Renal/GU Flashcards
1
Q
describe the nervous control of the bladder
A
parasympathetic = pelvic nerve = S2-S4
sympathetic = hypogastric plexus = T11-L2
somatic nerves = pudendal nerve = S2-S4
afferent pelvic nerve = sensory
2
Q
how often is the bladder in storage phase
A
98% of the time
3
Q
describe the storage phase of the bladder
A
= receptive relaxation
sympathetic stimulation = hypogastric plexus T11-L2 = detrusor relaxation
somatic stimulation = pudendal nerve S2-S4 = external sphincter contraction
4
Q
describe the voiding phase of the bladder
A
= voluntary control from cortex and PMC
parasympathetic stimulation = pelvic nerve S2-S4
somatic = pudendal nerve relaxation S2-S4 = external sphincter relaxation
5
Q
what is the guarding reflex
A
occurs in anatomically and functionally normal adults
sympathetic nerve stimulation (hypogastric plexus) = relax detrusor
pudendal nerve stimulation = external sphincter contraction
6
Q
what is the normal daily and nightly volume and frequency of micturition
A
day = less than 2.7L, 2-8 times a day night = less than 900mls, 0-1 time per night
7
Q
what is the functional capacity of the bladder
A
around 400ml
8
Q
what is urgency associated incontinence
A
incontinence associated with an urgent desire to void
presents with nocturia, urgency and frequency
9
Q
what are the symptoms of LUT storage issues
A
FUND Frequency Urgency Nocturia Dysuria
incontinence
10
Q
what are the symptoms of LUT voiding issues
A
SHIPP Straining Hesitancy Incomplete emptying Poor/intermittent stream Post-micturition dribble Dribbling
11
Q
what is benign prostatic hyperplasia
A
histological finding of increased epithelial and stromal cell numbers in periureteral area of prostate = may be due to increase in cell number and decrease in apoptosis
= androgens related
12
Q
what is benign prostatic enlargment
A
enlargement of the prostate on DRE
13
Q
describe acute urine retention
A
painful, relieved by catheterisation
typically 600ml - 1L urine present
if precipitated by something = one off
if spontaneous = likely to reoccur
14
Q
what is used in spontaneous acute urine retention to prevent recurrence
A
alpha blockers
15
Q
describe chronic urine retention
A
caused by incomplete bladder emptying over time
usually asymptomatic/no pain
increased risk infection, stones, obstructive uropathy
can be low pressure = detrusor failure to contract
can be high pressure = obstructive uropathy
16
Q
what is obstructive uropathy
A
blockage of urine flow
residual volume up to 4L
treated with TURP/long term catheter
17
Q
what is overflow incontinence
A
bladder overfills = leakage
18
Q
what is continuous incontinence
A
continual leakage
19
Q
what is social incontinence
A
those with dementia = dont know when appropriate
20
Q
what is mixed incontinence
A
stress and urgency mixed incontinence
21
Q
describe the effect of a higher spinal cord injury on urinary function
A
detrusor muscle + ext. sphincter = too tight and spastic, loss of coord between them and contract at same time
= leaking and incontinence
= reflux = kidney damage
22
Q
describe the effect of a lower spinal cord injury on urinary function
A
detrusor and sphincter fail to contract = leakage/incontinence = flaccid bladder
= stress incontinence
23
Q
what is autonomic dysreflexia
A
lesion above T6 overstimulation of sympathetic nerves below lesion in repsonse to noxious stimuli = uncontrolled severe hypertension = severe headache seizures/stroke/AKI/death
24
Q
what is spastic (reflex) bladder
A
usually when injury above T12
not know when or if bladder will empty
25
what is the effect of raised bladder pressure
prolonged detrusor contraction and loss of compliance
| = problems with urine drainage from kidneys = hydronephrosis and renal failure
26
name 3 managements for paraplegic bladder
suprapubic catheter
conveen (bag on leg)
convert bladder to safe bladder then empty regularly using ISC
27
what is ISC
intermittent self catheterisation
28
what are the bladder problems in MS
overactive bladder syndrome = incontinence and frequency caused by detrusor overactivity
incomplete bladder emptying
29
what type of cancer is prostate cancer
adenocarcinoma
30
what type of cancer is bladder cancer
90% transitional cell carcinoma
| 5% squamous cell carcinoma
31
what type of cancer is renal cancer
90% renal cell carcinoma
| 10% transitional cell carcinoma
32
what type of cancer is testicular cancer
germ cell tumour
| seminoma / non-seminoma
33
what is an epididymal cyst
