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PHASE 2A > Renal and Urogenital > Flashcards

Renal and Urogenital Flashcards

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1
Q

What anatomical structures make up the lower urinary tract?

A

Bladder
Bladder neck
Prostate gland
Urethra and urethral sphincter

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2
Q

Give 4 functions of the lower urinary tract

A
  1. Storage of urine
  2. Converts the continuous process of excretion to an intermittent, controlled and volitional process
  3. Prevents leakage of stored urine
  4. Allows rapid, low pressure voiding
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3
Q

Is the detrusor muscle relaxed or contracted during storage?

A

Relaxed

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4
Q

Is the detrusor muscle relaxed or contracted during voiding?

A

Contracted

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5
Q

Is the urethral sphincter relaxed or contracted during storage?

A

Contracted

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6
Q

Is the urethral sphincter relaxed or contracted during voiding?

A

Relaxed

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7
Q

Briefly describe the storage phase of micturition

A

As the volume in the bladder increases the pressure remains low due to receptive relaxation and inhibition of detrusor muscle contraction

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8
Q

What maintains the inhibition of detrusor muscle contraction (relaxation of detrusor)?

A

Sympathetic nerve = Hypogastric plexus
T11-L2
Noradrenergic

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9
Q

Briefly describe the filling phase of micturition

A 
At lower volume the afferent pelvic nerve (parasympathetic = S2-4) send slow firing signals to the pons via the spinal cord 
Sympathetic nerve (hypogastric plexus) stimulation maintains detrusor muscle relaxation
Somatic (pudendal = S2-4) nerve stimulation maintains urethral contraction
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10
Q

Briefly describe the voiding phase of micturition

A

Higher volumes stimulated the afferent pelvic nerve (parasympathetic) to send fast signals to the sacral micturition centre in the sacral spinal cord
Pelvic parasympathetic nerve is stimulated and detrusor muscle contracts
Pudendal nerve is inhibited and the external sphincter relaxes

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11
Q

What nerve causes the contraction of the detrusor muscle?

A

Pelvic parasympathetic nerve

S2-4

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12
Q

What nerve causes the contraction of the urethral sphincter?

A

Somatic pudendal nerve

S2-4

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13
Q

What kind of reflex is the micturition reflex?

A

Autonomic spinal reflex

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14
Q

What is the guarding reflex?

A

Reflex that occurs when voiding is inappropriate

Controlled by Onuf’s nucleus

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15
Q

What type of epithelium line the bladder?

A

Urothelium (transitional epithelium) - pseudo-stratified

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16
Q

Give 4 functions of the kidneys

A
  1. Filter or secrete waste excess substances
  2. Retain albumin and circulating cells
  3. Reabsorb glucose, amino acids and bicarbonates
  4. Control BP, fluid status and electrolytes
  5. Activates 25-hydroxy vitamin D
  6. Synthesis erythropoietin
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17
Q

What are lower urinary tract symptoms (LUTS) in men >50 likely to be due to?

A

Benign prostatic enlargement

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18
Q

LUTS: Give 3 symptoms of storage problems

A
  1. Frequency
  2. Urgency
  3. Nocturia
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19
Q

LUTS: Give 4 symptoms of voiding problems

A
  1. Hesitancy
  2. Straining
  3. Intermittent stream
  4. Incomplete emptying
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20
Q

LUTS: give 3 other symptoms other than storage or voiding problems

A
  1. Post-micturition voiding
  2. Haematuria
  3. Dysuria
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21
Q

What might dysuria suggest?

A

Inflammation

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22
Q

What investigations might you do on someone who presents with LUTS?

A

Urinary tests - dipstick
Urinary Flow - maximum flow rate and residual volume
Symptom assessment = international prostate scoring system
Blood tests - PSA, U+Es

