Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2a > Renal > Flashcards

Renal Flashcards

1
Q

What are the functions of the kidney?

A
  • filter or secrete waste substances
  • retain albumin + circulating cells
  • control BP
  • activate 25-hydroxy vitamin D
  • synthesises EPO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal GFR?

A

120ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is fanconi syndrome?

A

A rare condition

Failure of the PCT to absorb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does fanconi syndrome present?

A

Polyuria, glycosuria, aminoaciduria, rickets, phophaturia, metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can cause fanconi syndrome?

A
  • cystinosis
  • tenofovir
  • paraprotein disease
  • Wilson’s disease
  • glycogen storage disorders
  • sjorgren’s syndrome
  • nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is IgA nephropathy?

A

aka Bergers disease or mesangioproliferative GN
Abnormality in IgA glycosylation leads to deposition of IgA in the mesangial cells surrounding the glomerular capillaries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the commonest cause of glomerulonephritis worldwide?

A

IgA nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is IgA nephropathy often assoc with?

A

Tonsillitis

Macroscopic haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the common locations for renal stones?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RF for renal stones?

A 
Anatomical abnormalities (e.g. obstruction)
Family history
Chemical composition of urine
Dehydration
Infection
Primary renal disease
Gout
Diet (high oxalate levels)
Drugs (diuretics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some different types of renal stones?

A

Calcium stones
Uric acid stones
Infection induced stones
Cystine stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do renal stones present?

A 
Mostly asymptomatic
Renal colic
Dysuria
Recurrent UTIs
Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe renal colic?

A 
Rapid onset
Excruciating ureteric spasms
Pain is from loin to groin and comes and goes in waves
Worse when fluid loading
N+V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are renal stones diagnosed?

A

1st line: Kidney-Ureter Bladder X-Ray

Gold standard: Non-contrast Computerised Tomography (NCCT-KUB)

Other: USS, bloods, urine dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are renal stones treated?

A

IV diclofenac
IV cefuroxime if infection
Antiemetics

If <5mm in lower ureter, 90% pass spontaneously
If >5mm and pain = medical expulsive therapy:
- oral nifedipine

If still not passing:

  • Extracorporeal shockwave lithotripsy
  • Endoscopy with YAG
  • Percutaneous nephrolithotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can you prevent renal stones?

A

Active lifestyle
Over hydration
Low salt and calcium diet
Allopurinol (prevents uric acid stones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is AKI?

A

An abrupt sustained rise in serum urea and creatinine due to a rapid decline in GFR, leading to failure to maintain fluid, electrolytes and acid-base homeostasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What staging system is used to classify AKI?

A

KDIGO
Criteria:
1. rise in creatinine >26umol/L in 48hours
2. rise in creatinine >1.5 x baseline
3. urine output <0.5mL/kg/h for >6hrs consecutively

Need ONE to diagnose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some pre-renal causes of AKI?

A

Renal hypoperfusion
Hypovolaemia
Low cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some intrinsic renal causes of AKI?

A 
Acute tubular necrosis
Glomerular: glomerulonephritis or nephrotic syndrome
Drugs
Renal parenchyma damage
Vascular
- renal artery/vein thrombosis
- vasculitis
- HUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some post renal causes of AKI?

A

Urinary tract obstruction
Stones, clots
Extrinsic compression (e.g. malignancy)
Strictures (e.g. malignancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

RF for AKI?

A 
>75years
Heart failure
Poor fluid intake/increase loss
Peripheral vascular disease
Sepsis
Diabetes
Prostate cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does AKI present?

A

O/E:

  • palpable bladder + kidneys
  • pelvic masses
  • oedema
Oliguira
Thirst
Pericarditis
SOB
Postural hypotension
High urea Sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are symptoms of high urea levels?

A

Fatigue, weakness, anorexia, N+V, confusion, seizures, coma, pruritus, bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is AKI diagnosed?

A 
Serum calcium, phosphate and uric acid
Urine disptick
Blood count (v high ESR)
USS (obstruction)
ECG
CXR (pul oedema)
CTKUB
Renal biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is AKI treated?

