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Sandra Phase 2a > Renal & Genitourinary > Flashcards

Renal & Genitourinary Flashcards

1
Q

Sites of ureteric constriction (sites where urinary stones can lodge)

A
  1. Pelvicureteric junction
  2. Pelvic Brim
  3. Vesicoureteric junction
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2
Q

Anatomy of kidney

A
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3
Q

Structure of nephron

A
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4
Q

Pathophisiology of kidney stones (nephrolithiasis)

A

Within tubule of nephrons crystal like structures can form. These crystal like structures are precipitance of electrolytes that have acculumated. Urine supersaturation with stone forming salts -> crystal formation

If crystal is small it will pass in urine.
If crystal remains in kidney it becomes a stone

Continue on pic

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5
Q

Clinical presentation of kidney stones

A

Triad: fever, vomiting, flank pain

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6
Q

Risk Factors for developing kidney stones

A
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7
Q

What do the risk factors in developing kidney stones increase/decrease ?

A

Increase urinary solutes (Calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)

=this causes urine supersaturation leading to urinary crystal formation

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8
Q

What factors contribute to urine supersaturation and therefore urinary crystal formation

A

Increase urinary solutes (calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)
Dcerease urinary volume
Increase/decrease urinary pH

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9
Q

Stone pathology

A
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10
Q

Investigations for kidney/urinary stone formation

A
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11
Q

Acute management of kidney stones

A
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12
Q

Management of kidney stones

A

Percutaneous nephrostomy (symptomatic relief)
Ureteric stent insertion
Percutaneous nephrolithotomy
Endoscopic treatment/open surgery
Extracorporeal shock wave lithotripsy

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13
Q

What is acute kidney injury

A

sudden deterioration in kidney function

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14
Q

What is kidney fucntion measured in?

A

Glomelular Filtration Rate

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15
Q

What is GFR?

A

Flow rate of filtered fluid through the kidney

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16
Q

How is GFR measured?

A

Difficult to measure directly, estimated using creatinine clearance

Cockcroft-Gault formula:

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17
Q

Causes of Acute Kidney Injury

A
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18
Q

Signs and symptoms of acute kidney injury

A
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19
Q

Diagnosis of acute kidney injury

A

Definition:
1. Increase in serum creatinine of 26micromol/l in 48h
2. Increase in serum creatinine of 1.5x of baseline
3. Urine production below 0.5mol/kg/h

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20
Q

List some nephrotoxic medication (DAMN)

A

D:iuretics
A: CEi/ARB/antibiotics
M: etformin
N: SAIDs

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21
Q

Tretment for AKI

A
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22
Q

Indications for acute dialysis

A
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23
Q

What is chronic kidney disease

A

Progressive, irreversible condition characterised by reduced kidney function or kidney damage (Any cause), lasting for >=3 months

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24
Q

Classification of chronic kidney disease

A

Based on GFR

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25
Q

Symptoms and complication of chronic kidney disease

A
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26
Q

Aetiology of CKD

A

Most common causes:
1.Type 2 diabetes mellitus (30-50%)
Type 1 diabetes mellitus (4%)

  1. Hypertension
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27
Q

Pathophysiology of CKD

A
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28
Q

Epidemiology + Risk Factors for CKD

A
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29
Q

Diagnosis of CKD

A
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30
Q

Treatment for CKD

A

+Renal Replacement therapy:
Usually later stages but not based on GFR alone
Extracorporeal: haemodialysis/haemofiltration, peritoneal dialysis, renal replacement

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31
Q

What is a urinary tract infection

A

Bacterial infection of the urinary tract

Causative agents:
1. E-coli (80%)
2. Enterobacteriae
3. Proteus mirabilis
4. Klebsiella pneumoniae

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32
Q

Why are women at a greater risk of getting a UTI

A

Urethra is shorter than males

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33
Q

Lower Urinary Tract Infection

A
  1. Cystitis (bladder)
  2. Prostatitis (prostate)
  3. Urethritis (urethra)
  4. Epidydmo-Orchitis
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34
Q

Upper Urinary Tract Infection

A

Pyelonephritis (kidney)

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35
Q

Pathogenesis of UTI

A
  1. Contamination
  2. Colonisation in urethra/bladder
  3. Inflammatory response
  4. Neutrophil infiltration
  5. Bacteria multiply: Immune system evasion (virulence)
  6. Ascension to the kidney
  7. Colonisation of kidney
  8. Bacteremia
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36
Q

Risk Factors for UTI

A
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37
Q

Signs and symptoms of UTI

A
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38
Q

Classification of UTI

A
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39
Q

Investigations + Diagnosis for UTI

A
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40
Q

Treatment for UTI

A
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41
Q

Prevention of UTI

A
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42
Q

What is nephritic syndrome?