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23
Q

Describe the treatment for someone who presents with mild LUTS

A

Reassurance

Watch and wait

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24
Q

Describe the treatment for someone who presents with moderate LUTS

A

Fluid management and avoid caffeine

Bladder drill

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25
Give 2 pharmacological treatments for someone who presents with severe LUTS
1. Alpha-1-blockers - tamsulosin | 2. 5-alpha-reductase inhibitors
26
How do Alpha-1-blockers work?
Cause vasodilation and so rescue the resistance to bladder outflow Decreases smooth muscle tone in bladder and prostate
27
Give 2 potential side effects of tamsulosin
Tamsulosin = Alpha-1-blocker Hypotension Retrograde ejaculation
28
How do 5-alpha-reductase inhibitors work?
Inhibit the conversion of testosterone to dihydrotestosterone --> reduce prostate size
29
Give 5 potential complications of untreated LUTS
1. Bladder calculi 2. UTI's 3. Urinary incontinence 4. Reduced QOL 5. Acute urinary retention
30
Define benign prostatic hyperplasia (BPH)
Increase in cell number and size in transitional/peri-urethral prostate area WITHOUT the presence of malignancy
31
Describe the pathophysiology of Benign prostatic hyperplasia
Epithelial and stomal cell increase | Increased A1 adrenoreceptros --> smooth muscle contraction and mass effect of prostate size = obstruction
32
Give 4 symptoms of BPH
1. Increased frequency of micturition 2. Nocturia 3. Hesitancy 4. Post-void dribbling LUTS
33
What investigations might you do in someone who you suspect has BPH?
Digital rectal examination = enlarged but smooth prostate Urinalysis PSA Flexible cystoscopy
34
What are the aims of the management of BPH?
Improve urinary symptoms Improve QOL Reduce complications of bladder outflow obstruction
35
What lifestyle changes can be made to manage symptoms of BPH?
Redue caffeine and alcohol intake Distraction methods Bladder training
36
Describe the treatment for BPH
1. Mild symptoms = watchful waiting. 2. Alpha-1-antagonists e.g. tamulosin 3. 5-alpha-reductase inhibitors
37
Give the surgical treatment for BPH
Transurethral resection of prostate (TURP)
38
What are the indications in someone with BPH to do a TURP?
RUSHES - Retention - UTI's - Stones - Haematuria - Elevated creatinine - Symptom deterioration
39
Why is incontinence less common in men than it is in women?
Men have a bladder neck mechanism and a strong urethral sphincter whereas women have only a weak urethral sphincter
40
What is the role of pontine micturition centre and periaqueductal grey control in micturition?
Coordination and completion of voiding
41
Define incontinence
Involuntary loss of urine
42
Name 3 types of incontinence
1. Stress = associaste with coughing/strianing 2. Urgency 3. Mixed = stress and urgency 4. Continuous = due to fistula
43
What is the main cause of stress incontinence in women?
Usually secondary to birth trauma
44
Describe the treatment for stress incontinence in women
1. Pelvic floor physio 2. Duloxetine = increase contraction of urtheral sphincter 3. Surgery --> sling, colposuspension, bulking agents, artificial sphincter
45
What can cause stress incontinence in men?
Neurogenic | Iatrogenic (prostatectomy)
46
Describe the treatment for stress incontinence in males
Artificial sphincter | Male sling
47
What information can you get from a bladder diary?
1. Frequency 2. Volume 3. Functional capacity 4. Incontinence/day
48
What is an overactive bladder?
Urgency with frequency, with or without nocturia, when appearing in the absence of local pathology
49
Describe the treatment for an overactive bladder
1. Behavioural - limit caffeine and alcohol, bladder drill 2. Pelvic floor physio 3. Muscarinic antagonists 4. Beta 3 agonists 5. Botox 6. Sacral neuromodulation 7. Cystoplasty
50
How do muscarinic antagonists work in the treatment of an overactive bladder?
Decrease parasympathetic activity --> decrease bladder contraction
51
How do beta 3 agonists work in the treatment of an overactive bladder?
Increase sympathetic activity at B3 receptor in bladder
52
How does botox work in the treatment of an overactive bladder?
Blocks neuromuscular junction for Ach release
53
What is sacral neuromodulation?
Insertion of electrode to S3 nerve root to modulate afferent signals from bladder Preliminary trial
54
What is a cystoplasty?
Bladder enlargement using bowel (small bowel, colon or stomach)
55
What is the role of the cortex in micturition?
Sensation and voluntary ignition of voiding
56
What is a spastic spinal cord injury?
Supra-conal lesion = conus lesion above the caudal equina
57
What functions are lost due to a spastic spinal cord injury?
Coordination and completion of voiding
58
Give 3 features of a spastic spinal cord lesion
1. Reflex bladder contractions 2. Detrusor sphincter dyssynergia 3. Poorly sustained bladder contraction 4. Potentially unsafe = puts the kidneys at risk
59
What is a flaccid spinal cord injury?
Conus lesion --> decentralised bladder | Damage to sacral micturition centre
60
What functions are lost due to a flaccid spinal cord injury?
Reflex bladder contraction Guarding reflex Receptive relaxation
61
Give 3 features of a flaccid spinal cord injury
1. Areflexic bladder 2. Stress incontinence (as urethral sphincter is denervated) 3. Risks of poor compliance
62
What is an areflexic bladder?
Bladder not able to empty by a reflex Bladder will fill until it cannot fill anymore but there is no contraction and pressure will start to rise as it can’t stretch anymore
63
What are the aims of the management of a neurogenic bladder?
1. Maintain bladder safety 2. Continence/symtom control 3. Prevent autonomic dysreflexia
64
What is autonomic dysreflexia?
Overstimulation of the sympathetic nervous system below the level of the lesion in response to a noxious stimulus
65
Where does a lesion have to be for autonomic dysreflexia to occur?
Lesion above T6
66
What happens as a result of autonomic dysreflexia?
Everything blow the lesion will contract --> vasoconstriction --> overload --> BP increase Headache, hypertension, flushing
67
How do you treat autonomic dysreflexia?
Remove the noxious stimuli | Change catheter to allow bladder to drain
68
What is an unsafe bladder?
A bladder that put the kidneys at risk damage
69
Give 3 risk factors of an unsafe bladder
1. Raised bladder pressure 2. Vesico-ureteric reflux 3. Chronic infection
70
How can you manage micturition in a paraplegic patient?
1. Suprapubic catheter 2. Convene 3. Suppress reflexes or poorly compliant bladder converting bladder to safe type and then emptying regularly using intermittent self catheterisation (ISC)
