRI

134
Q

How is a renal biopsy done?

A
  1. Local anesthetic
  2. Insertion of needle through skin posteriorly into kidney
  3. Retrieves strand of tissue 1/2- 3/4 inch long
135
Q

What leads to increased risk for chronic kidney disease?

A
  1. DM, HTN, family history
  2. Age >65 (2x more likely)
  3. African Americans
136
Q

What are the stages of chronic kidney disease?

A
  1. Kidney damage with normal GFR (90 or above)
  2. Kidney damage with mild decrease in GFR (60-89)
  3. Moderate decrease in GFR (30-59) likely with anemia and bone issues
  4. Severe reduction in GFR (15-29): dialysis or transplant
  5. Kidney failure (GFR <15): dialysis or transplant
137
Q

What are symptoms of chronic kidney disease (CKD)?

A
  1. Fatigue
  2. Poor concentration and appetite
  3. insomnia
  4. nocturnal muscle cramping
  5. Peripheral/periocular edema
  6. Dry, itchy skin
  7. Increased frequency, nocturia
138
Q

What diet substances increase kidney issue risk?

A
  1. Protein
  2. Cholesterol
  3. Sodium (raise BP)
  4. Potassium
  5. Smoking
139
Q

How common are UTIs based on age and gender?

A

Infants (<1 year) Males more common than females
Age 1-65 Females more common
Age >65 Males equal females
Age <5 years: d/t congenital abnormalities
Age 6-15: related to dysfunctional voiding
Age 16-35: Females related to intercourse, contraception

140
Q

What is the definition of chronic UTIs?

A
  1. Do not respond to usual treatment
  2. Last longer than 2 weeks
  3. Do not resolve in 24-48 hours after treatment
141
Q

What usually causes UTIs?

A

E. Coli (90-95%)

Can be d/t: klebsiella, proteus, pseudomonas, staph, enterococcus, enterobacter

142
Q

What are risk factors for UTIs?

A
  1. Sexual activity (80% in 24 hours after sex)
  2. Hygiene (hot tubs, douching, wipe front to back)
  3. Hormones (estrogen receptors in bladder, urethra, pelvic floor): pregnancy, lactation, meopause
  4. BMI, low fluid intake, delayed voiding, catheters
143
Q

What are lower tract symptoms of UTIs?

A
  1. Urgency, urge continence
  2. Frequency
  3. Suprapubic, flank or LB pain
  4. Dysuria
  5. Hematuria (microscopic)
144
Q

What are upper tract symptoms of UTIs?

A
  1. Systemic signs (fever, chills, nausea, vomiting)
  2. Flank pain, CVA tenderness
  3. Lethargy, myalgia
  4. Odorous urine, macroscopic hematuria
145
Q

What should you R/O when you suspect a UTI?

A

STI, IC, stones, epididymitis, prostatitis, vaginitis

146
Q

How are UTIs diagnosed?

A
  1. Urinalysis: RBCs, proteinuria, nitrites, leukocyte esterase
  2. Urine culture and sensitivity: >100,000 cfu/ml = infection, mixed organisms = contamination
  3. Imaging: Chronic/recurrent: KUB, US, MRI, cystoscopy, renogram
147
Q

What is KUB imaging?

A

Kidneys Ureters, Bladders

148
Q

What can help prevent UTIs?

A
  1. Cranberry (inhibits adherence of E. coli)
  2. Hydration
  3. D-Mannose (helps expel e. coli)
  4. Lactobacillus
  5. Topical E3
  6. Hygiene
149
Q

What can help men with BPH prevent UTIs?

A
  1. Urinate frequently (hydration)
  2. Saw palmetto
  3. Cranberry
  4. Lactobacillus
150
Q

What is pyelonephritis?

A
  1. Infection/inflammation of kidney/renal pelvis
  2. Gram negative MC
  3. Infection secondary to ascending lower UTI
151
Q

What are signs and symptoms of pyelonephritis?

A
  1. Fever >102, chills
  2. CVA (costovertebral) tenderness/flank pain
  3. Tachycardia
  4. N/V
  5. Leukocytosis, bacteruria, hematuria, WBC casts
152
Q

How is pyelonephritis treated?

A
  1. Oral or IV antibiotics (depending on severity)
  2. Renal imaging if not responding
  3. Repeat urine culture 2-3 weeks post treatment
153
Q

Wha tare complications of pyelonephritis?

