Overview 3 Flashcards
Trigone of the bladder is formed from what? x3
Formed from the orifices of the ureters and the urethra
Epithelium of the bladder detrusor muscle is?
Transitional stratified epithelium
Micturition is controlled by what region in the brain?
Pontine micturition centre
Bladder fills with wee - activates what?
Stretch receptors of detrusor muscle
Activation of detrusor stretch muscles results in what?
Feedback to pontine micturition centre
Pontine micturition centre stimulates micturition via what nerve?
Pudendal nerve
Nerve roots of the pudendal nerve are?
S2, 3, 4
Action of pudendal nerve on the bladder is?
Relaxation of the sphincter of the bladder
Micturition pudendal nerve involvement is somatic or autonomic
Somatic - conscious relaxation of the sphincter
Relaxation of bladder sphincter results in activation of what?
Activation of parasympathetic reflex loop from pontine micturition centre
Parasympathetic to bladder nerve and nerve roots?
Parasympathetic pelvic nerves - S2, 3, 4
Detrouser muscle contraction involves what neurotransmitter?
Ach
Detrouser muscle contraction involves what neurotransmitter receptor?
ACh M3
Four stages of the bladder cycle are?
Bladder filling
First sensation to void
Normal desire to void
Bladder filling
Two modes of the bladder cycle are?
Storage phase
Emptying phase
Bladder spends most of the time in which stage of the bladder cycle?
Storage phase
Normal outflow of urine per day is?
1500ml of urine
Potential lower urinary tract symptoms? x4
Frequency/urgency/nocturia
Hesitancy/poor flow
Haematuria
Terminal dribbling
Main symptoms of overactive bladder syndrome? x3
Urgency - with or without incontinence
Frequency
Nocturia
Lower urinary tract symptoms are due to problems in which stage of the bladder cycle?
Storage phase
How can prostate symptoms be measured? (scoring system name)
Internation prostate symptom score (IPSS)
Score for mild IPSS?
0-7
Score for moderate IPSS?
8-19
Score for severe IPSS?
20-35
Benign prostate hyperplasia has what effect on the anatomy of the bladder?
Detrusor muscle hypertropies to compensate
Effect of BHP on the physiology of the bladder?
Hypertrophied detrusor muscle increases pressure - kidney damage
Too little fluid consumption has what effect on the bladder?
Too little - toxic concentration of urine irritates the bladder
Method to aid fluid management?
Voiding diary
Effect of caffeine consumption on bladder contraction?
Increases likelihood of bladder contraction
How does calcium act as a diuretic?
Releases calcium stores from the golgi body in the bladder wall
What is the effect of acidic drinks on the bladder?
Can irritate the bladder
Medical therapy for urinary problems x5
alpha blockers 5-alpha reductase inhibitors PDE5 inhibitors Antimuscarinincs Combination
What would antimuscarinics be used to treat?
OAB
Finasteride is a?
5-alpha reductor inhibitor
Caffeine causes the release of calcium from which organelle in the cells of the bladder wall?
Golgi apparatus
Tamsulosin is a?
Alpha-blocker
Doxazosin is a?
Alpha-blocker
Dutasteride is a?
5-alpha reductor inhibitor
Terazosin is a?
Alpha-blocker
How to alpha-blockers treat BHP?
Relaxation of the smooth muscle of the bladder and the prostate to pass urine more easily
How to 5-alpha reductase inhibitors treat BHP?
Prevent further growth of the prostate gland and aim to shrink it
5-alpha reductor inhibitors and alpha blockers are both used in the treatment of?
BHP
Gold standard surgical treatment for LUTS?
Transurethral resection of the prostate
Three types of urinary incontinence are?
Stress UI
Urge UI
Mix of the two
What is stress UI?
Leakage on effort or exertion i.e. increased abdominal pressure
What is urge UI?
Leakage accompanied by urgency
Treatment for stress UI?
Surgery
Treatment for urge UI?
Medication
Two nerves that can be stimulated for the treatment of UI are?
Posterior tibial
Sacral
Three medications that can be used for UI/OAB?
Anticholinergics
B3 adrenergics
Botox
What is the real name of botox?
Botulinum toxin A
Vaginal cones can be used in the treatment of what type of UI?
Stress
Neurological lesions between which two regions can lead to micturition problems?
Between the micturition centre in the pons and T12
What is acromegaly?