A

Collection of signs and symptoms as a result of glomerulonephritis

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43
Q

Nephritic syndrome vs nephrotic syndrome

A
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44
Q

Anatomy of Glomerulus

A
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45
Q

Pathophysiology of nephritic syndrome

A

Cause -> Inflammation: cell proliferation, complement, leukocyte recruitment, protease/free radials -> injury

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46
Q

Signs and symptoms of nephritic syndrome

A

Characteristics of nephritic syndrome:
1. Proteinuria
2. Haematuria: Acanthocyte
3. RBC casts: suggestive of GN
4. Sterile pyuria
5. RAAS activation -> Hypertension
6. Decrease GFR -> Oliguria

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47
Q

Causes of nephritic syndrome

A
  1. Rapidly progressive glomerulonephritis (RPGN) aka “crescentic GN”
    a. Anti glomerular basement membrane (Goodpasture’s)
    b. Immune complex mediated
    -IgA neuropathy (Berger disease)
    -Post Streptococcal Glomerulonephritis
    -Diffuse proliferative glomerulonephritis
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48
Q

Anti glomerular basement membrane (Goodpasture’s)

A
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49
Q

IgA neuropathy (Berger disease)

A
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50
Q

Post Streptococcal Glomerulonephritis

A
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51
Q

Diagnosis of nephritic syndrome

A
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52
Q

Treatment for nephritic syndrome

A
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53
Q

SLE neuropathy (Lupus nephritis)

A

caused by lupus and can present as nephrotic and nephritic syndrome

occurs due to immune complexes in the nephron. It is a type III hypersensitivity.
inflammation can be detected by biopsy

Treatment is the same as lupus:
-corticosteroids
-mycophenolate
-cyclophosphamide

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54
Q

Pathophisiology of nephrotic syndrome

A

Injury to structures -> Excessive protein loss -> Hypoalbuminemia

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55
Q

Signs and symptoms of nephrotic syndrome

A
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56
Q

Causes of nephrotic syndrome

A

1.Minimal change disease
2.Focal segmental glomerulosclerosis
3.Membranous nephropathy

Can be primary (idiopathic) or secondary

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57
Q

Minimal change disease

A

95% cases in children
abnormalities seen on electron microscopy
mostly primary
secondary causes include: hodgkin’s lymphoma & NSAIDs

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58
Q

Focal segmental glomerulosclerosis

A

Primary possible
More commonly secondary: HIV, obesity, reflux nephropathy, drugs: lithium, biphosphanates
Genetic: Nephrin (slit diaphragm), laminin 2 (GBM)

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59
Q

Membranous nephropathy (membranoproliferative glomerulonephritis)

A

Thickening of basement membrane
Spike and dome pattern of immune deposits in the suepithelial space
70% primary, 1/3 secondary
Secondary causes: malignancy, hepatitis, syphilis, lupus, drugs (penicillamine, NSAIDs)

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60
Q

Epedimiology/Risk Factors of nephrotic syndrome

A
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61
Q

Diagnosis of nephrotic syndrome

A
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62
Q

Treatment for nephrotic syndrome

A
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63
Q

What is benign prostatic hyperplasia (BPH)

A

non-cancerous growth of the prostate gland

common in men over 50
not premalignant
characterised by nodular prostatic hyperplasia

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64
Q

Anatomy of the prostate

A
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65
Q

Anatomy of prostate gland

A
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66
Q

Symptoms of BPH

A
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67
Q

Diagnosis of BPH

A
68
Q

Treatment for BPH

A
69
Q

Causes of BPH

A
70
Q

What is prostate cancer

A

prostate cancer is a tumor or growth that originates in the prostate gland

71
Q

Types of prostate cancer

A

1.Prostate adenocarcinoma: arises from luminal/basal cells
2.Transitional cell cancer: arises from prostatic urethra thransitional epithelium cells
3.Small cell prostate cancer: arises from neuroendocrine cells