A

Pre-renal: correct volume depletion with fluids, treat sepsis with Abx

Intrinsic renal: refer to nephrology

Post renal: catheterise, CTKUB, cystoscopy + retrograde stents

> sodium bicarbonate for acidosis
> diuretics for pul oedema
> optimise fluid balance
> stop nephrotoxic drugs
> consider dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the most common cause of AKI?

A

Acute tubular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is acute tubular necrosis?

A

Necrosis of renal tubular epithelial cells severely affects the functioning of the kidney. It is reversible in the early stages if the cause is removed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can cause acute tubular necrosis?

A

Renal ischaemia
- shock, sepsis, decreased renal perfusion

Toxins
- ahminoglycosides, tumour lysis syndrome, myoglobin secondary to rhabdomyolysis, contrast agents, urinary cast proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the phases of acute tubular necrosis?

A

Oliguric - Polyuric - Recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the features of acute tubular necrosis?

A

Raised: urea, creatinine, potassium

Muddy brown casts in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is seen on histology for acute tubular necrosis?

A

Tubular epithelium necrosis
- no nuclei, eosinophilic homogenous cytoplasm

Dilation of tubules

Necrotic cells obstruct tubule lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is glomerulonephritis?

A

Group of parenchymal kidney diseases that all result in inflammation of the glomeruli and nephrons:

  • acute nephritic syndrome
  • nephrotic syndrome
  • asymptomatic urinary abnormalities
  • CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is acute nephritic syndrome?

A

Often caused by an immune response triggered by infection of other disease. Characterised by:

  • haematuria
  • proteinuria
  • HTN
  • oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the commonest cause of acute nephritic syndrome?

A

IgA nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can cause acute nephritic syndrome?

A 
Post-strep infection
SLE
IgA nephropahty
Infective endocarditis
Good pastures disease
Systemic sclerosis
ANCA-assoc vasculitis
Malaria, schistomiasis, hep B+ C
Bacterial infection (e.g. MRSA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is good pastures disease?

A

Type 2 hypersensitivity reaction
Co-existance of acute glomerulonephritis and pulmonary alveolar haemorrhage and circulation antibodies directed against an intrinsic antigen to BM of kidney and lung.

Tx: plasma exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does acute nephritic syndrome present?

A 
Haematuria
Proteinuria
Hypertension + oedema
Oliguira
Uraemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is acute nephritic syndrome diagnosed?

A

Measure eGFR, urine analysis
Culture throat swabs
Renal biopsy if necesary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How is acute nephritic syndrome treated?

A

Depends on what causes it

Treat HTN with salt restriction, loop diuretics and CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the triad in nephrotic syndrome?

A
  1. proteinuria >3.5g/24hrs
  2. hypoalbuminaemia
  3. oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What can cause nephrotic syndrome?

A

Primary causes:

  • minimal change disease
  • membranous neuropathy
  • focal segmental glomerulosclerosis

Secondary causes:

  • diabetes
  • amyloid
  • infections
  • SLE, RA
  • drugs
  • malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does nephrotic syndrome present?

A

Frothy urine
Pitting oedema of ankles, genitals, abdominal wall + face
Proteinuria
Hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is nephrotic syndrome diagnosed?

A

Renal biopsy
Urine dipstick
CXR or USS
Antiphosplipase A2 receptor antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Complications of nephrotic syndrome?

A

Susceptibility to infection
Thromboembolism
Hyperlipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How is nephrotic syndrome treated?

A

Reduce oedema: diuretics
Reduce proteinuria: ACE-i, ARB
Reduce risk of compilations: anticoagulants, statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is minimal change disease?

A

Disease of kidney that can cause nephrotic syndrome. Mainly in boys under age of 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How does minimal change disease present?

A
  • proteinuria
  • oedema (mainly face)
  • fatigue
  • frothy urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is seen on electron microscopy in minimal change disease?

A

Fusion of food processes of podocytes

> diagnosed on biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How is minimal change disease treated?

A

High dose corticosteroids (e.g. prednisolone)

Relapse: cyclophosphamide or ciclosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What can cause asymptomatic urinary abnormalities?

A

IgA nephropathy

Thin membrane disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is CKD?

A

Longstanding, usually progressive, impairment in renal function for >3months.

GFR<60ml/min/1.73m^2 for >3months with or without evidence of kidney damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What can cause CKD?