71
Give 3 complications of a suprapubic catheter
1. Infections 2. Stones 3. Autonomic dysreflexia if blocked
72
What bladder problems can occur due to MS?
Overactive bladder syndorme Urinary urgency and frequency Incomplete bladder emptying
73
What is the function of the prostate?
Secretes proteolytic enzymes into the semen which breaks down clotting factors in the ejaculate
74
Define prostate cancer
Adenocarcinoma in the peripheral zone of the prostate gland
75
Where can prostate cancer metastasise to?
Lymph nodes and bone | Rarely = brain, liver, lung
76
Briefly describe the pathophysiology of prostate cancer
Spreads locally through prostate capsule Enter the transitional or central zones Androgen dependent cancer that is dependent on testosterone
77
By what routes can prostate cancer spread?
1. Lymphatic - to external iliac and internal iliac and presacral node 2. Haematogenous - to bone, lung. liver, kidneys 3. Direct - within in the prostate capsule
78
What can cause prostate cancer?
1. High testosterone levels | 2. Family history - 2/3x increased risk if 1st degree relative is affected
79
Give 2 symptoms of prostate cancer
1. LUTS 2. Bone pain, weight loss, anaemia = mets Most picked up in asymptomatic stage
80
What investigations might you do in someone who you suspect has prostate cancer?
``` DRE --> hard, irregular, craggy Serum --> PSA and postage specific membrane antigen Urine --> PCA3 and gene fusion produces History of LUTS Trans-rectal USS CT/MRI = staging Prostate biopsy --> DIAGNOSTIC ```
81
What are the indications for a prostate biopsy?
1. Palpably suspicious DRE regardless of PSA 2. PSA >3.0 ng/ml 3. Suspicious lesion on MRI
82
What grading system is used in prostate cancer?
Gleason grading = higher the score, the more aggressive the cancer
83
What is the treatment for localised prostate cancer?
Observation Radical prostatectomy Radiotherapy (external beam) Adjuvant hormones
84
What is the treatment for metastatic prostate cancer?
Surgical castration Androgen deprivation therapy - Orchidectomy, LH antagonists, peripheral androgen receptor antagonists Palliative care
85
Give 2 advantages and 1 disadvantage of radical treatment for localised prostate cancer
``` Advantages: 1. Curative 2. Reduced patient anxiety Disadvantages: 1. Can have adverse effects ```
86
How do LH antagonists work in treating prostate cancer?
First stimulate and then inhibit pituitary gonadotrophin | E.g. Leuprolide
87
Is a raised PSA confirmatory of prostate cancer?
NO | Prostate cancer indication
88
Other than prostate cancer, what can cause an elevated PSA?
1. Benign prostate enlargement 2. UTI 3. Prostatitis
89
Give 2 advantages and 2 disadvantages of screening in prostate cancer
Advantages: 1. Early diagnosis of localised disease (cure) 2. Early treatment of advanced disease (effective palliation) Disadvantages: 1. Over diagnosis of insignificant disease 2. Harm caused by investigation/treatment
90
What is PSA?
A glycoprotein secreted by the prostate into the blood stream
91
Give 5 risk factors for haematuria
1. Smoking 2. UTI's 3. Catheterisation 4. Travel parasites 5. Cyclophosphamide (chemo) 6. Family history
92
Give 3 causes of haematuria
1. Kidney tumour, trauma, stones, cysts 2. Ureteric stones or tumour 3. Bladder infection, stone or tumour 4. BPH or prostatic cancer
93
What further investigations might you do in someone who presents with haematuria?
1. Urinalysis 2. Urine cytology 3. USS of abdomen 4. CT of abdomen 5. Cystoscopy
94
Where might a transitional cell carcinoma arise?
1. Bladder (50%) 2. Ureter 3. Renal pelvis
95
Describe the epidemiology of transitional cell carcinoma
1. M:F = 3:1 | 2. Age >40 years old
96
Give 5 risk factors for transitional cell carcinoma (bladder cancer)
1. Smoking 2. Occupational exposure - working in rubber factories (aromatic amines) 3. Increasing age 4. Male gender 5. Family history
97
Give 5 symptoms of transitional cell carcinoma (bladder cancer)
1. Painless haematuria 2. Recurrent UTI's 3. Voiding problems - hesitancy, intermittent stream etc 4. Flank pain 5. Lower limb oedema
98
What investigations might you do in someone you you suspect has transitional cell carcinoma (bladder cancer)?
1. Urine microscopy/cytology 2. Flexible cystoscopy and bladder wall biopsy 3. Urinary tumour markers 4. CT urogram 5. Imaging - CT, MRI, USS
99
Give 2 potential risks of flexible cystoscopy
1. UTI's | 2. Problems passing urine
100
Why would you want to image the upper urinary tract of someone with transitional cell carcinoma (bladder cancer)?
Confirm three is no other TCC elsewhere in the urinary tract
101
Why might you do a trans-urethral resection of bladder tumour (TURBT) in someone with TCC?
For histological and staging analysis
102
What staging system is used for transitional cell carcinoma (bladder cancer)?
TNM | T1 (submucosa) --> T2 (muscle) --> T3 (outer fat) --> T4 (other organs)
103
Describe the treatment for non-muscle invasive bladder cancer (T1)
Transurethral resection of the bladder (TURB) | Adjuvant chemotherapy
104
Describe the treatment for muscle invasive bladder cancer (T2/3)
``` Radical cystectomy (bladder removal) Adjuvant radio/chemotherapy ```
105
Describe the treatment for T4 bladder cancer
Metastasis so: - Palliative chemo/radiotherapy - Chronic catheterisation for pain
106
Name a helminth that can cause squamous cell carcinoma of the bladder
Schistosomiasis
107
Name the 2 types of renal cancer
1. Renal cell carcinoma (95%) = arises from renal tubule | 2. Transitional cell carcinoma = arises from renal pelvis (less aggressive)
108
Where does renal cancer commonly metastasise to?
Lung, skin, lymphoma and breast
109
Give 3 risk factors for renal cell carcinoma
1. Smoking 2. Regular NSAID use 3. Obesity 4. Hypertension 5. Family history
110
Describe the epidemiology of renal cell carcinoma
Incidence increase in those >60 years old | Males > females
111
Name an inherited renal disease that can cause renal cell carcinoma
Von Hippel Lindau disease
112
What is Von Hippel Lindau disease?
- Autosomal dominant, loss of tumour suppressor gene BHL | - Lots of benign cysts grow - some may develop into cancer
113
What are the 3 classical signs of renal cell carcinoma?
1. Haematuria 2. Flank mass 3. Loin pain Often detected incidentally through imaging for something else in asymptomatic stage
114
What investigations might you do in someone with renal cell carcinoma?
``` USS Bloods - FBC, U+Es, LFT, Ca profile Abdominal CT Renal biopsy Bone scan - for bone mets ```
115
Name the classification that helps differential between benign cystic lesion and cancerous cystic lesions
Bozniak classification
116
What is the treatment for localised renal cell carcinoma?