a cyst on the epididymis which contains free fluid
34
how do epididymal cysts present
lump felt separate to testicle
| = transiluminesent
35
how are epididymal cysts treated
```
small = no treatment
large/painful = surgical drainage/removal
```
36
what is a hydrocele
accumulation of serous fluid around the testicle
37
how do hydrocele present
bulge in groin
scrotal enlargment
pain = if expand too quick
38
how are hydrocele treated
most dont require treatment
some remove through surgery
aspiration
39
what is a varicocele
abnormal enlargement of the pampiniform venus plexus (veins) in the scrotum
described as bag of worms
40
how is a varicocele treated
surgery
41
what is testicular torsion
twisting of spermatic cord = cuts off blood supply
42
how does testicular torsion present
```
testicular/groin/lower abdo pain sudden onset
nausea/vomiting
testicle lie higher than usual
warmth/redness
dysuria
polyuria
absent cremasteric reflex
```
43
what is the cremasteric reflex
superficial reflex = stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal
44
how is testicular torsion treated
surgical correction ASAP
45
name 5 functions of the kidney
```
filtration
reabsorption
blood pressure homeostasis
vitamin D activation
erythropoietin production
```
46
what is GFR
glomerular filtration rate = rate kidneys filter blood
47
what is creatinine
product of muscle breakdown
| freely excreted by kidneys
48
name 5 things that cause changes in blood creatinine
1. increased muscle mass = increased Cr
2. cachexia = muscle wasting = increased Cr
3. amputation = decrease Cr less muscle
4. kidney disease = filtration/excretion issues
5. trimethoprim/cimetidine/ritonavir = increase Cr
49
what is nephritic syndrome
```
classic triad of:
haematuria
proteinura
oligouria
proteinure but less than nephrotic
(azotaemia = increased blood urea and creatinine)
```
50
what is nephrotic syndrome
```
classic pentad of:
oedema
proteinuria
hypoalbuminaemia
(hyperlipidaemia)
```
51
what is the important side effect to know for cyclophosphamide
can cause infertility in males and females
52
what is erectile dysfunction
persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
53
what is priaprism
erection lasting more than 4 hours
| needs aspirating
54
what drugs cause an increase in creatinine in the blood
```
trimethoprim = antibiotic
cimetidine = stomach ulcer Tx
ritonavir = antiretroviral
```
55
what can a urine albumin of more than 300mg indicate
nephrotic disease
56
what can a urine albumin of more than 3g indicate
development of nephrotic syndrome
57
what is erythropoietin
produced by kidneys
| cause RBC to mature in the bone marrow
58
what is fanconi syndrome
= inadequate resorption of PCT
caused by PCT damage
increase Phosphate, Na, glucose, amino acids in urine due to decreased reabsorption
59
what can a lack of phosphate cause
osteomalacia
| rickets
60
what can cause Fanconi syndrome
```
tenofovir
cystinosis
paraprotein disease
Wilson's disease
glycogen storage disease
```
61
how is volume/fluid status assessed
urine output = catheter
blood pressure
skin turgor = pinch forehead
jugular venous pressure = lie patient 45 degrees, flickering of neck
oedema = check ankles and front of shins
fluid in lungs = crackling at base with stethoscope
capillary refill time
62
name 3 causes of dehydration
diarrhoea
vomiting
infection
63
what is a typical GFR
120ml/min = 7.2L/hr = 170L/day
| = 20% of CO
64
describe the stages of CKD
```
1 = eGFR =90 with signs of kidney damage
2 = eGFR 60-89mil/min with signs of kidney damage
3a = eGFR 45-59ml/min
3b = eGFR 30-45ml/min
4 = eGFR 15-29mil/min
5 = eGFR <15 complete loss of function
```
65
what is the key thing that controls blood volume
sodium
66
how can NSAIDs and ARB/ACEi cause a fall in GFR
NSAIDs = block prostaglandins that cause vasodiltation in afferent arteriole = vasoconstriction = less blood gets to glomerulus
ACEi/ARB = blocks angiotensin 2 from vasoconstricting efferent arteriole = dilation = reduces resistance of glomerular outflow
= less filtration as glomerular blood pressure is low
67
describe the action of calcitriol (activated vitamin D)
increase calcium and phosphate absorption from the gut
suppress PTH
deficiency causes secondary hyperparathyroidism
68
what is renal anaemia
erythropoietin deficiency leads to reduced haemopoiesis and anaemia
occurs in advanced kidney disease
69
explain the albumin creatinine ratio
albumin in urine can be concentrated or dilute depending on urine volume
creatinine is excreted in the urine at a constant rate