A 
T2DM
HTN
PCKD
Amyloidosis
FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How does CKD present?

A 
Asymptomatic in early stages
Itching
Anorexia + weight loss
Nocturia + polyuria
Peripheral or pulmonary oedema
N,V,diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Complications of CKD?

A 
Anaemia
Bone disease
Postural hypotension
CVD
Pruritus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How is CKD diagnosed?

A 
Urinalysis: haematuria, proteinuria
Urine microscopy: WCC, eosinophilia
High urea + creatinine, high alk phosphatase
Biopsy + histology
Imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How is CKD treated?

A

Treat underling cause of renal disease and limit progression of complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is third space?

A

Where fluid doesn’t normally collect in large amounts

  • pul oedema + pleural effusion
  • ascites
  • bowel obstruction
  • intra-abdominal collection/bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is euvolaemia?

A

No signs or symptoms of hypo or hypervolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you manage hypovolaemia?

A

Oral fluid if able

IV fluid if very ill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How do you manage hypervolaemia?

A

Diuretics (oral or IV)

Fluid restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the types of IV fluid?

A

Crystalloid

Colloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Explain crystalloid fluid

A

Small molecules which pass through cell membrane. Move from intravascular space to extravascular space.
Salt containing fluid stays in intravascular space a bit longer than 5% dex.

e.g. Isotonic solutions:
5% dextrose, 0.9% NaCl, Hartmann’s solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Explain colloid fluid

A

Large molecules which do not pass through cell membrane. Remains in intravascular compartment. Also expand intravascular volume through higher oncotic pressure.

e.g. gelofusine (contains modified fluid gelatine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is renal cystic disease?

A

Solitary or multiple renal cysts

- simple, polycystic, hydronephrosis, acquired cystic disease, medullary sponge, dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Describe congenital renal cysts?

A

Present at birth

  • uni/bilateral
  • isolated to kidney
  • autosomal dom/rec
  • genetic mutation leads to predisposition for cyst formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Describe acquire renal cysts?

A 
Develop over time 
No genetic mutation
- bilateral/unilateral
- isolated to kidneys
- normal/small kidney size
- assoc with CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is ADPKD?

A

Autosomal dominant polycystic kidney disease
Multiple cysts develop, gradually + progressively, throughout the kidney resulting in renal enlargement and kidney tissue destruction.

> commonest inherited kidney disease
high penetrance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the mutation in ADPKD?

A

85%: PKD1 gene on Chr 16

15%: PKD2 gene on Chr 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How does ADPKD present?

A 
Can be clinically silent for many years
Loin pain 
Haematuria
Nocturia
Renal stones
Bilateral kidney enalrgemtn
Renal colic
HTN
SAH
Pancreatitis
Ovarian cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How is ADPKD diagnosed?

A

USS
Screening
Genetic testing

72
Q

How is ADPKD treated?

A 
No specific treatment
BP control
Analgesia
Laparoscopic removal of cysts
Nephrectomy
Counselling
73
Q

What is ARPKD?

A

Autosomal recessive polycystic kidney disease

  • disease of infancy
  • rarer than ADPKD
74
Q

What is the mutation in ARPKD?

A

PKHD1 mutation on long arm of Chr 6

75
Q

How does ARPKD present?

A

Multiple renal cysts and congenital hepatic fibrosis
Enlarged polycystic kidneys
Kidney failure (30%)

76
Q

How is ARPKD diagnosed?

A

Antenatally or neonatally
USS
CT/MRI
Genetic testing

77
Q

Treatment for ARPKD?

A 
None
Genetic counselling
Laparoscopic removal of cysts
BP control 
Analgesia
78
Q

Describe haemodialysis?

A

Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction, thus blood is always meeting a less concentrated solution and diffusion of small solutes occurs down concentration gradient. Larger solutes do not clear as effectively.

> blood taken from artery and returned into vein at AV fistula
allows good clearance of solutes in short periods but pt must be harm-dynamically stable

79
Q

Advantages and disadvantages of haemodialysis?

A

+ good for visually impaired, dementia, poor state of health
+ 3x a week for 4hrs

  • time consuming
  • travel restrictions
  • have to come to hosp
  • dietary restrictions
80
Q

Describe peritoneal dialysis?