Surgical excision - partial nephrectomy
117
What is the treatment for metastatic renal cell carcinoma?
Radical nephrectomy Chemotherapy and radiotherapy Palliative care
118
Name the 2 types of testicular cancers that arise from germ cells
1. Seminoma = most common, slow growing | 2. Non-seminoma = yolk sac carcinoma/teratoma, rapid growth
119
Where does testicular cancer spread?
Locally into epididymis, spermatic cord and scortal wall | Pelvic and inguinal Metastasises
120
Give 3 risk factors for testicular cancer
1. Cryptorchidism (undescended testes) 2. Family history 3. Previous testicular tumour 4. Infant hernia
121
Give 3 symptoms of testicular cancer
1. Painless testis lump - hard and craggy 2. Testicular or abdominal pain 3. UG = blood in ejaculate, secondary hydrocele 4. Abdominal mass 5. Dyspnoea
122
What investigations might you do on someone you suspect to have testicular cancer?
1. Tumour markers = Alpha-fetoprotein (a-FP) and Beta subunit of human chorionic gonadotrophin (B-hCG) 2. Testicular biopsy 3. Imaging = US, CT/MRI
123
How is testicular cancer staged?
``` 1 = no mets 2 = nodes under diaphragm 3 = above diaphragm 4 = lungs ```
124
What is the treatment for testicular cancer?
Orchidectomy = testis and spermatic cord excised | Chemo and radiotherapy (more effective in seminomas)
125
What is epididymitis?
Inflammation of the epididymis | Occurs mainly in young males
126
Give 2 causes of epididymitis
1. E. coli | 2. Chlamydia
127
What is an epididymal cyst?
Smooth extra-testicular, spherical cyst in the head of the epididymus
128
What is hydrocele?
Scrotal swelling as a result of excessive fluid in the tunica vaginalis
129
When does primary hydrocele normally occur?
In absence of disease in testis Large and tense testis Young boys mainly effected
130
Name 3 causes of secondary hydrocele
1. Testicular tumours 2. Infection 3. Torsion
131
What is varicocele?
An abnormal enlargement of the pampiniform venous plexus in the scrotum Caused by venous reflux
132
Why might renal cell carcinoma cause left sided varicocele?
If the renal tumour obstructs where the gonadal vein drains into the renal vein blood can back up and so you may see left sided varicocele
133
What is testicular torsion?
Twisting of the spermatic cord resulting in occlusion of testicular blood vessels Leads to ischaemia and postnatal loss of testis
134
What nerve fibres do cavernous nerves carry?
``` Parasympathetic = S2-4 (erection) Sympathetic = T11-L2 (ejaculation) ```
135
Describe the physiology of an erection
1. Parasympathetic stimulation 2. Arteriolar dilation 3. Trabecular smooth muscle relaxation 4. Testosterone
136
What chemical compound is responsible for the smooth muscle relaxation the is required for an erection?
``` Nitric oxide (NO) Causes a increase in intracellular cyclic GMP --> fall in cytoplasmic calcium --> smooth muscle relaxation ```
137
Define erectile dysfunction
Persistent inability to attain and maintain an erection sufficiently to permit satisfactory sexual performance
138
What are the 2 main causes of erectile dysfunction?
1. Organic - vasculogenic, neurogenic, hormonal, anatomical, drug induced 2. Psychogenic
139
Give 3 risk factors of erectile dysfunction
1. Obesity 2. Lack of exercise 3. Smoking 4. DM 5. Liver disease and alcohol 6. Iatrogenic - prostatectomy
140
Give 3 characteristics of psychogenic erectile dysfucntion
1. Sudden 2. Situational 3. Good nocturnal and early morning erections 4. Younger males effected
141
What is the non-pharmacological management of erectile dysfunction?
1. Lose weight and stop smoking | 2. Education and counselling for patient and partner
142
What is the first line pharmacological management of erectile dysfunction?
Phosphodiesterase inhibitors - Viagra Inhibit smooth muscle relaxation Cause vasodilation --> increase arterial blood flow to penis SE = headache, flushing, dyspepsia
143
What is the second line pharmacological management of erectile dysfunction?
1. Intracavernous injections 2. Sublingual apomorphine 3. Vacuum devices
144
What is the third line pharmacological management of erectile dysfunction?
Penile prothesis implantation
145
What is priapism?
Prolonged erection lasting >4 hours
146
What is a potential complication of priapism?
Permanent ischaemic damage so aspirate corpora
147
Define glomerular disease
= Glomerulonephritis | Group of parenchymal kidney diseases that all result in the inflammation of the glomeruli and nephrons
148
Give 3 consequences of glomerulonephritis
1. Damage to filtration mechanism --> haematuria and proteinuria 2. Damage to glomerulus restricts blood flow --> hypertension 3. Loss of usual filtration capacity --> AKI
149
Briefly describe the pathophysiology of glomerulonephritis
Immunologically mediated --> immunoglobulin deposits and inflammatory cells
150
How can glomerulonephritis present?
1. Nephritic syndrome 2. Nephrotic syndrome 3. Asymptomatic haematuria
151
Give 3 causes of nephritic syndrome
1. IgA nephropathy 2. Post streptococcal infection 3. Thin BM disease 4. Cresenteric/rapidly progressive GN 5. SLE 6. DM 7. Infections (MRSA, Hep B/C, Typhoid)
152
Give 5 signs of acute nephritic syndrome
1. Inflammation of glomeruli 2. HAEMATURIA and PROTEINURIA 3. Hypertension 4. Oedema 5. Oliguria (low urine output) 6. Red cell casts
153
What investigations might you do in someone who has nephritic syndrome?
Urinalysis (dipstick) = haematuria and proteinuria Blood tests = high creatinine and urea Kidney biopsy = diagnostic
154
How do you manage nephritic syndrome?
Symptom control = antihypertensive to decrease BP and proteinuria Inflammation control = corticosteroids Treat underlying cause
155
Describe the pathophysiology behind nephritic syndrome
Kidney inflammation --> large podocytic pores --> RBC, WBC, protein leaks into urine
156
What are the 4 signs needed in order to make a diagnosis of nephrotic syndrome?
1. Hypoalbuminaemia 2. Oedema 3. Proteinuria (>3.5ng/day) 4. Hyperlipidaemia
157
Describe the pathophysiology of nephrotic syndrome
Podocytes or basement membrane aren't working properly --> portion leaks into urine
158
What can nephrotic syndrome be secondary to?
1. DM 2. SLE 3. Amyloidosis 4. Infection 5. Drugs
159
What does primary nephrotic syndrome present as?
Either: - Minimal change disease - Membranous nephropathy - Membranoproliferative GN
160
What would you see on the electron microscopy taken from someone with minimal change disease?
Fused podocyte foot processes
161
How is minimal change disease treated?
High dose corticosteroids = prednisolone
162
What is membranous nephropathy?
Thickening of glomerular capillary wall | IgG, complement deposition in sub-epithelial surface --> leaky glomerulus