therefore ratio of albumin to Cr should be constant irrespective of volume
70
what is CKD
gradual loss of kidney function over time
| characterised by a decrease in GFR over time
71
what are the stages of albuminuria in CKD
```
A1 = <30mg/24h
A2 = 30-300mg/24h
A3 = >300mg/24h
```
72
what are the complications of CKD
reduced EPO production and blood loss = normochromic normocytic anaemia
reduced calcitriol production = decresed serum Ca conc = compensatory PTH increase = skeletal decalcification/metabolic bone disease
acid base disorders
uremic symptoms
73
why does anaemia occur in CKD
reduced kidney function = reduced EPO secretion
reduced kidney function = hepcidin buildup = reduced iron absorption = iron deficiency
iron def + reduced EPO = anaemia
74
what drugs should be stopped in unwell CKD patients
```
ACEi
ARB
diuretics
metformin
NSAIDs
```
75
what is acute kidney injury
kidneys fail over short period of time
characterised by rapid fall in GFR and increase in creatinine/urea
may be reversible
can occur even if kidneys have been removed
76
what are the risk factors for AKI
increasing age
comorbidities
nephrotoxic drugs
low water consumption
77
name the pre-renal causes of AKI
BASICALLY anything that fucks with things entering the kidney
1. hypovolaemia = dehydration/vomiting
2. shock = sepsis/cardiogenic
3. hypoperfusion = renal vein thrombosis/ACEi
4. conditions with oedema = HF/nephrotic syndrome
78
name the renal causes of AKI
BASICALLY anything that fucks with the kidney
1. glomerulonephritis
2. vasculitis
3. SLE
4. vascular lesions
5. acute tubular necrosis (gentamycin/ACEi etc)
6. multiple myeloma
79
name the post-renal causes of AKI
BASICALLY anything that fucks with things leaving the kidney
1. obstruction = stones/tumour
2. benign prostatic hypertrophy/enlargment
3. urethra stricture
80
what is an important complication of AKI and how does it present
hyperkalaemia
normal Ka 3.5-5mEq/L
metabolic acidosis + reduced kidney function
81
what are the ECG features of hyperkalaemia
tachycardia
tall tented T waves
long PR interval
wide QRS complex
82
name an alpha blocker used to treat BPH
tamulosin
83
name a 5 alpha reductase inhibitor used to treat BPH and what does it do
finasteride
| inhibit conversion of testosterone to dihydrotestosterone
84
what are the side effects of alpha blockers used to treat BPH
postural hypotension
dizzy
headaches
85
what are the side effects of 5 alpha reductase inhibitors
low libido
erectile dysfunction
retrograde ejaculation
86
how long do alpha blockers take to work
will be reviewed 4-6 weeks
87
how long do 5 alpha reductase inhibitors take to work
6-12 months before see effect
88
what are urinary stones
stones that form within the renal tract
89
what are urinary stones made of
```
most = crystals of normal urinary constituents
80% calcium based = oxalate, phosphate
10% uric acid
5-10% struvite = infection stones
1% cystine = congenital
```
90
where do urinary stones occur
anywhere from collecting ducts to external urethral meatus
upper tract = renal, ureteric
lower tract = bladder stones, prostatic stones, urethral stones
91
how can urinary stones be prevented
overhydration
low sodium diet
BMI reduction/weight loss
healthy dairy/protein intake
92
how can cysteine stones in particular be prevented
urine alkylation or captopril and penicillamine = cysteine binders
93
how can uric acid stones in particular be prevented
deacidification of urine to pH7-7.5
94
what are randall's plaques
calcium oxalate precipitates form in basement membrane of loops of henle = plaques in the renal papillae
95
what are urinary tract infections
combination of symptoms and presence of microorganism in the urinary tract
96
how are UTIs classified
asymptomatic bacteriuria
uncomplicated
complicated
97
describe asymptomatic bacteriuria
usually in over 65, not treated if over 65
| usually women
98
describe uncomplicated UTI
must be in lower urinary tract and in non-pregnant woman
99
describe a complicated UTI
```
any UTI in:
men
child
pregnant
catheter
recurrent
immunocompromised
in structurally abnormal urinary tract
```
100
name the most common gram +ve UTI causative organisms
staphylococcus saprophyticus
staphylococcus aureus
enterococci
101
name the most common grame -ve UTI causative organisms
E.coli
klebsiella
Pseudomonas aruginosa
proteus
102
name the most common UTI causative STI
C. trachomatis
| N. gonorrhoea
103
describe the treatment of breast cancer
no spread = remove tumour/mastectomy