72
Q

Prostate adenocarcinoma

A

most common type
genetic mutation in a luminal cell or basal cell
mutation in 2 genes (BRCA1 & BRCA2)

Risk Factors:
1. Old age
2. Obesity
3. High fat/low fiber diet

73
Q

Symptoms of prostate cancer

A

early on there are no symptoms

if cancer does compress urethra or bladder:
difficulty urinating
bleeding
pain with urination and ejaculation

if metastatic, spreads to bones (e.g vertebrae or pelvis) -> hip/lower back pain

74
Q

Diagnosis of prostate cancer

A

Digital rectal exam
Transrectal ultrasound or MRI
Prostate cancer can cause elevation in prostate specific antigen

=ULTIMATELY REQUIRES BIOPSY for GLEASON GRADING SYSTEM

75
Q

What is the Gleason Grading system

A

Identifies 2 most common cell patterns for prostate cancer
Score (1-5)
Numbers added = total gleason score (2-10)

1: Normal (well differentiated)
5: Abnormal cells

76
Q

Treatment for prostate cancer

A
77
Q

Scrotal diseases:

A

Varicocele
Testicular torsion
Epididymal cyst
Hydrocele

78
Q

What is a varicocele

A

testicular disorder of young adults characterised by dilatation of pampiniform venous plexus, internal spermatic vein

most common cause of scrotal enlargement in young adults

usually let sided (>80%) due to increase in flow of resistance from left testicular vein drainage into left renal vein; right testicular vein drains directly to inferior vena cava (decrease flow resistance)

79
Q

Types of varicocele

A

Large: easily identified by inspection as distention
Moderate: identified by palpation as “bag of worms”
Small: identified only as bearing down -> Increase abdominal pressure -> impeding drainage -> Increase varicocele size

80
Q

Causes of varicocele

A
81
Q

Signs and symptoms of varicocele

A

throbbing/dull pain: worse on standing
dragging sensation
infertility

82
Q

Diagnosis of varicocele

A

Doppler ultrasound
CT scan
Semen analysis

83
Q

Treatment for varicocele

A

surgery

84
Q

What is testicular torsion

A

Rotation of the testicle with strangulation of its blood supply
Emergency
Can lose testicle in 6 hours
Ages 12-18

85
Q

Symptoms of testicular torsion

A

Severe local pain
Nausea/vomiting
Scrotal oedema
Testis may be horizontally elevated
Loss of cremasteric reflex: stroke inner thigh, pulls up testis
(-) Prehn’s sign: elevate testis, pain is NOT relieved in testicular torsion

86
Q

Diagnosis of testicular torsion

A

Color doppler ultrasound
Contrast enhanced MRI

87
Q

Treatment for testicular torsion

A

Manual detorsion
Surgical

88
Q

Risk factor for testicular torsion

A

Bell Clapper deformity

89
Q

What is testicular cancer

A

Malignant tumours that form in one or both testes
often detected in the early stages
good prognosis

90
Q

testes anatomy

A
91
Q

semineferous tubule anatomy

A
92
Q

Types of germ cell tumours

A

Seminomas: most common
Yolk sac tumour: most common germ cell tumour in children
Teratomas
Choriocarcinoma
Embryonal carcinoma

93
Q

seminomas

A

made of germ cells that multiply without differentiating into other types of cells

germ cells: big with central nuclei surrounded by clear cytoplasm “fried egg”
surrounded by fibrous tissue
placental alkaline phosphatase

94
Q

Yolk sac tumour

A
95
Q

Teratomas

A
96
Q

Choriocarcinoma

A
97
Q

Embryonal carcinoma

A
98
Q

Sex cord/gonadal stromal tumours

A

Sertoli cell tumours
Leydig cell tumours

99
Q

Sertoli cell testicular tumours

A
100
Q

Leydig cell tumours

A
101
Q

Risk Factors for testicular cancer

A

cryptorchidism
klinefelter syndrome
in utero exposure: pesticides, synthetic sex hormones
genetic