A

Mainly used in CKD. Process uses the patient’s peritoneum in the abdomen as a membrane across which fluid + solutes are exchanged with blood.

81
Q

Advantages and disadvantages of peritoneal dialysis?

A

+ can do it at home at night
+ portable equipment, fewer travel restrictions
+ less dietary restrictions

  • risk of peritonitis
  • has to be done every day
  • catheter into abdomen
  • can cause reduction in protein levels = lack of energy = malnutrition
  • SE: weight gain
82
Q

Complications of haemodialysis?

A 
Hypotension/cramps
Nausea/headaches
Chest pain
Fever/rigors
Infected dialysis catheter
83
Q

Complications of peritoneal dialysis?

A

Infection
Abdominal wall herniation
Intestinal perforation

84
Q

What is BPH?

A

Benign prostatic hyperplasia
Increase in size of the prostate, without the presence of malignancy.
Inner transitional zone enlarges in contrast to the peripheral layer expansion in prostate carcinoma.

85
Q

Clinical features of BPH?

A

LUTS
Enlarged bladder on abdo exam
Acute urinary retention

86
Q

How is BPH diagnosed?

A

Digital rectal exam (prostate feels large but SMOOTH)
Transrectal US
PSA
Biopsy + endoscopy
Flow rates + residual volume (<10ml per second suggestive of obstruction due to BPH)
Frequency volume chart
MSU

87
Q

How do you treat BPH?

A 
Lifestyle: avoid caffeine + alcohol
Drugs: 
Oral tamulosin 
> alpha-1-antagonist
> relaxes smooth muscle

Oral finasteride
> 5-alpha-reductase inhibitor
> blocks conversion of testosterone to dihydrotesterone which is responsible for prostatic growth

Surgery:

  • transurethral resection of prostate (TURP)
  • transurethral incision of prostate (TUIP)
88
Q

SE of tamulosin?

A

Drowsiness, dizzy, depression, ejaculatory failure, EPSE, increased weight and nasal congestion

Avoid in postural hypotension

89
Q

SE of finasteride?

A

Impotence

Decreased libido

90
Q

Complications of BPH if left untreated?

A

Bladder calculi
UTI
Haematuria
Acute retention

91
Q

Describe prostate cancer

A

Mainly adenocarcinomas arising in the peripheral zone of the prostate gland.

92
Q

Where does prostate cancer commonly metastasise to?

A

Bone

Lymph nodes

93
Q

RF for prostate cancer?

A

FHx
Genetic: HOXB13 + BRCA2 gene
Increasing age
Black

94
Q

Clinical presentation of prostate cancer?

A

LUTS
Weight loss
Bone pain
Anaemia

95
Q

How is prostate cancer diagnosed?

A 
DRE: hard, irregular prostate
Urine biomarkers: PCA3 or gene fusion protein
Endorectal coli MRI
Trans-rectal US + biopsy = diagnostic
PSA
96
Q

What grading system is used in prostate cancer?

A

Gleason - looks at how well differentiated the cancer is histologically.
Sample from peripheral zone is scored, higher the score the more aggressive it is.

97
Q

How is prostate cancer treated?

A

Confined to prostate:

  • radical prostatectomy if <70 years
  • radio therapy
  • hormonal therapy

Metastatic disease:

  1. endocrine therapy
    - SC Gosorelin/leuprorelin
    - bicalutamide
  2. symptomatic
    - anaglesia
    - radiotherapy

Surgery
- radical prostatectomy

98
Q

What is TURP syndrome?

A

Rare and life threatening complication of TURP. Venous destruction and absorption of the irrigation fluid.
Biochem: hyponatraemia + metabolic acidosis

Sx:

  • headache, tachypnoea, restless
  • resp distress, hypoxia, pul oedema, convulsion, acute renal failure
99
Q

Describe renal cell carcinoma (RCC)

A

Arises from the proximal convoluted tubular epithelium.

- von hippel lindau syndrome is an autosomal dominant condition that is a RF for RCC

100
Q

Clinical features of RCC?

A 
Often asymptomatic
TRIAD:
1. Haematuria
2. Loin/flank pain
3. Abdominal/flank mass
101
Q

How is RCC diagnosed?

