Renal/GU Flashcards
describe the nervous control of the bladder
parasympathetic = pelvic nerve = S2-S4
sympathetic = hypogastric plexus = T11-L2
somatic nerves = pudendal nerve = S2-S4
afferent pelvic nerve = sensory
how often is the bladder in storage phase
98% of the time
describe the storage phase of the bladder
= receptive relaxation
sympathetic stimulation = hypogastric plexus T11-L2 = detrusor relaxation
somatic stimulation = pudendal nerve S2-S4 = external sphincter contraction
describe the voiding phase of the bladder
= voluntary control from cortex and PMC
parasympathetic stimulation = pelvic nerve S2-S4
somatic = pudendal nerve relaxation S2-S4 = external sphincter relaxation
what is the guarding reflex
occurs in anatomically and functionally normal adults
sympathetic nerve stimulation (hypogastric plexus) = relax detrusor
pudendal nerve stimulation = external sphincter contraction
what is the normal daily and nightly volume and frequency of micturition
day = less than 2.7L, 2-8 times a day night = less than 900mls, 0-1 time per night
what is the functional capacity of the bladder
around 400ml
what is urgency associated incontinence
incontinence associated with an urgent desire to void
presents with nocturia, urgency and frequency
what are the symptoms of LUT storage issues
FUND Frequency Urgency Nocturia Dysuria
incontinence
what are the symptoms of LUT voiding issues
SHIPP Straining Hesitancy Incomplete emptying Poor/intermittent stream Post-micturition dribble Dribbling
what is benign prostatic hyperplasia
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
what is benign prostatic enlargment
enlargement of the prostate on DRE
describe acute urine retention
painful, relieved by catheterisation
typically 600ml - 1L urine present
if precipitated by something = one off
if spontaneous = likely to reoccur
what is used in spontaneous acute urine retention to prevent recurrence
alpha blockers
describe chronic urine retention
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
what is obstructive uropathy
blockage of urine flow
residual volume up to 4L
treated with TURP/long term catheter
what is overflow incontinence
bladder overfills = leakage
what is continuous incontinence
continual leakage
what is social incontinence
those with dementia = dont know when appropriate
what is mixed incontinence
stress and urgency mixed incontinence
describe the effect of a higher spinal cord injury on urinary function
detrusor muscle + ext. sphincter = too tight and spastic, loss of coord between them and contract at same time
= leaking and incontinence
= reflux = kidney damage
describe the effect of a lower spinal cord injury on urinary function
detrusor and sphincter fail to contract = leakage/incontinence = flaccid bladder
= stress incontinence
what is autonomic dysreflexia
lesion above T6 overstimulation of sympathetic nerves below lesion in repsonse to noxious stimuli = uncontrolled severe hypertension = severe headache seizures/stroke/AKI/death
what is spastic (reflex) bladder
usually when injury above T12
not know when or if bladder will empty
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
name 3 managements for paraplegic bladder
suprapubic catheter
conveen (bag on leg)
convert bladder to safe bladder then empty regularly using ISC
what is ISC
intermittent self catheterisation
what are the bladder problems in MS
overactive bladder syndrome = incontinence and frequency caused by detrusor overactivity
incomplete bladder emptying
what type of cancer is prostate cancer
adenocarcinoma
what type of cancer is bladder cancer
90% transitional cell carcinoma
5% squamous cell carcinoma
what type of cancer is renal cancer
90% renal cell carcinoma
10% transitional cell carcinoma
what type of cancer is testicular cancer
germ cell tumour
seminoma / non-seminoma
what is an epididymal cyst
a cyst on the epididymis which contains free fluid
how do epididymal cysts present
lump felt separate to testicle
= transiluminesent
how are epididymal cysts treated
small = no treatment large/painful = surgical drainage/removal
what is a hydrocele
accumulation of serous fluid around the testicle
how do hydrocele present
bulge in groin
scrotal enlargment
pain = if expand too quick
how are hydrocele treated
most dont require treatment
some remove through surgery
aspiration
what is a varicocele
abnormal enlargement of the pampiniform venus plexus (veins) in the scrotum
described as bag of worms
how is a varicocele treated
surgery
what is testicular torsion
twisting of spermatic cord = cuts off blood supply
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