Excessive release of GH in the pituitary gland
First presentation of acromegaly is?
Enlargement of the hands and feet
Most common cause of acromegaly is?
Pituitary adenoma
GH is released from where?
Pituitary gland
Release of GH is stimulated by what hypothalamic hormone
GHRH
Release of GH is inhibited by what hormone?
Somatostatin
GH causes the release of what?
Insulin like growth factor
IGF-1
GH causes release of IGF-1 in which three regions?
Liver
Bone
Muscle
Negative feedback to GH release is mediated by what?
IGF-1 release from the liver
General function of diuretic?
Increase urinary sodium and water loss
General mechanism of action of diuretic?
Reduces reabsorption of sodium at different sites of the nephron
Five classes of diuretic are?
Carbonic anhydrase inhibitor Loop Thiazide Potassium sparing Osmotic
Acetazolamide is?
Carbonic anhydrase inhibitor
Acetazolamide has function where in the kidney?
Proximal convoluted tubule
How commonly are carbonic anhydrase inhibitors used and why?
Weak diuretic - not commonly used anymore
Acetazolamide main uses? x3
Glaucoma
Epilepsy
Mountain sickness
Side effects of carbonic anhydrase inhibitors? X3
Metabolic acidosis
Sedation
Bone marrow suppression
Frusemide is?
Loop diuretic
Loop diuretics work at what part of the loop of Henle?
Thick ascending region
Loop diuretics work on what transporter?
Na+/Cl-/K+ transporter
Three indications for usage of loop diuretics?
Hypertension
Heart failure
Volume overload from CKD
Four side effects of loop diuretics?
Hypokalaemia
Dehydration and acute renal failure
Kidney stones
Deafness
Bumetanide is?
Loop diuretic
Bendroflumethiazide is?
Thiazide diuretic
Thiazide diuretic works at which transporter?
Na+/Cl- channel - prevents function
Thiazide diuretic at which region of the kidney?
DCT
Most potent diuretic is?
Loop diuretic
Hydrochlorothiazide is?
Thiazide diuretic
Main usage of thiazide diuretics?
Antihypertensives
Five s/e of thiazide diuretics
Hypokalaemia Hypercalcaemia Hyponatraemia Hyperglycaemia Hypercholesterolaemia
Two groups of potassium sparing diuretics are?
Epithelial Na+ channel antagonists
Aldosterone antagonist
Amiloride is?
Potassium sparing diuretic - epithelial Na+ channel antagonist
Spironolactone is?
Potassium sparing diuretic - aldosterone antagonist
Potassium sparing diuretics work where in the kidney?
Collecting tubule
Three indications for amiloride usage?
Heart failure
Hypokalaemia
Cirrhosis
Two side effects of amiloride usage?
HypERkalaemia
Hyponatraemia
Four indications for aldosterone inhibitor usage?
Hyperaldosteronism
Heart failure
Hypokalaemia
Cirrhosis
Main s/e of aldosterone inhibitor usage
Hyperkalaemia!!!!!!!!!!!!!!
What is an osmotic diuretic?
Any osmotically active molecule that is freely filtered in the glomerulus and is not reabsorbed by the tubules
Most important osmotic diuretic?
Mannitol
Two indications for osmotic diuretic?
Cerebral oedema
Oliguric acute renal failure
Three main contraindications for diuretic usage?
Hypotensive
Dehydrated
Post surgery with poor urine output
Three s/e of osmotic diuretic usage
Pulmonary oedema
DKA
Disequilibrium syndrome
Mannitol works as a diuretic via what mechanism?
Water drag (osmotic diuretic)
Mannitol is absorbed where in the kidney?
Glomerulus
What are the three types of hormones?
Steroid
Peptide
Amine
Three regions an endocrine hormone may act?
Cell surface
Cytoplasm
Nucleus
Three effects of an endocrine hormone?
Increased hormone production
Release of stored hormone
Cell multiplication
What factor expression is required for adrenal gland development?
Steroidogenic factor 1
Five zones of the adrenal gland are?
Adrenal cortex ZG ZF ZR Adrenal medulla
Hormones produced by adrenal medulla?
Catecholamines adrenaline and noradrenaline
Hormones produced by ZG + eg
Mineralcorticoids e.g. aldosterone
Hormones produced by ZF + eg
Glucocorticoids e.g. cortisol
Hormones produced by ZR + eg
Androgens e.g. testosteone
Right hand adrenal gland shaped?