A 
USS
CT chest + abdo with contrast
Bone scan
Renal biopsy
MRI
BP
102
Q

How is RCC treated?

A

Nephrectomy
Cryoablation + radiotherapy
IL-2 + interferon alpha

103
Q

What is Wilm’s tumour?

A

Nephroblastoma
Childhood tumour of the primitive renal tubules and mesenchymal cells
> abdominal mass
Tx: nephrectomy, radiotherapy + chemotherapy

104
Q

Describe bladder cancer

A 
A transitional cell carcinoma 
RF:
- smoking
- exposure to carcinogens (benzidine, azo-dyes)
- cyclophosphamide
- schistomiasis
105
Q

How does bladder cancer present?

A

Painless haematuria
Recurrent UTIs
Voiding irritability

106
Q

How is bladder cancer diagnosed?

A 
Cystoscopy with biopsy
CT/MRI of pelvis
Urine microscopy
CT urogram
Urinary tumour markers
107
Q

Treatment for bladder cancer?

A

Surgical resection
Chemo
Radical cystectomy

108
Q

How does a testicular tumour present?

A 
Painless lump in testicle 
Testicular pain/abdo pain
Hydroecele
Cough + dyspnoea 
Back pain
Abdo mass
109
Q

How do you diagnose a testicular tumour?

A 
Serum tumour markers: AFP + b-HCG (seminomas)
Lactate dehydrogenase
Scrotal USS
Biopsy + histology
XR + CT
110
Q

What are the different types of testicular tumours?

A

Germ cells origin (>96%)

  • serminomas
  • teratomas

Non-germ cell origin (4%)

  • leydig cell tumours
  • Sertoli cell tumours
  • sarcomas
111
Q

How are testicular tumours treated?

A

Radical orchidectomy
Radiotherapy + chemo
Sperm storage

112
Q

What is Bozniak classification?

A

Developed to help differentiate between benign cystic lesions + cancerous lesions of the kidney.

113
Q

What is a UTI?

A

Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteria + pyuria.
Caused by the presence and multiplication of microorganisms in the urianry tract.

> 10^5 organisms/ml or fresh MSU

114
Q

What pathogens can cause UTI?

A 
Klebsiella
E.coli
Enterococci
Proteus
Staphylococcus
115
Q

How do UTIs present?

A

Polyuria
Dysuria
Haematuria

116
Q

How are UTIs diagnosed?

A

Urinalysis
Urine sample
Microscopy
Culture

117
Q

How do you treat UTIs?

A

Asymptomatic bacteriuria >65 = DO NOT TREAT
Encourage fluid intake, hygiene

Abx:

  • nitrofurantoin
  • trimethoprim (NOT in pregnancy)
118
Q

What is prostatitis?

A

Infection and inflammation of the prostate gland. Acute or chronic.

119
Q

What can cause prostatitis?

A 
Acute:
- strep faecalis
- e coli
- chalmydia
Chronic:
- bacterial (above)
- non-bacterial (elevated prostate pressure, pelvic floor myalgia)
120
Q

RF for prostatitis?

A

STI, UTI, increasing age
Indwelling catheter
Post-biopsy

121
Q

How does prostatitis present?

A 
Type 1: acute
- systemically unwell
- fevers, riggers ,malaise
- pain on ejaculation
- voiding LUTS
- pelvic pain
O/E: boggy exquisitely tender prostate

Type 2: chronic

  • acute sx >3months
  • recurrent UTIs
  • pelvic pain, voiding lUTS
  • uropathogen in urine +/- blood

Type 3: CPPS

  • chronic pelvic pain
  • +/- LUTS/UTIs
122
Q

How is prostatitis investigated?

A 
DRE: hot + tender + hard prostate
Urine dipstick
STI screen
Blood cultures
MSU microscopy + sensitivity
Transurethral US
123
Q

How is prostatitis treated?

Name a complication

A 
Acute:
IV gentamicin + IV co-amoxiclav 
2-4 weeks on ciprofloxacin once well
2nd line: trimethoprim
TRUSS guided abscess drainage
Chronic: 
Pain relief
Stool softener
Ciprofloxacin 
Tamsulosin

Complications: urinary retention

124
Q

What is urethritis?