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
how is testicular torsion treated
surgical correction ASAP
name 5 functions of the kidney
filtration reabsorption blood pressure homeostasis vitamin D activation erythropoietin production
what is GFR
glomerular filtration rate = rate kidneys filter blood
what is creatinine
product of muscle breakdown
freely excreted by kidneys
name 5 things that cause changes in blood creatinine
- increased muscle mass = increased Cr
- cachexia = muscle wasting = increased Cr
- amputation = decrease Cr less muscle
- kidney disease = filtration/excretion issues
- trimethoprim/cimetidine/ritonavir = increase Cr
what is nephritic syndrome
classic triad of: haematuria proteinura oligouria proteinure but less than nephrotic (azotaemia = increased blood urea and creatinine)
what is nephrotic syndrome
classic pentad of: oedema proteinuria hypoalbuminaemia (hyperlipidaemia)
what is the important side effect to know for cyclophosphamide
can cause infertility in males and females
what is erectile dysfunction
persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
what is priaprism
erection lasting more than 4 hours
needs aspirating
what drugs cause an increase in creatinine in the blood
trimethoprim = antibiotic cimetidine = stomach ulcer Tx ritonavir = antiretroviral
what can a urine albumin of more than 300mg indicate
nephrotic disease
what can a urine albumin of more than 3g indicate
development of nephrotic syndrome
what is erythropoietin
produced by kidneys
cause RBC to mature in the bone marrow
what is fanconi syndrome
= inadequate resorption of PCT
caused by PCT damage
increase Phosphate, Na, glucose, amino acids in urine due to decreased reabsorption
what can a lack of phosphate cause
osteomalacia
rickets
what can cause Fanconi syndrome
tenofovir cystinosis paraprotein disease Wilson's disease glycogen storage disease
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
name 3 causes of dehydration
diarrhoea
vomiting
infection
what is a typical GFR
120ml/min = 7.2L/hr = 170L/day
= 20% of CO
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
what is the key thing that controls blood volume
sodium
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
describe the action of calcitriol (activated vitamin D)
increase calcium and phosphate absorption from the gut
suppress PTH
deficiency causes secondary hyperparathyroidism
what is renal anaemia
erythropoietin deficiency leads to reduced haemopoiesis and anaemia
occurs in advanced kidney disease
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
what is CKD
gradual loss of kidney function over time
characterised by a decrease in GFR over time
what are the stages of albuminuria in CKD
A1 = <30mg/24h A2 = 30-300mg/24h A3 = >300mg/24h
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
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
what drugs should be stopped in unwell CKD patients
ACEi ARB diuretics metformin NSAIDs
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
what are the risk factors for AKI
increasing age
comorbidities
nephrotoxic drugs
low water consumption
name the pre-renal causes of AKI
BASICALLY anything that fucks with things entering the kidney
- hypovolaemia = dehydration/vomiting
- shock = sepsis/cardiogenic
- hypoperfusion = renal vein thrombosis/ACEi
- conditions with oedema = HF/nephrotic syndrome
name the renal causes of AKI
BASICALLY anything that fucks with the kidney
- glomerulonephritis
- vasculitis
- SLE
- vascular lesions
- acute tubular necrosis (gentamycin/ACEi etc)
- multiple myeloma
name the post-renal causes of AKI
BASICALLY anything that fucks with things leaving the kidney
- obstruction = stones/tumour
- benign prostatic hypertrophy/enlargment
- urethra stricture
what is an important complication of AKI and how does it present
hyperkalaemia
normal Ka 3.5-5mEq/L
metabolic acidosis + reduced kidney function
what are the ECG features of hyperkalaemia
tachycardia
tall tented T waves
long PR interval
wide QRS complex
name an alpha blocker used to treat BPH
tamulosin
name a 5 alpha reductase inhibitor used to treat BPH and what does it do
finasteride
inhibit conversion of testosterone to dihydrotestosterone
what are the side effects of alpha blockers used to treat BPH
postural hypotension
dizzy
headaches
what are the side effects of 5 alpha reductase inhibitors
low libido
erectile dysfunction
retrograde ejaculation
how long do alpha blockers take to work
will be reviewed 4-6 weeks
how long do 5 alpha reductase inhibitors take to work
6-12 months before see effect
what are urinary stones