163
How would you diagnose membranous nephropathy?
Serum PLA2R antibodies | Renal biopsy = subepithelial immune complex deposits
164
What is the management of membranous nephropathy?
30% = spontaneous remission Immunosuppression Control of symptoms
165
What is the main symptom of nephrotic syndrome?
Pitting oedema
166
What investigations might be carried out in someone with nephrotic syndrome?
Urinalysis (dipstick) = proteinuria Blood tests = hyperlipidaemia and hypoalbuminaemia Renal biopsy
167
Describe the treatment for nephrotic syndrome
1. Treat complications - diuretics (furosemide) and fluid/salt restriction for oedema, ACEi for proteinuria 2. Treat underlying cause 3. Stains and anticoagulation
168
Give 3 complications of nephrotic syndrome
1. Infections (Ig loss, complement activity decrease) 2. Thromboembolism (more clotting factor) 3. Hyperlipidaemia
169
Give 3 causes of asymptomatic haematuria
1. IgA nephropathy 2. Thin membranous disease 3. Alport's syndrome
170
What is IgA nephropathy?
Abnormality in IgA glycosylation --> IgA deposition in Mesangium
171
What is the treatment for IgA nephropathy?
BP control | Immunosuppression - steroids if renal function declines
172
What is Thin membranous disease?
Thin basement membrane causes blood to leak into urine | Autosomal dominant
173
Give 3 features of Alport's syndrome
1. Haematuria, proteinuria --> progressive renal failure 2. Sensorineural deafness 3. Lens dislocation and cataracts 4. Retinal flecks
174
Where can urinary tract stones be found?
``` Upper = renal and ureteric Lower = bladder, prostatic and urethral ```
175
What are urinary tract stones composed of?
Calcium based (oxalate and phosphate) = 80% Uric acid Cystine Struvite
176
Describe the pathophysiology of stone formation in the upper urinary tract?
Stones form from crystals in supersaturated urine
177
Describe the epidemiology of stones in the urinary tract
10-15% lifetime risk Males > females (2:1) Increases with age
178
Give 5 potential causes of urinary tract stones
1. Congenital abnormalities - horseshoe kidney, spina bifida 2. Hypercalcaemia/high urate/high oxalate 3. Hyperuricaemia 4. Infection 5. Trauma
179
Give 5 symptoms of urinary tract stones
1. Loin pain --> groin pain 2. Renal colic 3. UTI symptoms = dysuria, urgency, frequency 4. Recurrent UTI's 5. Haematuria and proteinuria
180
Give 3 differential diagnosis of urinary tract stones
1. AAA (until proven otherwise) 2. Diverticulitis 3. Appendicitis 4. Ectopic pregnancy 5. Testicular torsion
181
What investigations might you do on some who you suspect has a urinary tract stone?
Midstream urine = haematuria Blood tests - FBC, U+Es, Ca, Uric acid Kidney ureter bladder (KUB) XR = first line imaging Non-contrast CT-KUB = diagnostic
182
Give 5 ways in which urinary tract stones can be prevented
1. Stay well hydrated 2. Low salt diet 3. Healthy protein intake 4. Reduced BMI 5. Active lifestyle 6. Urine alkalisation
183
When are urinary tract stone removed?
<5mm = watch and wait >5mm: - Oral nifedipine (CCB) or alpha blocker (tamsulosin) - Extracorporeal shock wave lithotripsy (ESWL) - Ureteroscopy (laser/basket)
184
What is urosepsis?
Obstruction and infection | Treat with antibiotics, oxygen and surgical drainage
185
What is renal colic?
Pain due to obstruction in the urinary tract
186
What investigations might you do to find out what is causing someone's renal colic?
1. Bloods - including calcium, phosphate, urate 2. Urinalysis 3. MCS MSU 4. NCCT-KUB = gold standard
187
Describe the treatment for renal colic
1. Analgesia - NSAIDS (diclofenac) 2. Anti-emetics 3. Check for sepsis
188
Give 3 causes of renal colic
1. Urinary tract stones 2. UTI 3. Pyelonephritis
189
Give 3 places where urinary tract stones are likely to get stuck
1. Ureteropelvic junction 2. Pelvic brim 3. Vesoureteric junction
190
Give 5 functions of the kidney
1. Filters and secretes waste/excess substances 2. Blood volume/fluid management (BP control) 3. Synthesises Erythropoietin 4. Acid base regulation (reabsorption go Na, Cl, K, glucose, H2O, AA's) 5. Converts 1-hydroxyvitamin D --> 1,25-dihydroxyvitamin D (active)
191
What is the GFR?
Volume of fluid filtered from the glomeruli into Bowman's space pre unit time
192
What would you expect a typical GFR to be?
120 ml/min
193
Write an equations for GFR
(Um X urine flow rate) / Pm Um = conc of marker substance in urine Pm = conc of marker substance in plasma
194
Give an example of a marker substance for estimating GFR
Creatinine
195
Give 3 essential features of a marker substance for estimating GFR
1. Not metabolised 2. Freely filtered 3. Not reabsorbed/secreted
196
Name a drug that can inhibit creatinine secretion and what is the affect of this on GFR?
Trimethoprim | Serum creatinine rises and so kidney function (GFR) appears worse
197
What is the affect on GFR of afferent arteriole vasoconstriction?
Decreased GFR
198
What is the affect on GFR of efferent arteriole vasoconstriction?
Increased GFR
199
What does the eGFR require to be calculated?
Steady state
200
Where in the nephron does the bulk of reabsorption occur?
Proximal convoluted tubule
201
What is reabsorbed at the PCT?
1. Sodium 2. Chlorine 3. Potassium 4. Glucose 5. Water 6. Amino acids 7. Bicarbonate
202
What is Fanconi syndrome?
Failure of nephron to reabsorb essential ions | proximal tubular insult
203
Give 2 signs of Fanconi syndrome
1. Glycosuria 2. Acidosis with failure or urine acidification 3. Phosphate wasting --> rickets/osteomalacia 4. Aminoaciduria
204
Give 2 causes of Fanconi syndrome
1. Cystinosis 2. Tenofovir 3. Wilson's disease
205
What is the function of the counter current multiplication system?
It generate a hypertonic medullary interstitium for H2O reabsorption Na+ moves out of the ascending limb which increases the medullary osmolality so H20 follows
206
Describe the tubuloglomerular feedback
Macula densa cells of the DCT detect NaCl and use this as an indicator of GFR
207
Macula dense cells detect a raised NaCl - what is the response?
Afferent arteriole constriction
208
Macula densa cells detect a reduced NaCl - what is the response?
Renin secretion
209
What hormone is responsible for regulating sodium reabsorption?
Aldosterone
210
Which might aldosterone secretion lead to hypokalaemia?
Aldosterone secretion --> increase sodium reabsorption --> increased potassium secretion --> hypokalaemia
211
What is the effect of NSAIDs on the afferent arteriole of glomeruli?
NSAIDs inhibit prostaglandins and so lead to afferent arteriole vasoconstriction = reduced GFR
212
What is the effect of AECi on the efferent arteriole of glomeruli?