A
  1. Recurrence
  2. Perinephric abscess (infection around kidneys)
  3. Sepsis
  4. Acute renal failure
154
Q

What are the types of urinary stones?

A
  1. Naphrolithiasis: calculi in kidney

2. Ureterolithiasis: calculi in ureter (typically originate in kidneys but may continue to grow)

155
Q

Who gets kidney stones most often?

A
  1. Men (12%) to female (5%)
  2. Caucasian
  3. Peak age: 35 males, 30 and 55 for females
156
Q

How do urinary stones form?

A
  1. Salts (calcium oxalate, uric acid) can become extremely concentrated with low urine volumes or high levels of crystal forming salts
  2. Increased concentration = precipitation into stones
157
Q

What are risk factors for urinary stones?

A
  1. Pregnancy
  2. urinary tract abnormalities
  3. Souther US (higher rates of HTN, poor diet)
  4. Specific foods (animal protein, low fiber/fluids)
  5. Weight considerations (obese = higher risk)
  6. Stress (vasopressin)
  7. Bedridden
  8. Medical conditions (UTI, HTN, gout, IBD, hyperparathyroidism, kidney disease)
  9. Meds (AIDS, chemo, thyroid hormones, diuretics, antacids)
158
Q

What are symptoms of kidney stones?

A
  1. Sudden onset of pain: acute, colicky flank pain radiating to groin (Location travels with stone)
  2. Localized pain with rebound tenderness
  3. Dysuria, urinary urgency and increased frequency
  4. CVA tenderness
  5. Hematuria
  6. Systemic : diarrhea, N/V, sweating
159
Q

Can the size of a kidney stone be related to symptoms?

A

No

160
Q

How are kidney stones diagnosed?

A
  1. Urinalysis (hematuria (85%), infection)
  2. CBC: elevated WBC, low RBC (chronic)
  3. Serum electrolytes, creatinine, calcium, uric acid and phosphorus
  4. Plain film, Non-contrast spiral CT, IVP, US
161
Q

What are male differentials for kidney stones?

A
  1. Testicular torsion
  2. Pyelonephritis
  3. Acute prostatitis
  4. Appendicitis
  5. Pancreatitis
162
Q

What are female differentials for kidney stones?

A
  1. Ovarian cysts or torsion
  2. Ectopic pregnancy
  3. Pyelonephritis
  4. Appendicitis
  5. Pancreatitis
163
Q

A kidney stone will likely pass on its own if the diameter is less than ___

A

5mm (>85% within 3 weeks)

164
Q

What are treatments for kidney stones (in the absence of infection or obstruction)?

A
  1. NSAIDs for pain
  2. Medical expulsive therapy (MET)
  3. Corticosteroids (prednisone)
  4. Calcium channel blockers or alpha blockers
165
Q

What types of foods contain oxalates and should possibly be avoided to prevent kidney stones?

A

Spinach, rhubarb, beets, tea, strawberries, chocolate, wheat, bran, nuts

166
Q

At what age is urine leakage normal

A

Only in infants

167
Q

What are the types of urinary incontinence?

A
  1. stress (MC): usually related to poor sphincter function: leakage with effort, dejurines
  2. Urge: accompanied/preceded by urgency, usually related to detrusor overactivity/instability, BPH
  3. Mixed: features of both the above (more common in women >65)
  4. Overflow: overdistension/overfilling
168
Q

What are risk factors for incontinence?

A
  1. Damage to pelvic floor muscles/nerves
  2. Vaginal deliveries (esp. forceps)
  3. Chronic increases in intra-abdominal pressure
  4. Pelvic organ prolapse
  5. Smoking
  6. Pelvic/prostate surgery
  7. Estrogen deficiency
  8. BPH
  9. UTI
  10. bladder outlet obstruction
  11. foreign bodies (suture, catheter, tumors)
  12. Neuro disorders (parkinson’s, stroke, MS…)
  13. Diabetes
  14. Meds
169
Q

How can you begin to assess seriousness of incontinence?

A

Voiding diary (frequency, volume, fluid intake): can help determine treatments

170
Q

How is incontinence managed?