stones that form within the renal tract
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
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
how can urinary stones be prevented
overhydration
low sodium diet
BMI reduction/weight loss
healthy dairy/protein intake
how can cysteine stones in particular be prevented
urine alkylation or captopril and penicillamine = cysteine binders
how can uric acid stones in particular be prevented
deacidification of urine to pH7-7.5
what are randall’s plaques
calcium oxalate precipitates form in basement membrane of loops of henle = plaques in the renal papillae
what are urinary tract infections
combination of symptoms and presence of microorganism in the urinary tract
how are UTIs classified
asymptomatic bacteriuria
uncomplicated
complicated
describe asymptomatic bacteriuria
usually in over 65, not treated if over 65
usually women
describe uncomplicated UTI
must be in lower urinary tract and in non-pregnant woman
describe a complicated UTI
any UTI in: men child pregnant catheter recurrent immunocompromised in structurally abnormal urinary tract
name the most common gram +ve UTI causative organisms
staphylococcus saprophyticus
staphylococcus aureus
enterococci
name the most common grame -ve UTI causative organisms
E.coli
klebsiella
Pseudomonas aruginosa
proteus
name the most common UTI causative STI
C. trachomatis
N. gonorrhoea
describe the treatment of breast cancer
no spread = remove tumour/mastectomy
axillary nodes affected = remove axillary nodes
metastases = chemo/radiotherapy
describe adjuvant therapy for breast cancer
extra Tx after surgery, tries to remove micro-mets:
radiotherapy to breast
anti-oestrogen therapy (tamoxifen)
patient with symptoms of urinary tract stones - what is the immediate diagnosis
abdominal aortic aneurysm until proven otherwise
what are the 3 requirements for AKI (only need 1 out of 3)
- rise in Cr above 26micromols/L in 48hr
- rise in Cr above 50% of initial in past 7 days/48hr
- urine output less than 0.5ml/kg body weight in more than 6 hrs
what can be an effect of renal cancer
kidney secretes: EPO ACTH PTH renin
what is the diagnostic tool in bladder cancer
flexible cytoscopy
what are the tumour markers for testicular cancer
a-FP (alpha feto-protein)
B-hCG
where does prostate cancer metastasis to
BLBL bone lung liver brain
describe prostatitis
inflammation of prostate gland = 50% men
e.coli/proteus/klebsiella UTI
treated with ciprofloxacin (1) then trimethoprim (2)
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
describe urethritis
inflammation of urethra caused by chlamydia or gonorrhoea
chlamydia = Tx azithromycin
gonorrhoea = Tx ceftriaxone and azithromycin
describe the presentation and diagnosis of urethritis
dysuria
hesitancy
urethral discharge
urethral smear/urinalysis/STI screening
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
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
what is the management of epididymo-orchiditis
pain relief and no sex
antibiotics if STI = ceftriaxone and doxycycline
antibiotics if other = ofloxacin and ciprofloxacin
what are the 3 main complications of chlamydia
- pelvic inflammatory disease in females = chronic pain/infertility
- epididymo-orchiditis in males
- reactive arthritis
what symptom is syphilis until proven otherwise
painless ulcer on genitals
what is the medical name for viagra and what are its side effects
phosphodiesterase inhibitor (sildenafil) headache/dizzy/flushing/dyspepsia
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
what is trimethoprim contraindicated for/YOU SHOULD NOT GIVE IT IN
pregnancy
what are the 2 different forms of polycycstic kidney disease
autosomal dominant = more common/present after 20s
autosomal recessive = present any time
what is the most common cause of nephritic syndrome
IgA nephropathy = most common
post-strep glomerulonephritis
anti-GBM (goodpastures)
SLE
what is the most common cause of nephrotic syndrome
membranous nephropathy
focal segmental glomerulosclerosis
minimal change disease = most common for child
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
what are the complications of nephrotic syndrome
- thromboembolism
- infection
- hyperlipidaemia
where are the most common sites for urinary stones to get stuck and what is the gold standard for diagnosis
- pelvic-ureteric junction
- pelvic brim
- vesico-uteric junction
non-contact CT KUB = gold!!!
a testicular lump is WHAT until proven otherwise
cancer!
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
why is chlamydia more diagnosed in women
more common in women 16-25
they notice changes in menstruation