ACEi cause efferent arteriole vasodilation = reduced GFR
213
Name 2 factors that govern renal potassium
1. Na+ | 2. Aldosterone
214
What ion is responsible for volume control?
Sodium
215
Name 2 hormones that increase sodium reabsorption
1. Aldosterone | 2. Angiotensin II
216
Name a hormone that decrease sodium reabsorption
ANP
217
What is the function of EPO?
Stimulates bone marrow --> RBC maturation
218
Give 2 functions of calcitriol
1. Increases Ca and phosphate absorption form the gut | 2. Suppresses PTH
219
Why might someone with advanced CKD also have hyperparathyroidism?
Advanced CKD = calcitriol deficiency | Calcitriol suppresses PTH therefore in deficiency = hyperparathyroidism
220
What triggers PTH secretion?
Low serum calcium
221
Give 3 ways in which PTH increase serum calcium
1. Increased bone resorption 2. Increase reabsorption of calcium at the kidneys 3. Stimulates 1-hydroxylase --> 1,25-dihydroxyvitamin D --> increase calcium absorption from the intestine
222
Describe the function of ADH
Acts on the collecting ducts to increase insertion of aquaporin 2 channels --> H20 retention
223
Give 3 factors that stimulate renin release
1. Sympathetic stimulation 2. Decreased BP 3. Decreased Na detected by macula densa
224
Give 3 functions of ANP
1. Renal vasodilator 2. Inhibits aldosterone 3. Closes ENaC (decreased reabsorption of Na+)
225
Where on the nephron does aldosterone act?
Collecting ducts
226
Describe the action of aldosterone
Increase ENaC and H+/K+ pumps | Increases Na+ absorption and K+ secretion --> H20 retention --> increases BP
227
Define chronic kidney disease
Long standing, usually progressive, impairment in renal function for more than 3 months
228
How is CKD classified?
``` Using eGFR G1 = >90 ml/min G2 = 60-90 ml/min = only CKD if other signs of kidney damage G3a = 45-60 ml/min = mild/moderate CKD G3b = 30-45 ml/min = moderate/severe CKD G4 = 15-30 ml/min = severe CKD G5 = <15ml/min = renal failure ```
229
How is kidney damage staged?
Using album/creatinine ratio A1 = <30 mg/24h = normal/mild A2 = 30-300 mg/24h = moderate increase A3 = >300 mg/24h = severe increase
230
Briefly describe the pathophysiology begins CKD
Hyper-filtration for nephrons that work --> glomerular hypertrophy and reduced arteriolar resistance --> raised intraglomerular capillary pressure and strain --> accelerates remnant nephron failure (progressive)
231
Name 4 cause of CKD
1. DM 2. Hypertension 3. Glomerulonephritis 4. Congenital - polycystic kidney disease 5. Urinary tract obstruction 6. Amyloidosis
232
Give 3 signs of CKD
Often asymptomatic until very low kidney function 1. Anaemia = pallor, fatigue, lethargy 2. Bone disease = osteomalacia, bone pain, hyperparathyroidism (due to reduced vitamin D) 3. Haematuira, Proteinuria and nocturia 4. High urea = malaise, anorexia, weight loss, insomnia 5. CVD 6. Polyneuropathy - confusion, seizures --> coma
233
What investigations might be done in someone who has CKD?
FBC = anaemia U+Es = raised phosphate, uric acid, urea, creatine and decreased Calcium Urine dipstick = haematuria and proteinuria GFR Imaging - USS, CT KUB, ECG, Xrays
234
Describe the management of CKD
1. Treat the underlying cause 2. Maintain BP = antihypertensives - follow treatment plan for hypertension (ACD pathway) 3. Reduce CV risk - statins, smoking cessation 4. Treat complications - anaemia (give EPO), bone disease (give bisphosphonates, vitamin D supplements) 5. End stage renal failure = Renal replacement therapy
235
What is renal replacement therapy?
Dialysis or renal transplantation
236
Name 2 types of dialysis?
1. Haemodialysis | 2. Peritoneal dialysis
237
What is the access point in haemodialysis?
AV fistula
238
How does haemodialysis work?
Blood passes over semi-permeable membrane against dialysis fluid Impurities, salt, excess fluid drawn into dialysis fluid
239
Give 3 examples of waste products that are removed from the blood in dialysis
1. Urea 2. Creatinine 3. Potassium 4. Phosphate
240
How many times a week and for how long does someone have haemodialysis for?
3/4 times a week for around 4 hours | Can be done at home or in hospital
241
Give 5 potential complications of haemodialysis
1. Hypotension 2. Cramps 3. Nausea 4. Chest pain 5. Fever 5. Blocked or infected dialysis catheter
242
Give 3 groups of people who haemodialysis is good for?
1. People who live alone/frail/elderly 2. People who fear operating machines 3. People who are unsuitable for peritoneal dialysis (abdominal surgery/hernia)
243
What is the access point for peritoneal dialysis?
A peritoneal catheter is placed into the peritoneal cavity through a SC tunnel
244
How often does someone have to do continuous ambulatory peritoneal dialysis (CAPD)?
30-40 minute exchanges, 3-5 times a day
245
How often does someone have to do automated peritoneal dialysis (APD)?
One exchange overnight (8 hours)
246
Give 4 potential complications of peritoneal dialysis
1. Infection (peritonitis/catheter exit site infection) 2. Peri-catheter leak 3. Abdominal wall herniation 4. Intestinal perforation
247
Give 3 groups of people who peritoneal dialysis is good for
1. Young people/those in full time work 2. People who want control/responsibility of their care 3. People with severe HF
248
Where in the abdomen does a transplanted kidney lie?
In the iliac fossa
249
What has to be assessed for a renal transplant to occur?
Virology status = CMV, hepatitis, EBV CVD TB ABO and HLA haplotype
250
What tests can be done to evaluate kidney function in a potential kidney donor?
1. Serum creatinine 2. Creatinine clearance 3. Urinalysis 4. Urine culture 5. GFR
251
Give 3 contraindications for renal transplant
1. ABO incompatibility 2. Active infection 3. Recent malignancy 4. Morbid obesity 5. Age >70 6. AIDS
252
What are the 2 main causes of death after a kidney transplant?
1. CV disease | 2. Infection
253
Name 4 potential complications of a kidney transplant
1. Thrombosis 2. Obstruction 3. Infections - URTI, chest 4. Rejection (12% in 1st year)
254
Describe the fluid distribution in the body
``` Total = 42L ICF = 28L ECF = 14 L - interstitial = 11L - plasma = 3L ```
255
How much extra-vascular fluid is there in the body?
ICF + interstitial = 39L
256
How much intra-vascular fluid is there in the body?
Plasma = 3L
257
Name the determinants of fluid movement
1. Hydrostatic pressure 2. Osmotic pressure (salt and electrolytes ) 3. Oncotic pressure (protein)
258
What happens to the heart rate in hypovolaemia?
Increases - tachycardia
259
What happens to the BP in hypovolaemia?
Decreases - hypotension
260
What happens to the JVP in hypovolaemia?
JVP is low
261
What happens to tissue turgor in hypovolaemia?
Reduces
262
What happens to the urine output in hypovolaemia?