102
Q

Symptoms for testicular cancer

A
103
Q

Complications of testicular cancer

A
104
Q

Diagnosis for testicular cancer

A
105
Q

Treatment for testicular cancer

A
106
Q

Bladder carcinoma

A

common urogenital cancer
common in the lederly and is strongly associated with smoking

107
Q

Types of bladder carcinoma

A

1.urothelial carcinoma (transitional cell carcinoma)
2.Squamous cell carcinoma
3.Adenocarcinoma

108
Q

Risk Factors for bladder cancer

A
109
Q

Signs and symptoms of bladder cancer

A
110
Q

Investigations for bladder cancer

A
111
Q

Staging of bladder cancer

A

PET scan/CT scan

Who staging:
Low malignancy potential
Low grade
High grade

112
Q

Management of bladder cancer

A
113
Q

What is polycystic kidney disease?

A

Condition characterised by development of multiple cysts within the renal tubules. It is the most common hereditary renal disease

114
Q

Pathophisiology of polycystic kidney disease

A

1.May begin in utero
2.Size ranges - microscopic to cm
3.Cyst formation + compression -> dysfunctional tubules -> intially compensated

But over time GFR falls -> end stage renal disease

115
Q

Types of polycystic kidney disease

A

Autosomal Dominant Polycystic Kidney Disease
Autosomal Recessive Polycystic Kidney Disease

116
Q

Autosomal Dominant Polycystic Kidney Disease

A
117
Q

Autosomal Recessive Polycystic Kidney Disease

A
118
Q

Signs and symptoms of polycystic kidney disease

A
119
Q

Complications of polycystic kidney disease

A
120
Q

Diagnosis of polycystic kidney disease

A
121
Q

Treatment for polycystic kidney disease

A
122
Q

What is an epididymal cyst?

A

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

Usually develop around the age of 40
Not uncommon
Rare in children

123
Q

Pathophisiology of an epididymal cyst

A

Contain clear and milky (spermatocele) fluid
Lie above and behind the testes

124
Q

Signs and symptoms of an epididymal cyst

A
125
Q

Epididymal cyst differential diagnosis

A
126
Q

Diagnosis of an epididymal cyst

A

Scrotal ultrasound

127
Q

Treatment of an epididymal cyst

A

Usually not necessary
If painful and symptomatic then surgical excision

128
Q

What is a hydrocele

A

abnormal collection of serous fluid in tunic vaginalis

129
Q

Types of hydrocele based on aetiology

A

Congential
Acquired

Acquired can be further subdivided into primary and secondary

130
Q

What is primary acquired hydrocele

A

Defective absorption of fluid from tunica vaginalis
Most common hydrocele

131
Q

Secondary acquired hydrocele

A

Excessive production of fluid

Causes:
1.Epididymo-orchitis (most common)
2.Torsion of testes
3.Testicular tumours
4.Trauma

132
Q

Clinical Features of hydrocele

A

Primary:
Painless, progressive swelling
starts in scrotum (unlike hernia)
penis might be buried in scrotum

Secondary:
Testicular pain prior to swelling (epididymo-orchitis)
Sudden severe testicular pain (torsion)

Lied anterior to and below the testis and will transilluminate

133
Q

Diagnosis of hydrocele

A

ultrasound
transilluminate

134
Q

Treatment for hydrocele

A

Resolve spontaneously
Many of infancy resolve by 2 years
Therapeutic aspiration or surgical removal

135
Q

What are lower urinary tract symptoms

A

Nocturia
Frequency
Urgency
Post-micturition dribbling
Poor stream/flow
Hesitancy
Overflow incontinence
Haematuria
Bladder stones
UTI

136
Q

Classification of incontinence

A

overactive bladder (OAB)/urge incontinence: due to detrusor over activity
stress incontinence: leaking small amounts when coughing or laughing
mixed incontinence: both urge and stress
overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

137
Q

Causes of urge continence

A

UTIs
CNS disorders: stroke, Parkinsons, MS

138
Q

Causes of stress incontinence

A

Increased abdominal pressure: coughing, sneezing, laughing
Pregnancy

139
Q

Causes of overflow incontinence

A

Problem with emptying:
-Blockage: BPH, prostate cancer,
-Ineffective detrusor muscle: diabetes mellitus, spinal cord injury, cauda equina syndrome