Pyramidal
Left hand adrenal gland shape?
Crescent
Adrenal gland blood supply?
Subscapular plexus from adrenal artery
ZG, ZF and ZR are found in which part of the adrenal gland?
Adrenal cortex
Adrenal gland responds to which three types of stress?
Starvation
Infection
Severe volume loss
CYP enzyme expressed at the glomerulosa is?
CYP11B2
CYP enzyme expressed at the fasciculata is?
CYP11B1
CYP enzyme expressed at the reticulosa is?
CYP17A1
Two factors causing release of aldosterone?
Low BP
High potassium
Two hormones that can activate the mineralocorticoid receptor are?
Aldosterone
Cortisol
Which out of aldosterone and cortisol can actually activate the mineralocorticoid receptor and why?
Aldosterone
Cortisol is inactivated to prevent it from binding
Aldosterone activates what channel?
Sodium and potassium ATPase - ENAC
Primary hyperaldosterone is known as?
Conn’s syndrome
Three signs of Conn’s syndrome
Hypertension
Suppressed plasma renin activity
Increased aldosterone secretion
Two causes of Conn’s syndrome?
Aldosterone producing adenoma
Bilateral adrenal hyperplasia
What is cortisone?
Inactivated form of cortisol
Can cortisone bind to the mineralocorticoid receptor?
No
Three signs of Liddle Syndrome
Hypertension
Hypokalaemia
Metabolic alkalosis
Cause of Cushing’s syndrome? x4
Iatrogenic
ACTH releasing adenoma of pituitary
Cortisol secreting adrenal adenoma
Bilateral adrenal hyperplasia
What is the hormone corticotroph?
This is the same as ACTH
What is Cushing’s syndrome?
Elevated levels of cortisol
What is Addison’s syndrome?
Reduced levels of cortisol
Two causes of Addison’s disease?
Autoimmune adrenal failure
TB
Addisonian crisis is?
Failure to respond to stress - low BP, low glucose, low Na, high K
Treatment for Addison’s disease? x2
Hydrocortisone - glucocorticoid
Fludrocortisone - mineralocorticoid
Treatment for addisonian crisis?
IV fluid resuscitation
IM hydrocortisone
Cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
Four consequences of lack of 21-hydroxylase?
Salt-losing
Adrenal insufficiency
Virilisation
Adrenal hyperplasia
Noradrenaline is important in what stress response?
Low BP
Adrenaline is important in what stress response?
Low blood sugar
Adrenaline and noradrenaline are metabolised by what enzyme?
COMT
Chromaffin cells are found where?
Adrenal medulla
Significance of chromaffin cells?
These are prone to tumour development
Alpha-1 receptors are found where?
Smooth muscle
Endothelium
Function of alpha-1 receptor?
Vascular and smooth muscle contraction
Beta-1 receptors are found where?
Heart
Activation of beta-1 receptors? x2
Increase heart rate and strength of contraction
Beta-2 receptors are found where?
At the lungs - bronchioles
Skeletal muscle
Activation of beta-2 receptors?
Relaxation of smooth muscle
Symptoms of catecholamine excess? x7
Hypertension Dyspnoea Headache Tremor Nausea and vomiting Fatigue Weight loss
Treatment for catecholamine excess? x2
Phenoxybenzamine
Propranolol
What drugs should be avoided in those with catecholamine excess?
Opiates
T3 is called?
Liothyronine/triiodothironine
T4 is called?
Levothyroxine
Superior thyroid artery originates from?
External carotid artery
Inferior thyroid artery originates from?
Thyrocervical trunk from the subclavian artery
Superior thyroid vein drains to?
Internal jugular
Middle thyroid vein drains to?
Internal jugular
Inferior thyroid vein drains to?
Brachiocephalic vein
Thyroid follicles contain what substance?
Colloid
Cells of the thyroid gland are?
Thyroid follicular cell
Where does the thyroid gland originate from?
Branchial pouch
Which lobe of the thyroid gland is larger?
Right
Which lobe of the thyroid gland is first palpable in goitre?
Right
What does thyroglobulin contain and what is it’s function?
Contains iodine for T4 production
Which thyroid hormone is first produced?
T4
Enzyme responsible for T4 conversion to T3?
Deiodinase enzymes
Three types of deiodinase enzymes are?