Reduces
263
What happens to weight in hypovolaemia?
Reduces
264
Give 2 symptoms of hypovolaemia
1. Thirst | 2. Dizziness
265
What happens to creatinine, haemoglobin and haematocrit levels in hypovolaemia?
Raised
266
Name 3 groups of people at risk of hypovolaemia
1. Elderly 2. Those who have had a ileostomy 3. Bowel obstruction 4. People taking diuretics 5. People with short bowel syndrome
267
Describe the management for hypovolaemia
1. Oral fluid 2. IV fluid is very ill/elderly with difficulties 3. Treat reversible causes - stop ACEi, ARBs, diuretics
268
What type of IV fluid moves form intra-vascular to the extra-vascular space?
Crystalloid | Small molecules pass through cell membrane
269
Give an example of crystalloid IV fluid
Isotonic solutions - 5% dextrose - 0.9% NaCl
270
Give an example of a colloid IV fluid
Gelofusine
271
What happens to the heart rate in hypervolaemia?
HR is normal
272
What happens to BP in hypervolaemia?
BP is high or normal
273
What happens to JVP in hypervolaemia?
High
274
What happens to tissue turgor in hypervolaemia?
Normal
275
What happens to urine output in hypervolaemia?
Normal
276
What happens to weight in hypervolaemia?
Increases
277
Give 2 symptoms of hypervolaemia
1. SOB | 2. Peripheral oedema
278
Where might fluid accumulate in someone with hypervolaemia?
1. Pulmonary oedema 2. Pleural effusion 3. Ascites 4. Bowel obstruction 5. Intra-abdominal collection
279
What happens to creatinine, haemoglobin and haematocrit levels in hypervolaemia?
Reduced
280
Name 3 groups of people who are at risk of hypervolaemia
1. AKI patients 2. CKD patients 3. Heart failure patients 4. Liver failure patients
281
Describe the management of hypervolaemia
1. Diuretics - furosemide (loop) 2. Fluid and salt restriction 3. Treat reversible causes
282
Why do advanced CKD patients need regular fluid assessment?
They may be oliguric or anuric
283
Name a loop diuretic
Furosemide - acts on NKCC2 transporter
284
Give 3 potential side effect of furosemide
1. Hypokalaemia 2. Hypotension 3. Dehydration
285
What other drug might you prescribe with furosemide in someone with poorly controlled potassium?
A potassium sparing diuretic e.g. spironolactone | Work on RAAS not ion channels so help control potassium levels in the blood
286
On which part of the nephron do thiazides act?
The distal tubule | Act on NCC channels
287
On which part of the nephron do aldosterone antagonists act on?
Collecting ducts
288
Define Acute Kidney Injury (AKI)
An abrupt (hours-days) sustained rise in serum urea and creatinine due to a rapid decline in GFR
289
Name 3 types of AKI and briefly describe their pathophysiology
1. Pre-renal = decreased blood flow to kidneys --> decreased GFR 2. Renal = kidney damage 3. Post-renal = Urinary tract obstruction
290
Give 5 risk factors for AKI
1. Increasing age 2. CKD 3. HF 4. DM 5. Nephrotoxic drugs - NSAIDs, ACEi
291
Give 2 pre-renal causes of AKI
1. Heart failure 2. Sepsis 3. Hypotension 4. Hypovolaemia (dehydration/haemorrhage)
292
Give 2 renal causes of AKI
1. Glomerulonephritis 2. Nephrotoxic drugs 3. Tubular necrosis 4. Vasculitis
293
Give 2 post-renal causes of AKI
1. BPE/BPH 2. Urinary tract stones 3. Malignancy 4. Strictures
294
How does AKI present?
1. Uraemia (high urea) = fatigue, weakness, vomiting, seizures 2. Acidosis 3. Arrhythmias 4. Oliguria 5. Oedema
295
What investigations might you do to determine whether someone has AKI?
1. Check potassium 2. Bloods - Creatinine, U+Es 3. Urine output 4. Auto-antibodies 5. Distinguish whether pre-renal, renal or post renal using imaging
296
What is the affect of AKI on creatinine and urine output?
Creatinine = raised | Urine output = reduced
297
What is the diagnostic criteria for AKI?
1/3 = diagnostic 1. Rise in CR >26 mmol/L in 48 hours 2. Rise in Cr >50% in 48 hours 3. Urine output < 0.5 ml/kg/h for 6 hours
298
How do you treat AKI?
1. IV fluids (beware in post-renal) 2. Stop nephrotoxic drugs (NSAIDs, ACEi, gentamicin) 3. Treat underlying cause - Pre-renal = fluids, HF drugs, Abs for sepsis - Renal = Biopsy --> specialist treatment - Post-renal = Stone removal 4. Renal replacement therapy = dialysis
299
What is the major complication someone with AKI might develop?
Hyperkalaemia Can lead to arrhythmias ECG = tall tented T waves, increase PR interval and wide QRS complex
300
How can hyperkalaemia be prevented in someone with AKI?
Give calcium gluconate to protect myocardium | Give insulin and dextrose (insulins drives K+ into cells and dextrose is to rebalance the blood sugar)
301
Define urinary tract infection
Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteriuria and pyuria
302
What determines if a UTI is complicated or uncomplicated?
A UTI is deemed complicated if it affects: - Someone with an abnormal urinary tract - A man - Pregnant lady - Children - Immunocompromised - If it is recurrent
303
Describe the pathophysiology of UTI's
Organisms colonise the urethral meatus --> bacterial sent --> bacteriuria
304
Name 3 UTI causative organisms
1. Uropathogenic strains of E. coli (UPEC) - 82% 2. Coagulase negative staph (s. saprophyticus) 3. Proteus mirabilis 4. Enterococci 5. Klebsiella pneumonia
305
Describe the epidemiology of UTI's
More common in women due to short urethra and its proximity to the anus
306
Give 4 risk factors of UTI's
1. Catheter 2. Female 3. Prostatic hypertrophy (obstructs) 4. Low urine volume 5. Urinary tract stones 6. Pregnancy
307
Give 3 bacterial virulence factors that aid their ability to cause UTI's
1. Fimbriae/pili that adhere to urothelium 2. Acid polysaccharide coat resists phagocytes 3. Toxins (e.g. UPEC releases cytotoxins) 4. Enzyme production (e.g. urease)
308
What type of pili would you associate with lower UTI?
Type 1 | Bind to uroplakin
309
What type of pili would you associate with upper UTI?
Type P | Bind to glycolipids on urothelium
310
The vagina is heavily colonised with lactobacilli, what is the function of this?
Helps maintain a low pH = host defence mechanism
311
Give 2 reasons why a post-menopausal women is more susceptible to a UTI
1. pH rises --> increased colonisation by colonic flora | 2. Reduced mucus secretion
312
Give 3 host defence mechanisms against UTIs
1. Antegrade flushing of urine 2. Tamm-horsfall protein 3. GAG layer 4. Low urine pH 5. Commensal flora 6. Urinary IgA
313
Define pyuria
Presence of pus in urine
314
Name 4 lower urinary tract infections
1. Cystitis 2. Prostatitis 3. Epididymo-orchitis 4. Urethritis
315
Name a upper urinary tract infection
Pyelonephritis
316
Give 4 classic UTI symptoms
1. Urgency 2. Frequency 3. Dysuria 4. Haematuria 5. Abdominal pain 6. Malaise 7. Confusion (old patients)
317
