Nephro 2 Flashcards
How would you investigate a testicular lump?
Testicular lump = cancer until proven otherwise
- can you get above it?
- is it separate from the testis?
- cystic or solid?
Cannot get above - inguinoscrotal hernia
Separate and cystic - epididymal cyst
Separate and solid - epididymitis or varicocele
Testicular and cystic - hydrocele
testicular and solid - tumour , haematocele
What is an Epididymal cyst?
smooth, extratesticular, spherical cyst on head of the epididymis
develops around 40
How would an epididymal cyst present?
often multiple and bilateral
asymp until large
well defined and will transluminate since fluid-filled
testis palpable separately from cyst
scrotal USS investigation
How would you treat an epididymal cyst?
none needed
if painful then surgical excision
What is a primary hydrocele? Whom do you normally see it in?
Abnormal collection of fluid within the tunica vaginalis
more common in younger men
assoc. with patent processus vaginalis
What are causes of secondary hydroceles?
older boys and older men
testis tumour trauma infection TB testicular torsion
How does a hydrocele present? How would you investigate?
scrotal enlargement with a non-tender smooth cystic swelling
no pain unless infected
usually clinical or USS
What is a varicocele? Whom do you normally see it in?
abnormal dilation of the testicular veins in pampiniform venomous plexus - caused by venous reflux
usually around 40 y/o
How does a varicocele present?
Often visible as distended scrotal blood vessels - bag of worms
Dull ache or scrotal heaviness
scrotum hangs lower on the side of the varicocele
How would you investigate varicocele?
scrotal USS
semen analysis
serum FSH
What is testicular torsion? How urgent is treatment needed?
torsion of spermatic cord resulting in occlusion of testicular blood vessels = ischaemia and infarct
Typically neonates or post-pubertal boys 11-30
surgery <6 hrs salvage rate is 90-100%
> 24 hrs 0-10%
How does testicular torsion present? What treatment is needed?
Any boy presenting with abdo pain - check testis
Sudden onset pain in one testis
testis - very tender, hot and swollen
emergency scrotal exploration - manual detorsion
What are some causes of acute urinary retention?
Prostatic obstruction Urethral strictures Anti-cholinergics Alcohol Constipation Post-op Infection Neurological
What examinations would you carry out in a presentation of acute urinary retention?
Abdomen exam
Prostate exam (DRE)
Perineal sensation (check for cauda equina)
What investigations would you do for acute urinary retention? management?
normal renal biochem
renal USS
PSA - for BPH/prostate cancer
Manage - catheter, Tamsulosin (alpha-1 blocker, relaxes smooth muscle neck to aid voiding)
What are some causes/RFs of chronic urine retention?
Prostatic enlargement
Pelvic malignancy or rectal surgery
Diabetes
low pressure - detrusor failure
high pressure - interactive obstructive uropathy
How would chronic urinary retention present?
Overflow incontinence
Loss of appetite
Constipation
Distended abdomen
UTI
What is the function of the prostate?
secretes 70% of the volume of seminal fluid and is hormone dependent
How does BPH present?
Nocturia Frequency Urgency Post-micturition dribbling Poor stream/flow Hesitancy haematuria Bladder stones Abdo exam = enlarged bladder
How would you investigate BPH?
PSA
Urinalysis
International Prostate Symptom score
Treatment of BPH?
Watchful waiting
Alpha-blocker - Tamsulosin
5-alpha-reductase inhibitor - finasteride
Phosphodiesterase-5 inhibitor - sildenafil
Anticholinergic - tolterodine
TURP - transurethral resection of prostate
What some characteristics of Renal Cell Carcinoma?
Also known as hypernephroma/Grawitz tumour
Arises from proximal convoluted tubular epithelium
Most common renal tumour in adults
Usually after 50 y/o
What are risk factors for RCC?
Smoking Obesity Hypertension Renal failure PKD Von Hippel Lindau syndrome
Presentation of RCC?
Asymp haematuria, loin/flank pain anorexia, malaise and weight loss can cause varicocele hypertension anaemia (erythropoietin suppression)