A

Urethral inflammation due to infection or non-infectious causes. Mainly SEXUALLY ACQUIRED DISEASE.
- usually men at GUM clinics

125
Q

Main causes or urethritis?

A 
Neisseria gonorrhoea
Chlamydia
Trichomonas
Trauma
Urethral stricture Urinary calculi
126
Q

RF for urethritis?

A

Sexually active
Unprotected sex
Male to male sex
Male

127
Q

Clinical presentation of urethritis?

A

Dysuria +/- blood or pus
Urethral pain
Penile discomfort
Skin lesions

128
Q

How is urethritis diagnoses?

A

NAAT
F: self collected vaginal swab
M: first void volume

Microscopy
Blood cultures
Urine dipstick

129
Q

How is urethritis treated?

A

Chlamydia: oral azithromycin or 1 week doxyclince

Gonorrhoea: IM ceftriaxone + oral azithromycin

130
Q

What is epidiymo-orchitis?

A

Pain, swelling and inflammation of the epididymis that can extent into the testis.

131
Q

Causes of epidiymo-orchitis?

A

Under 35

  • chlamydia
  • gonorrhoea

Over 35

  • Klebsiella
  • e coli
  • enterococci
  • pseudomonas
  • staph

Other:

  • mumps
  • trauma
  • bechet’s disease
  • catheter (elderly)
132
Q

Clinical features of epidiymo-orchitis?

A 
Subacute onset of unilateral scrotal pain + swelling
Urethritis
UTI sx
Urethral discharge
Hydrocoele
Erythema +/- oedema of scrotum
Pyrexia
133
Q

What must you rule out when diagnosing epidiymo-orchitis?

A

Testicular torsion

134
Q

How do you diagnose epidiymo-orchitis?

A

NAAT
MSU
US
STD screening

135
Q

How do you treat epidiymo-orchitis?

A

Usual tx for chlamydia/gonorrhoea/UTI
Scrotal support
Abstain from sexual intercourse
Partner notification + testing

136
Q

What is cystitis?

A

Urinary infection of the bladder

  • LUTS sx
  • microcopy + sensitivity of sterile MSU
  • Abx treatment
137
Q

What is pyelonephritis?

A

Infection of the renal parenchyma and soft tissues of renal pelvis and upper ureter.
- main organisms KEEPS

138
Q

Clinical presentation for pyelonephritis?

A

TRIAD

  1. loin pain
  2. fever
  3. pyuria

O/E:

  • tender loin
  • renal angle tenderness
139
Q

How is pyelonephritis diagnosed?

A

Urine disptick
MSU
Urgent US

140
Q

Treatment for pyelonephritis?

A

Fluid replacement
Analgesia
IV ciprofloxacin
Surgery to remove calculi if necessary

141
Q

What are some luminal causes of urinary tract obstruction?

A

Stones, blood ,clot, sloughed papilla, tumour

142
Q

What are some mural causes of urinary tract obstruction?

A

Congenital or acquired stricture neuromuscular dysfunction or schistomiasis

143
Q

What are some extra-mural causes of urinary tract obstruction?

A

Abdo or pelvic mass/tumour, BPH, prostate cancer, pregnancy, inflammation from peritonitis or diverticulitis

144
Q

How does an acute upper urinary tract obstruction present?

A

Loin pain radiating to the groin

145
Q

How does a chronic upper urinary tract obstruction present?

A

Flank pain, renal failure, infection + polyuria

146
Q

How does an acute lower urinary tract obstruction present?

A

Acute urinary retention with severe suprapubic pain

147
Q

How does a chronic lower urinary tract obstruction present?

A

Urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence

148
Q

Treatment for upper urinary tract obstructions?

A

Nephrostomy
Tamsulosin
Finasteride
TURP

149
Q

Treatment for lower urinary tract obstruction?

A

Urethral catheter

Suprapubic catheter

150
Q

What is hydronephrosis?

A

Dilatation of the renal pelvis or calyces as a result of obstruction of the outflow or urine distal to the renal pelvis.

151
Q

What are some bilateral causes of hydronephrosis?

A 
Stenosis of the ureter
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retroperitoneal fibrosis
152
Q

What are some unilateral causes of hydronephrosis?