What investigations might you do in someone who you suspect has a UTI?
1. Take a good history 2. Urinalysis --> haematuria, proteinuria, increased WCC, pH, nitrates, ketones 3. Microscopy, culture and sensitivity of MSU 4 In recurrent/complicated UTI = imaging (bladder scan, USS, XR)
318
What is the first line treatment for an uncomplicated UTI?
Trimethoprim or nitrofurantoin for 3 days | Increase fluid intake and regular voiding
319
How does trimethoprim work?
It affects folic acid metabolism
320
Describe the management for a complicated UTI
Culture sample --> Abx for 7 days
321
Define recurrent UTI
>2 episodes in 6 months or >3 in 12 months
322
Describe the management for someone who is having recurrent UTIs
1. Increase fluid intake 2. Regular voiding 3. Void pre and post intercourse 4. Abx prophylaxis 5. Vaginal oestrogen replacement
323
What is cystitis?
Inflammation of the bladder secondary to infection
324
Give 3 risk factors for cystitis
1. Urinary obstruction 2. Previous damage to bladder epithelium 3. Poor bladder emptying
325
Give 4 symptoms of cystitis
1. Dysuria 2. Frequency and urgency 3. Suprapubic pain 4. Offensive smelling/cloudy urine 5. Haematuria
326
What is the treatment for cystitis?
Trimethoprim or Cefalexin | ciprofloxacin or Co-amoxiclav = 2nd line
327
Name 3 causative organism of prostatitis
1. E. coli 2. Proteus 3. Klebsiella 4. UTI's
328
Give 4 symptoms of acute prostatitis
1. Fever 2. Rigors 3. Malaise 4. Voiding LUTS (straining, hesitancy, incomplete emptying, poor flow) 5. Pelvic --> anal pain
329
Give 3 symptoms of chronic prostatitis
1. Recurrent UTI's 2. Pelvic --> anal pain 3. Voiding LUTS Symptoms for > 3 months
330
What investigations might you do in someone with prostatitis?
1. Urinalysis and MSU 2. DRE = boggy, tender and hot to touch 3. STI screen 4. Microbiology = uropathogens in urine 5. Imaging - TRUSS +/- CT abdo/pelvis
331
How would you treat prostatitis?
Quinolone (ciprofloxacin) or trimethoprim (if unable to take quinolones) for 4-6 weeks Treat pain = paracetamol/ibuprofen
332
What can cause urethritis?
STI's = Chlamydia, Gonorrhoea
333
Give 3 symptoms of urethritis
1. Dysuria 2. Hesitancy 3. Urethral discharge
334
How would you treat urethritis?
STI treatment = Abx - ceftriaxone and doxycycline
335
What is epididymo-orchitis?
Inflammation of the epididymus and testes
336
Describe the aetiology of epididymo-orchitis
If < 35 = STI = chlamydia or gonorrhoea | If >35 = UTI = E.coli, enterococci
337
Give 3 symptoms of epididymo-orchitis
1. Unilateral scrotal pain +/- swelling 2. UTI symptoms 3. Fever 4. Urethral discharge
338
What investigations might you do on someone who you suspect has epididymo-orchitis?
1. Urethral swab 2. MSU 3. STI screen Must rule out testicular torsion
339
Describe the treatment for epididymo-orchitis
Pain relief, no sex Abx for 14 days - STI = ceftriaxone and doxycycline - UTI = ofloxacin or ciprofloxacin
340
Define pyelonephritis
Inflammation secondary to infection of the renal pelvis and upper ureter
341
What can cause pyelonephritis?
UTI = E.coli, Klebsiella, proteus | Haematogenous spread = S. aureus, candida
342
Give 3 symptoms of pyelonephritis
1. Loin --> back pain 2. Fever 3. Pyuria (pus in urine) 4. Malaise 5. UTI symptoms 6. Septic shock
343
What investigations might you do in someone with pyelonephritis?
1. Urinalysis 2. MCS MSU 3. Bloods - raised WCC, ESR and CRP
344
Describe the treatment for pyelonephritis
Fluid replacement IV Abs - Ciprofloxacin or co-amoxiclav Analgesics
345
What can a prolonged pyelonephritis infection cause?
Renal abscess | Treatment = drainage
346
Name 2 groups of people that you would treat for bacteriuria
1. Pregnant ladies | 2. Children
347
What is septic shock?
Severe sepsis with persistent hypotension
348
Describe the treatment for sepsis
``` The sepsis 6: 1. Give high flow oxygen 2. Take blood cultures 3. Give IV Abx 4. Give IV fluids 5. Check lactate 6. Monitor hourly urine output Drainage to relieve pressure ```
349
Describe the pathophysiology of urosepsis
A symptomatic UTI combined with >1 of: 1. Microbial resistance 2. Immunosuppression 3. Pressure
350
Describe the epidemiology of gonorrhoea
More common in men --> 25-30 years
351
Give 3 symptoms of gonorrhoea
Very common asymptomatic stage 1. Dysuria 2. Discharge 3. Menstrual irregularity (women)
352
What investigations might you do in someone you suspect to have gonorrhoea?
1. Microbiology = gram -ve diplococci with polymorph cytoplasm - genital secretion from urethra (M)/endocervix (F) 2. Culture on selective medium = confirmation 3. Sensitivity testing 4. Nucleic Acid Amplification Test (NAAT)
353
What is the management of gonorrhoea?
Partner notification and further STI testing | 500mg ceftriaxone AND 1g oral azithromycin
354
Describe the epidemiology of Chlamydia
More common in women --> 16-20 years
355
Give 3 symptoms of Chlamydia
1. Dysuria 2. Discharge 3. Menstrual irregularities (F)
356
What investigations might you do in someone you suspect to have Chlamydia?
Nucleic acid application test (NAAT) - Vaginal/endocervix swab (F) - First void urine (M)
357
What is the management of Chlamydia?
Partner notification and further STI testing 1g oral azithromycin stat or Doxycycline 100mg bd for 7days OR 500mg erythromycin (14 days) in pregnancy Community screening
358
Give 3 possible complications of chlamydia
1. Reactive arthritis 2. Epididymo-orchitis (M) 3. Pelvic inflammatory pain (F) 4. Neonatal transmission --> ophthalmia neonatorum and atypical pneumonia
359
Name 3 types of Syphilis
1. Primary = <90 days after inoculation = highly infectious 2. Secondary = dissemination 4-10 weeks after chancre 3. Tertiary = 20-40 years after infection
360
How does primary Syphilis present?
1. Primary chancre = painless ulcer (Macule --> papule --> typically painless ulcer) 2. Regional nodes
361
How does secondary Syphilis present?
1. Presents with a skin rash 2. Mucous membrane lesions 3. Generalised lymphadenopathy 4. Myalgia 5. Hepatitis
362
How does Tertiary Syphilis present?
Neurosyphilis = aseptic meningitis, focal neurological deficits, seizures, psychiatric symptoms Gummatous syphilis = destructive granulomata in skin, mucus membrane, bones and viscera Cardiovascular = aortitis, aortic regurgitation/aneurysm
363
What investigations would you do for someone who you suspect to have syphilis?
Serology - genital ulcer - if negative, repeat 6-12 weeks to exclude diagnosis Confirmatory tests = TPPA (Treponema pallidum particle agglutination test) Non-treponemal test for disease activity
364
What is the treatment for syphilis?
Penicillin injection | Partner notification

PHASE 2A (16 decks)

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