140
Q

Incontinence table

A
141
Q

Causes of retention

A
142
Q

Diffuse proliferative glomerulonephritis

A
143
Q

Membranoproliferative glomerulonephritis

A
144
Q

Malignant renal tumour

A

Renal carcinoma

145
Q

Types of renal carcinoma

A

Renal cell carcinoma: arises from renal tubule
Transitional cell carcinoma: arises from the renal pelvis

146
Q

Clinical presentation of renal carcinoma

A

Haematuria
Abdominal mass
Lethargy
Anorexia
Weight loss
Abdominal pain

147
Q

Pathophisiology of renal cell carcinoma

A

Can secrete PTH (hypercalcaemia), ACTH (Cushing like syndrome), EPO (polycythaemia), renin (HTN)

Common metastases: Lymphoma, lung, breast, skin

148
Q

Common metastases of transitional cell carcinoma

A

Lymphoma
Lung
Breast
Skin

149
Q

Causes of renal carcinoma

A

Smoking
Horshoe kidney
Adult polycystic kidney disease
Kidney failure

150
Q

Sympotms and signs of renal carcinoma

A

Passing of blood in urine
Flank pain
Abdominal mass

151
Q

Diagnosis of renal carcinoma

A

CT
Abdominal ultrasonography

152
Q

Treatment of renal cell carcinoma

A

Surgery
Chemo/radiation therapy

153
Q

What is chlamydia

A

It is a sexually transmitted disease caused by a bacteria chlamydia trachomatis

154
Q

Signs and symptoms of chlamydia

A

Known as “silent” disease as there are usually no symtpoms
Symptoms appear within 1-3 weeks after exposure

Women:
Vaginal discharge
Pain during urination
Heavier periods
Irregular periods
Bleeding between periods
Pain and bleeding during/after sex

Men:
Pain in testicles
Pain during urination
Swelling of the testicles
Burning/itching of urethra

155
Q

Pathophisiology of chlamydia

A

Women: bacteria intially infects the cervix and urethra. then spreads to fallopian tube. chlamydial infection of the cervix can spread to the rectum

156
Q

Complication of chlamydia

A

Women:Pelvic Inflammatory Disease
-Pelvic pain
-Infertility
-Ectopic pregnancy
-5x more likely to get HIV

Arthritis
Skin lesions
Reiter’s syndrome

Premature delivery

157
Q

Treatment for chlamydia

A

Antibiotics: Azithromycin, doxycycline

158
Q

Signs and symptoms of gonorrhea

A

Mostly asymptomatic

Men:
white/green/yellow discharge 1-14 days after infection

Women:
Painful urination
Increased discharge
Bleeding
-can be misdiagnosed as bladder/vaginal infection

159
Q

Complications of gonorrhea

A

Women:
Can spread to infect the fallopian tubes/uterus
Causes pelvic inflammatory disease -> can result in infertility/ectopic pregnancy

Men:
Infertility

160
Q

Pathophisiology of gonorrhoea

A

Gonorrhoea can spread through the blood via bacteria Neisseria gonorrhoeae

Disseminated Gonococcal Infection (DGI)
-can be life threatening
-causes arthritis
-other forms of inflammation

161
Q

Diagnosis of gonorrhoea

A

culturiong a swab specifen in lab
testing swab specimen using nucleic acid amplification testing

162
Q

Treatment for gonorrhoea

A

Antibiotics

163
Q

What is syphilis

A

Syphilis is a bacterial infection which spread by sexual contact
Sexually transmitted disease
Infection is caused by Treponema pallidum

164
Q

Stages of syphilis

A

Primary Stage (3-90 days after infection): stores at original site of infection
Secondary Stage (4-10 weeks after infection)
Latent stage
Tertiary Stage

165
Q

Signs and symptoms of syphilis

A

Primary: sores on/around genitals, around anus/rectum, or in and around mouth
Secondary: Skin rash, swollen lymph nodes, fever
Latent stage: no symptoms
Tertiary: development of granulomatous lesions (gummas) in the liver, onset of cardiovascular lesions, characterised by degenerative changes in nervous system

Sandra Phase 2a (17 decks)

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