D1, D2, D3
Function of D1?
Conversion of T4 to T3 - plasma T3 production
Function of D2?
Conversion of T4 to T3 - local T3 production
Function of D3?
Can inactivate both T4 and T3 - T3 degredation
Where is D1 located? x4
Liver
Kidney
Muscle
Thyroid
Where is D2 located? x2
Brain
Pituitary
Where is D3 located? x3
Brain
Placenta
Foetus
Which of the deiodinase enzymes are downregulated/upregulated in hypothyroidism?
Upregulate D2
Downregulate D1 and D3
Which of the deiodinase enzymes are downregulated/upregulated in hyperthyroidism?
Down regulate D2
Upregulate D1 and D3
Function of deiodinase enzyme?
Removal of an iodine for conversion of T4 to T3
Where is the majority of T4 converted to T3?
Liver
In which organ is regulation of T3 levels the most important?
Brain
T4/T3 - which is produced by the thyroid gland?
T4
T4/T3 - which is the active thyroid hormone?
T3
How many more times potent is T3 than T4?
3/4 times
Significance of raised thyroid binding globulin?
Signifies reduced levels of free thyroid - more is bound to the globulin
Increased activity fo the thyroid gland to produce T4
Physiological cause of raised thyroid binding globulin?
Pregnancy
Thyrotoxicosis is?
Too much thyroid hormone
Hyperthyroidism is?
Overproduction of thyroid hormone - leads to thyrotoxicosis
Hyperthyroidism cardiac effect?
AF
Hyperthyroidism effect on metabolism? x6
Increased BMR Increased appetite Heat intolerance Protein and lipid degredation Weight loss and myopathy Hyperglycaemia
Hyperthyroidism effect on nervous system? x2
Nervousness
Seizures
Hyperthyroidism effect on the eyes? x3
Lid lag
Proptosis
Widening eyes
Hyperthyroidism effect on skin? x4
Plumber’s nails
Warm and moist skin
Vitiligo
Pretibial myxodoedema
Hyperthyroidism effect on bone? x3
Accelerated osteoclast activity
Hypercalcaemia
Osteoporosis
Hyperthyroidism - haematological effect?
Pernicious anaemia
B12 deficiency
Hyperthyroidism effect on reproduction? x2
Oligomenorrhoea
Erectile dysfunction
What is Graves disease?
Overactive thyroid gland - leads to thyrotoxicosis
Four risk factors for Graves’ disease?
HLA status
Infection
Stress
Female sex
Three treatments used in management of Graves?
Thionamide drugs
Radioactive Iodine
Thyroidectomy
Name two thionamide drugs
Propylthiouracil
Carbimazole
Signs of hypothyroidism?
Reduced sweat and sebum Hair loss and wispy Brittle nails Bradycardia Reduced appetite Constipation Slow relaxing reflexes Growth retardation Reduced BMR Reduced GFR Reduced libido Erectile dysfunction Hypoglycaemia
Which GLUT expression is reduced in hypothyroidism?
GLUT4
Causes of hypothyroidism x4
Hashimoto’s disease
Endemic goitre
Lithium
Hypopituitarism
Histological feature of Hashimoto’s thyroditis?
Lymphocytic infiltration
AST/ALT ratio of what signifies liver cirrhosis?
AST/ALT ratio >1
When does cirrhosis occur?
This is the end stage to any liver disease
Wavelength of x-rays are?
0.01-10 nanometres
Effect of x-rays on DNA?
Damage to DNA
Why is ultrasound used more than x-rays in urology?
X-rays for hard materials
Ultrasound - soft materials - liquid urine
What is the main role of MRI in urology?
Prostate imaging
Two advantages of nuclear imaging?
Can give function and obstruction information rather than just static information
Can also give static information
Two routes of endoscopy?
Natural hole
Laparoscopy - use a new hole
Glomerulus afferent and efferent arteriole - which is under the greatest pressure?
Afferent
What volume of plasma is filtered per day?
180L
Normal volume of urine per day?
1-2L
Five factors that determine the filtrate through glomerulus?
Net filtration pressure Podocyte slit pores Size of the molecule Charge of the molecule Negative charge of the GBM glycoproteins
Molecular weight of proteins that are cut off from passing through glomerulus?
> 52,000 daltons
What is the molecular weight of albumin?
69,000 daltons
GFR value per minute?
