PBL ILO’s Flashcards
Where are the kidneys located?
• Kidneys lie retroperitoneally in the abdomen
• They typically extend from T12 to L3, right kidney is often situated slightly lower due to the presence of the liver
• Adrenal glands sit immediately superior to the kidneys within a separate envelope of the renal fascia
What is the renal parenchyma divided into?
Renal parenchyma can be divided into two main areas → outer cortex and inner medulla
Important functions of the kidney
• Kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals → potassium and sodium in balance
• Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine
• Other important functions of the kidneys:
○ Blood pressure regulation
○ Production of erythropoietin → controls red blood cell production in the bone marrow
○ Regulates acid-base balance and conserve fluids
Shape of the bladder
• When full it exhibits an oval shape, and when empty it is flattened by the overlying bowel
External features of the bladder
• External features of the bladder are:
○ Apex → located superiorly, pointing towards the pubic symphysis. It is connected to the umbilicus by the median umbilical ligament
○ Body → main part. Located between apex and the fundus
○ Fundus (base) → located posteriorly. It is triangular-shaped, tip of the triangle pointing backwards
○ Neck → formed by the convergence of the fundus and the two inferolateral surfaces. It is continuous with the urethra
Anatomy of the ureters
• Two ureters → narrow tubes carry urine from the kidneys to the bladder. Muscles in the wreter walls continually tighten and relax forcing urine downward, away from the kidneys
○ If urine backs up, or stands still, a kidney infection can develop
What is a urinary tract obstruction?
→ urinary tract obstruction is a blockage that inhibits the flow of urine through its normal path (the urinary tract)
What can cause ureteral obstructions?
• Many reasons can cause a ureteral obstruction:
○ Benign prostatic hyperplasia
○ Scar tissue in the ureter → makes it hard to micturate
○ Tumours or cysts in the abdominal area that press on the ureter
○ Vascular disease and blood clots
○ GI issues → Crohn’s disease, diverticulitis or a swollen appendix
○ Ureteral stones
○ Ureteropelvic junction obstruction → blockage of the ureter at its connection to the kidney
○ Ectopic ureter → ureter connects to the wrong place in the body
○ Ureterocele → birth condition that causes swelling in the ureter
○ Pregnancy, endometriosis or uterine prolapse
Symptoms of urinary tract obstruction
• Symptoms:
○ Pain in the abdomen, lower back or flank pain
○ Fever, nausea or vomiting
○ Difficulty urinarting or emptying the bladder
○ Frequent urination
○ Recurring UTIs
○ Haematuria
○ Cloudy urine
○ Swollen legs
Prostate anatomy and structure
• The prostate gland is a walnut-sized gland located between the bladder neck and the external urethral sphincter.
• The prostatic urethra runs directly through the prostate, emerging as the membranous and penile urethra.
Four main zones of the prostate gland
There are four main zones in the prostate gland-
a. The peripheral zone (posteriorly)
i. This is the zone felt during DRE
b. The fibromuscular zone (anteriorly)
c. The central zone (centrally)
The transitional zone (surrounding the urethra) .
Function of the prostate
Prostate Function
• The prostate is the largest accessory gland in the male reproductive system. • It secretes proteolytic enzymes into the semen, which act to break down clotting factors in the ejaculate. • This allows the semen to remain in a fluid state, moving throughout the female reproductive tract for potential fertilisation. • The proteolytic enzymes leave the prostate via the prostatic ducts. These open into the prostatic portion of the urethra, through 10-12 openings at each side of the seminal colliculus (or verumontanum); secreting the enzymes into the semen immediately before ejaculation.
Describe micturition
Micturition is the process of excreting urine out of the urinary system.
It can be split into two phases:
• Storage/continence phase
• Voiding phase
Both of these phases are controlled by the sympathetic, parasympathetic and somatic nervous systems which coordinate the relaxation and contraction of bladder and urethral sphincters.
A 30-year-old man who works as a dance music DJ presents to his GP surgery with recurrent episodes of frequency and dysuria. Cultures have been performed several times with no growth, dipsticks are always NAD and antibiotics make no difference to his symptoms.
Which of these illicit drugs is most likely to be contributing to his problem?
A) cocaine
B) ecstasy
C) ketamine
D) MDMA
E) “poppers”
C) ketamine - destroys your bladder, urgency but struggle to pass urine - cause interstitial cystitis and ulceration in the bladder
A 52-year-old man had a respiratory viral illness 4 weeks ago. He has subsequently been hospitalised for the last week after developing a progressive, ascending and symmetrical weakness in his legs. He is currently unable to walk and has gone into urinary retention.
Which is the most likely condition to explain these symptoms?
A) Parkinson’s disease
B) Prostate cancer
C) Multiple sclerosis
D) Guillain-Barre syndrome
E) Interstitial cystitis
D) Guillain-Barré syndrome
A 26-year-old man has been to his GP with a lump in his testicle. On examination there is a hard lump affixed to the testicular body.
Which of these tumour markers is most likely to be raised in testicular cancer?
A) CA125
B) Carcinoembryonic antigen
C) Prostate specific antigen
D) Alpha feto-protein
E) CA19-9
A) CA125 - ovarian cancer
B) Carcinoembryonic antigen - check how well treatment is working in certain types of cancer, particularly bowel cancer
C) Prostate specific antigen - prostate cancer
Correct D) Alpha feto-protein - raised in liver cancer, ovarian and testicular
E) CA19-9 - pancreatic cancer
A 57-year-old man with a short history of depression has been referred to urology by his GP due to a penile problem. He reports painful erections and is embarrassed because his penis has started to curve to the left, making intercourse very difficult.
Which is the most likely diagnosis?
A) Peyronie’s disease
B) Priapism
C) Paraphimosis
D) Phimosis
E) Paruresis
A) Peyronie’s disease (correct)
B) Priapism - prolonged erection
C) Paraphimosis - can’t put foreskin back (swollen) - usually after catheterisation
D) Phimosis - tight foreskin
E) Paruresis - difficult or impossible to wee when others are around
A 70-year-old woman has been referred by her GP for a 2ww appointment in the “non-specific but concerning” clinic. She has been experiencing unintentional weight loss, night sweats and is anaemic but with no other obvious focal point. The GP wants to rule out a malignancy.
Which type of cancer generally has the poorest prognosis (lowest 5-year survival rate)?
A) Malignant melanoma
B) Ovarian cancer
C) Lung cancer
D) Non-Hodgkin’s lymphoma
E) Pancreatic cancer
A) Malignant melanoma - best prognosis
B) Ovarian cancer - 3rd best
C) Lung cancer - 4th best
D) Non-Hodgkin’s lymphoma - second best
E) Pancreatic cancer (correct)
