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Z Year3 Conditions > RENAL 3 > Flashcards

RENAL 3 Flashcards

1
Q

What are the risk factors for renal cell carcinoma?

A
  1. Smoking
  2. Male
  3. Obese
  4. Hypertension
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2
Q

What are the symptoms of renal cell carcinoma?

A
  1. Haematuria
  2. Flank pain
  3. Abdominal/flank mass
  4. Appetite loss, malaise, weight loss
  5. Shortness of breath: aneamia as erythpoeitin production is hindered
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3
Q

What is the gold standard investigation for renal cell carcinoma?

A

CT abdo/pelvis: definitive diagnosis and staging

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4
Q

What bloods are measured for renal cell carcinoma

A
  1. FBC: anaemia from chronic disease, ethroycytosis from lack of erythropoietin
  2. U+Es: idea of kidney function
  3. LDH: poor prognostic marker in advanced RCC
  4. Calcium
  5. LFTs: liver mets
  6. Coagulation
    - ALSO URINALYSIS
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5
Q

What are the causes of urinary tract calculi?

A
  1. Idiopathic

2. Metabolic (↑Ca2+, ↑urea)

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6
Q

What are the risk factors of urinary tract calculi?

A
  1. Low fluid intake
  2. Structural urinary tract abnormalities
  3. Crystalluria
  4. High protein and salt intake
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7
Q

What are the 3 common sites of impaction or obstruction?

A
  1. Ureteropelvic junction
  2. Crossing of the iliac artery (midureter)
  3. Uretero-vesical junction
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8
Q

What is crystalluria?

A
  • Stone formers (especially calcium oxalate stones) frequently excrete more calcium oxalate crystals in the urine
  • Increased urinary excretion of cystine, struvite, and uric acid crystals is also a risk factor for stone formation
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9
Q

What are the 4 types of stone?

A
  1. Calcium oxalate (most common)
  2. Urate stones
  3. Magnesium ammonium phosphate stones
  4. cysteine stones
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10
Q

What are the symptoms of urinary tract calculi?

A
  1. Often asymptomatic
  2. Severe loin to groin pain
  3. Nausea and vomiting
  4. Urinary frequency/urgency
  5. Haematuria
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11
Q

What are the investigations for urinary tract calculi?

A
  1. Urinalysis
  2. Non contrast CT-KUB (Gold standard)
  3. U+Es
  4. FBC
  5. Urine pregnancy test
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12
Q

What is the difference between renal stone and peritonitis?

A

Flank/ loin to groin pain:

  1. If patient is writhing around in pain = renal stone
  2. If patient is lying still = peritonitis (as move too painful)
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13
Q

What is the management of urinary tract calculi?

A
  1. Analgesia – NSAIDs, Paracetamol (same as opiates in terms of controlling ureteric colic pain)
  2. Increase Fluid intake
  3. Anti-emetics
  4. Tamsulosin (α1- antagonist) or Nifedipine (CCB) – to relax smooth muscle
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14
Q

What do you do if the stone is <5mm?

A

pass spontaneously

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15
Q

What do you do if the stone is >5mm?

A

surgery

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16
Q

What must you check for in urinary tract calculi?

A

pregnancy and for infection higher up the tract

17
Q

What are the 3 surgical options for stone removal?

A
  1. Ureteroscopic lithotripsy
  2. Extracorporeal schockwave lithotripsy (ESWL)
  3. Percutaneous Nephrolithotomy (PCNL)
18
Q

What are utis?

A

presence of a pure growth of >10^5 organisms per mL in MSU

19
Q

What is an upper UTI?

A
  1. pyelonephritis (infection of kidney/ renal pelvis)

2. Ureters (ureteritis)

20
Q

What is a lower UTI?

A
  1. bladder: cystitis
  2. urethra (urethritis)
  3. prostatitis in male
21
Q

What are risk factors for UTI

A
  1. Sexual intercourse
  2. Spermicide use
  3. Pregnancy
  4. DM
  5. Obstruction to the urinary tract
22
Q

What is the most common causative agent of uti?

A

E.coli

23
Q

What other bacteria is found in utis in immunocompromised people?

A

Klebsiella and candida

24
Q

Why are women more commonly affected by utis than men?

A

shorter urethra

25
Q

How would pyelonephritis present (kidneys)?

A
  1. Fever
  2. rigors
  3. vomiting
  4. loin pain
  5. costovertebral pain
  6. Cystitis symptoms
26
Q

How would cystitis present? (bladder)

A
  1. FUND: frequency urgency nocturia (elderly), dysuria (storage symptoms)
  2. Suprapubic pain
  3. Polyuria and haematuria
27
Q

How would prostatitis present?

A
  1. Flu-like symptoms
  2. loin pain
  3. low back ache
  4. Swollen or tender prostate on PR
  5. HIPS: hesitancy, intermittent flow, poor stream (obstructive symptoms)
28
Q

What is the first line investigation of UTI?

A

urine dipstick:

  • leucocytes: infection
  • nitrites: presence of bacteria
  • haematuria
29
Q

What are the other investigations of UTIs?

A
  1. Urine microscopy (can identify organism tyoe
  2. Urine culture and sensitivity (more specific and sensitive test- measures growth of colonies)
  3. May also consider doing blood tests if patient is systematically unwell or imaging if pt has recurring UTIs
30
Q

What is the prophylactic management of UTIs?

A
  1. high fluid intake
  2. regular micturition to keep bladder empty
  3. cranberry-based products
31
Q

What antibiotics would you give for cystitis/lower UTI?

A
  1. trimethoprim
  2. nitrufuratoin
    - don’t give trimethoprim in pregnancy as it is a folic acid antagonist (therefore alternative treatment would be using nitrofurantoin)
32
Q

What antibiotics do you give for pyelonephritis?

A
  1. Oral: Cefalexin, orciprofloxacin.
  2. IV antibiotics if unwell such as gentamicin are given – give before result from cultures comes back to prevent deterioration
33
Q

What are the complications for UTIs?

A
  1. Septicaemia
  2. AKI
  3. Pyelonephritis
  4. Confusion (elderly)
34
Q

What are the common types of bladder cancer?

A

> 90% are transitional cell carcinomas in the UK

35
Q

What condition is associated with squamous cell carcinoma?

A

Schistosomiasis = rare in the West (so is adenocarcinoma)

36
Q

What are the risk factors for bladder cancer?

A
  1. smoking
  2. those= hx of working in industrial and manufacturing plants (aromatic amines= risk factor AZO DYES= made up of aromatic amines)
  3. chronic cystitis
  4. More common in men
  5. elderly
37
Q

What is the presentation of bladder cancer?

A
  1. Painless haematuria
  2. Recurrent UTIs
  3. FUND
38
Q

Why are there no HIPS symptoms of bladder cancer?

A

does not affect urethra

39
Q

What are the investigations for bladder cancer?

A
  1. Cystoscopy (+urinary cytology key for diagnosis) - GOLD STANDARD
  2. US
  3. Intravenous urography
  4. CT/MRI for staging

Z Year3 Conditions (13 decks)

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