120mL
Three stages to measuring clearance of a substance?
Measure concentration of creatinine in plasma
Collect urine for fixed time period - urine flow
Measure concentration of creatinine in collected urine
Gold standard for measurement of GFR is?
Nuclear medicine scan
Four variables of the MDMR equation?
Creatinine
Age
Sex
Race
Creatine is produced by what?
Muscle
Effect of creatinine levels in muscular individuals?
They will have raised creatinine levels
Effect of trimethoprin drug on creatinine?
Inhibits tubular secretion of creatinine
Anatomy of PCT differs to that of DCT how?
PCT has apical brush border - microvilli
Glucose exceeding the glucose threshold results in what change in the urine?
Presence of glucose in the urine
What is Gitelman’s defect?
Problem at the DCT
What is Bartter type 1 defect?
Problem at the thick ascending loop of Henle
Superior rectal vein drains to where?
Inferior mesenteric vein
Inferior rectal vein drains to where?
Internal iliac vein
Two veins that form the hepatic portal vein are?
SMV
Splenic vein
Inferior mesenteric vein joins onto what vein?
Splenic vein
Pancreatoduodenal artery is a branch of what artery?
Gastroduodenal artery
Vertebral level of kidneys?
T12-L3
Which renal vein can you see extending in a CT?
Left renal vein crosses anterior to the aorta
Visceral layer of Bowman’s capsule composed of?
Podocytes
Parietal layer of Bowman’s capsule composed of?
Simple squamous epithelium
Graves; disease is hypo or hyperthyroidism?
Hyperthyroidism
How to tell apart collecting duct from loop of Henle histology?
Cells of the loop of Henle more spaced out and cells of collecting duct much closer together
Cause of nutmeg liver?
Right sided heart failure
Cirrhosis causes what in the liver?
Fibrosis of the liver
Fibrotic tissue of the liver composed of what component?
Type 1 collagen
Cirrhotic live contains what collagen type?
Type 1
Renal artery branches off of the aorta at what level?
L1
Aorta bifurcates into common iliac arteries at what level?`
L4/L5
Gonadal artery (vaginal/testicular) leaves aorta at what level?
L2
Catechalamines are produced from teh adrenal medulla or the adrenal cortex?
Medulla
GFR zones are part of teh adrenal medulla or teh adrenal cortex?
Cortex
Right gonadal vein drains into?
IVC
Left gonadal vein drains into?
Left renal vein
Three hormones secerted by the thyroid gland are?
T3
T4
Calcitonin
Cells that secrete hormone calcitonin are?
Parafollicular cells in the thyroid
Acinar cells are located in which organ?
Pancreas
Source of middle rectal artery?
Internal iliac artery
Source of inferior rectal artery?
Internal pudendal artery
Epithelium of renal papilla?
Transitional
Tissue that composes a cirrhotic nodule is?
Dense irregular fibrocollagenous tissue
Location of follicular cells vs. parafollicular cells
Both in thyroid gland
Follicular cells - within thyroid follicle
Parafollicular cells - around thyroid follicles
Parafollicular cells of thyroid secrete?
Calcitonin hormone
Follicular cells of thyroid secrete?
Hormones T3/T3
Papillae form in the thyroid gland in which condition?
Grave’s disease
Left suprarenal veins drain to?
Left renal vein
Parafollicular cells are also known as?
C cells
secretion of Calcitonin
Six structures found in the cavernous sinus are?
CNIII CNIV CNV - V1 CNV - V2 CNVI
+ Internal carotid artery
Acinar cells are located in which organ?
Pancreas
What is the renal papilla?
Region where renal medullary pyramids empty into the minor calyx
What empties into minor calyx from renal medullary pyramid?
Urine
Tissue that composes a cirrhotic nodule is?
Dense irregular fibrocollagenous tissue
Central veins of the liver are found where?
At the centre of hepatic lobules
Origin of uterine artery?
Internal iliac artery
Internal iliac artery - two terminal branches?
Inferior gluteal artery
Internal pudendal artery
Origin of vaginal artery?
Internal iliac artery
What are gallstones made from?
Cholesterol
Function of bile is?
Transportation to aid fat digestion
Obstruction where in the biliary tree would cause jaundice?
Common bile duct
Passage of bile is?
From the liver to the duodenum (half from the liver is stored in the gallbladder)
Two ketogenic amino acids are?
Leucine
Lysine