A
  1. Pelvic floor muscle eval and rehab: kegels, weighted vaginal cones, biofeddback
  2. Pharmaceuticals
  3. Electrical stimulation: biofeedback
  4. Pessaries/urethral barriers
  5. Behavioral treatment/modification
  6. Absorbent products
  7. Surgery
171
Q

What is interstitial cystitis?

A
  1. Painful bladder syndrome
  2. Condition that results in recurring discomfort or pain in bladder and surrounding tissue
  3. Mostly in women (90%) and caucasians
  4. Average age is 40
172
Q

What are symptoms of interstitial cystitis?

A
  1. Mild discomfort, pressur, tenderness or intense pain in bladder and pelvis (may change with bladder filling)
  2. Urgency, frequency (up to 60x a day!)
  3. Nocutria
  4. (pre)menstrual exacerbation
  5. Dysparunia
173
Q

What are theories for cause of Interstitial cystitis?

A
  1. Infectious
  2. Autoimmune
  3. Mechanical injury
  4. Mast Cell activation (1/3 have increases)
  5. Alteration to bladder lining (decreased GAGs)
174
Q

What are associations for interstitial cystitis in women?

A
  1. Chronic pelvic pain
  2. Dysparunia
  3. Vulvodynia
  4. Improve with pregnancy
175
Q

What are associations for interstitial cystitis in men?

A
  1. Chronic NB prostatitis
  2. BPH
  3. Prostadynia
176
Q

How is interstitial cystitis diagnosed

A
  1. history and physical

2. Confirmed with cystoscopy with hydrodistension and bladder biopsy

177
Q

What is bladder distention used to treat?

A

Interstitial cystitis: symptoms may worsen for 24-48 hours before receding

178
Q

What are lifestyle changes that can be made to prevent interstitial cystitis?

A
  1. Quit smoking idiot
  2. Exercise (gentle stretching)
  3. Bladder training
  4. Diet changes: decrease/eliminate alcohol, caffeine, spicy foods
179
Q

Where is bladder cancer most often found

A
  1. In the lining of the bladder (high stage if it invades muscle layer)
  2. Most commonly originates in transitional epithelial cells in industrialized countries (>90%)
  3. Most commonly squamous cell carcinomas caused by Schistosoma haematobium in developing countries (75%)
180
Q

What is the primary symptoms of bladder cancer?

A

hematuria (frequent urination and dysuria too)

181
Q

Where does the highest incidence of bladder occur?

A

In industrialized nations (asia and SA ~70% lower than US)

182
Q

Who gets bladder cancer most often?

A
  1. Increased age (>55)
  2. Men 2-3x more common
  3. Caucasians
183
Q

What are risk factors for bladder cancer?

A
  1. Smoking
  2. Chronic bladder inflammation (carcinogens in urine?)
  3. Diet (high in saturated fat)
  4. External beam radiation
  5. Family history
  6. Infection: shistosoma haematobium
184
Q

What is the prognosis for bladder cancer?

A
  1. Superficial: 5 year survival = 85%
  2. Invasive: ~5% live 2 years (mets)
  3. Recurrent/agreesive = poorer prognosis
185
Q

Most solid kidney tumors (>90%) are ____

A

Malignant

186
Q

What are symptoms of renal cancers?

A
  1. Often asymptomatic
  2. Flank/abdomen pain
  3. Palpable mass in flank/abdomen
  4. Varicoele (usually L sided d/t obstruction of testicular vein)
  5. HTN (20%)
  6. Hematuria (40%)
  7. supraclavicular adenopathy
187
Q

Where does renal cancer metastasize to?

A
  1. Lung 75%
  2. Soft tissues 36%
  3. Bone 20%
  4. Liver 18%
  5. Cutaneous sites 8%
  6. CNS 8%
188
Q

What is paraneoplastic syndrome and who gets it?

A
  1. Weight loss (33%), loss of appetite, fever, night sweats, HTN
  2. Occurs in 30% of kidney cancer patients
189
Q

What are lab findings for paraneoplastic syndrome?

A
  1. Elevated ESR
  2. low RBC count (anemia)
  3. Hypercalcemia
  4. Abnormal liver function tests (elevated alk phos)
  5. Elevated WBC count
190
Q

What is the prognosis for kidney cancer?

A
  1. > 50% cured in early stages
  2. Outcome of stage IV is poor (palliative care)
  3. Stage II-IV = less than 50% survival rate

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