axillary nodes affected = remove axillary nodes
metastases = chemo/radiotherapy
104
describe adjuvant therapy for breast cancer
extra Tx after surgery, tries to remove micro-mets:
radiotherapy to breast
anti-oestrogen therapy (tamoxifen)
105
patient with symptoms of urinary tract stones - what is the immediate diagnosis
abdominal aortic aneurysm until proven otherwise
106
what are the 3 requirements for AKI (only need 1 out of 3)
1. rise in Cr above 26micromols/L in 48hr
2. rise in Cr above 50% of initial in past 7 days/48hr
3. urine output less than 0.5ml/kg body weight in more than 6 hrs
107
what can be an effect of renal cancer
```
kidney secretes:
EPO
ACTH
PTH
renin
```
108
what is the diagnostic tool in bladder cancer
flexible cytoscopy
109
what are the tumour markers for testicular cancer
a-FP (alpha feto-protein)
| B-hCG
110
where does prostate cancer metastasis to
```
BLBL
bone
lung
liver
brain
```
111
describe prostatitis
inflammation of prostate gland = 50% men
e.coli/proteus/klebsiella UTI
treated with ciprofloxacin (1) then trimethoprim (2)
112
describe the presentation and diagnosis of prostatitis
```
acute = fever/malaise/voiding LUTS/pelvic to anal pain
chronic = recurrent UTI/voiding LUTS/pelvic to anal pain over 3 months
DRE = boggy, tender prostate
Microbio = pathogens in blood and urine
```
113
describe urethritis
inflammation of urethra caused by chlamydia or gonorrhoea
chlamydia = Tx azithromycin
gonorrhoea = Tx ceftriaxone and azithromycin
114
describe the presentation and diagnosis of urethritis
dysuria
hesitancy
urethral discharge
urethral smear/urinalysis/STI screening
115
describe pyelonephritis
infection/inflammation of renal pelvis caused by e.coli/klebsiella/proteus/s.aureus/candida
TRIAD: LOIN PAIN/FEVER/PYURIA
mid-stream urine = cloudy/foul smelling
treated with cefalexin or co-amoxiclav
prolonged infection can cause renal abscess needs draining
116
describe epididymo-orchitis
inflammation of epididymis caused by gonorrhoa/chlamydia or e.coli/enterococci/mumps
causes unilateral scrotal pain, swelling and discharge and fever
urethral smear and dipstick needed + STI screening
117
what is the management of epididymo-orchiditis
pain relief and no sex
antibiotics if STI = ceftriaxone and doxycycline
antibiotics if other = ofloxacin and ciprofloxacin
118
what are the 3 main complications of chlamydia
1. pelvic inflammatory disease in females = chronic pain/infertility
2. epididymo-orchiditis in males
3. reactive arthritis
119
what symptom is syphilis until proven otherwise
painless ulcer on genitals
120
what is the medical name for viagra and what are its side effects
```
phosphodiesterase inhibitor (sildenafil)
headache/dizzy/flushing/dyspepsia
```
121
what is the treatment for hyperkalaemia
10ml 10% calcium gluconate = 3-5 min changes
insulin-dextrose = 30-60 min change
dextrose must be given at same time as insulin to prevent hypoglycaemia due to very rapid uptake of glucose into cells
122
what is trimethoprim contraindicated for/YOU SHOULD NOT GIVE IT IN
pregnancy
123
what are the 2 different forms of polycycstic kidney disease
autosomal dominant = more common/present after 20s
| autosomal recessive = present any time
124
what is the most common cause of nephritic syndrome
IgA nephropathy = most common
post-strep glomerulonephritis
anti-GBM (goodpastures)
SLE
125
what is the most common cause of nephrotic syndrome
membranous nephropathy
focal segmental glomerulosclerosis
minimal change disease = most common for child
126
nephritic syndrome Tx vs nephrotic syndrome Tx
BOTH
= treat underlying cause
= ACEi/ARB to reduce proteinuria/improve renal function
= corticosteroids
nephrOtic = diuretics/fluid salt restriction to reduce oedema
127
what are the complications of nephrotic syndrome
1. thromboembolism
2. infection
3. hyperlipidaemia
128
where are the most common sites for urinary stones to get stuck and what is the gold standard for diagnosis
1. pelvic-ureteric junction
2. pelvic brim
3. vesico-uteric junction
non-contact CT KUB = gold!!!
129
a testicular lump is WHAT until proven otherwise
cancer!
130
describe the treatment for prostate cancer
```
localised:
1. w+w
2. active surveillance
3. radical prostectomy
4. external beam radiotherapy
5. hormone therapy
locally advanced:
3. radical prostectomy
4. external beam radiation
5. hormone therapy
6. chemo/radio/palliative
```
131
why is chlamydia more diagnosed in women
more common in women 16-25
| they notice changes in menstruation