A

Pelvis-ureteric obstruction
Abnormal renal vessels
Calculi
Tumours of the renal pelvis

153
Q

Ix for hydronephrosis?

A

USS
IV urogram
Ante/retrograde pyelography
CT scan

154
Q

How is hydronephrosis managed?

A 
Remove obstruction + drain urine
Nephrostomy tube (acute upper)
Ureteric stent or pyeloplasty (chronic upper)
155
Q

What are some permanent kidney changes after obstruction?

A

Tubulointerstital fibrosis
Tubular atrophy + apoptosis
Interstital inflammation

156
Q

What are the phases of renal recovery after obstruction?

A

Tubular function recovery

GFR recovery

157
Q

Explain the neural control of lower urinary tract?

A

Parasympathetic (Cholinergic): S3,4,5

  • drives detrusor contraction
  • smooth muscle sphincter relaxation

Sympathetic (noardrenergic): T10, L1, L2

  • inhibits detrusor contraction
  • urethral contraction
158
Q

What is stress incontinence?

A

Small leak of urine when intra-abdominal pressure rises

Tx:
M: artificial sphincter, male sling
F: pelvic floor exercise, duloxetine, TVT

159
Q

What is urge incontinence?

A

Strong desire to void and unable to hold urine

160
Q

What is OAB?

A

Urgency with frequency

Tx: bladder exercises, control caffein intake, frequency volume charts, oxybutynin, mirabegron, botox

161
Q

What are some features of spastic spinal cord injury?

A
  • reflex bladder contractions + reflex bowel
  • detrusor sphincter dyssynergia (loss of completion of voiding)
  • poorly sustained bladder contraction
162
Q

What are some features of flaccid spinal cord injury?

A
  • areflexic bladder + bowel
  • stress incontinence
  • risk of poor compliance
163
Q

What is an epididymal cyst?

A

Smooth, extratesticular, spherical cyst in the head of the epididymis

  • contains clear + milky fluid (spermatcoele)
  • lies above and behind the testis
164
Q

How does an epididymal cyst present?

A 
Lump
- often multiple, may be bilatera
Testis
- palpable quite separately from the cyst
Transluminate lump, well defined
Painful if large
165
Q

How is an epididymal cyst diagnosed + treated?

A

Scrotal USS

Tx: not usually necessary but if painful then surgical excision

166
Q

What is a hydrocele?

A

Abnormal collection of fluid within the tunica vaginalis.

  • overproduction of fluid
  • processus vaginalis fails to close, allowing the peritoneal fluid to communicate freely with the scroll portion
167
Q

How does a hydrocele present?

A

Scrotal enlargement with a non-tender, smooth, cystic swelling
Pain not a feature unless infected
Testis usually palpable
Lies anterior to + below the testis and will transluminate

168
Q

How is a hydrocele diagnosed + treated?

A

USS
Serum AFP + hCG

Tx:

  • resolve spontaneously by 2yrs
  • therapeutic aspiration or surgical removal
169
Q

What is a variocoele?

A

Abnormal dilation of the testicular veins in the pampiniform venomous plexus, caused by venous reflux.
- left side more commonly affeted

170
Q

How does a variocoele present?

A
  • distended scrotal blood vessels that feel like ‘a bag of worms’
  • dull ache or scrotal heaviness
  • scrotum hangs lower on side of varicocele
171
Q

How is a variocele diagnosed and treated?

A

Venography
Colour doppler US

Tx: surgery if pain, infertility or testicular atrophy

172
Q

What is testicular torsion?

A

Twisting of the spermatic cord resulting in occlusion of the testicular blood vessels which can rapidly lead to ischaemia + infarct = potential loss of testis.

urological emergency

173
Q

RF for testicular torsion?

A

Underlying congenital malformation

> belt-clapper deformity

174
Q

Clinical presentation of testicular torsion?

A

Sudden onset of pain in 1 testis - often during physical activity
Pain in abdomen
N+V
Inflammation of 1 testis: tender, hot, swollen
Testis may lie high and transversley

175
Q

How is testicular torsion diagnosed and treated?

A

Doppler US: lack of blood flow to testis
Urinalysis

Tx:

  • surgery: expose + untwist testis
  • orchiectomy

2a (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions