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Phase 2a > Renal/GU > Flashcards

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

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2
Q

how often is the bladder in storage phase

A

98% of the time

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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

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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

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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

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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
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7
Q

what is the functional capacity of the bladder

A

around 400ml

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8
Q

what is urgency associated incontinence

A

incontinence associated with an urgent desire to void

presents with nocturia, urgency and frequency

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9
Q

what are the symptoms of LUT storage issues

A 
FUND
Frequency
Urgency
Nocturia
Dysuria

incontinence

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10
Q

what are the symptoms of LUT voiding issues

A 
SHIPP
Straining
Hesitancy
Incomplete emptying
Poor/intermittent stream
Post-micturition dribble
Dribbling
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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

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12
Q

what is benign prostatic enlargment

A

enlargement of the prostate on DRE

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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

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14
Q

what is used in spontaneous acute urine retention to prevent recurrence

A

alpha blockers

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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

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16
Q

what is obstructive uropathy

A

blockage of urine flow
residual volume up to 4L
treated with TURP/long term catheter

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17
Q

what is overflow incontinence

A

bladder overfills = leakage

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18
Q

what is continuous incontinence

A

continual leakage

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19
Q

what is social incontinence

A

those with dementia = dont know when appropriate

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20
Q

what is mixed incontinence

A

stress and urgency mixed incontinence

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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

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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

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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
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24
Q

what is spastic (reflex) bladder

A

usually when injury above T12

not know when or if bladder will empty

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25
Q

what is the effect of raised bladder pressure

A

prolonged detrusor contraction and loss of compliance

= problems with urine drainage from kidneys = hydronephrosis and renal failure

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26
Q

name 3 managements for paraplegic bladder

A

suprapubic catheter
conveen (bag on leg)
convert bladder to safe bladder then empty regularly using ISC

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27
Q

what is ISC

A

intermittent self catheterisation

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28
Q

what are the bladder problems in MS

A

overactive bladder syndrome = incontinence and frequency caused by detrusor overactivity
incomplete bladder emptying

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29
Q

what type of cancer is prostate cancer

A

adenocarcinoma

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30
Q

what type of cancer is bladder cancer

A

90% transitional cell carcinoma

5% squamous cell carcinoma

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31
Q

what type of cancer is renal cancer

A

90% renal cell carcinoma

10% transitional cell carcinoma

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32
Q

what type of cancer is testicular cancer

A

germ cell tumour

seminoma / non-seminoma

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33
Q

what is an epididymal cyst

A

a cyst on the epididymis which contains free fluid

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34
Q

how do epididymal cysts present

A

lump felt separate to testicle

= transiluminesent

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35
Q

how are epididymal cysts treated

A 
small = no treatment
large/painful = surgical drainage/removal
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36
Q

what is a hydrocele

A

accumulation of serous fluid around the testicle

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37
Q

how do hydrocele present

A

bulge in groin
scrotal enlargment
pain = if expand too quick

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38
Q

how are hydrocele treated

A

most dont require treatment
some remove through surgery
aspiration

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39
Q

what is a varicocele

A

abnormal enlargement of the pampiniform venus plexus (veins) in the scrotum
described as bag of worms

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40
Q

how is a varicocele treated

A

surgery

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41
Q

what is testicular torsion

A

twisting of spermatic cord = cuts off blood supply

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42
Q

how does testicular torsion present

A 
testicular/groin/lower abdo pain sudden onset
nausea/vomiting
testicle lie higher than usual
warmth/redness
dysuria
polyuria
absent cremasteric reflex
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43
Q

what is the cremasteric reflex

A

superficial reflex = stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal

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44
Q

how is testicular torsion treated

A

surgical correction ASAP

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45
Q

name 5 functions of the kidney

A 
filtration
reabsorption
blood pressure homeostasis
vitamin D activation
erythropoietin production
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46
Q

what is GFR

A

glomerular filtration rate = rate kidneys filter blood

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47
Q

what is creatinine

A

product of muscle breakdown

freely excreted by kidneys

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48
Q

name 5 things that cause changes in blood creatinine

A
  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
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49
Q

what is nephritic syndrome

A 
classic triad of:
haematuria
proteinura
oligouria
proteinure but less than nephrotic
(azotaemia = increased blood urea and creatinine)
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50
Q

what is nephrotic syndrome

A 
classic pentad of:
oedema
proteinuria
hypoalbuminaemia
(hyperlipidaemia)
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51
Q

what is the important side effect to know for cyclophosphamide

A

can cause infertility in males and females

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52
Q

what is erectile dysfunction

A

persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

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53
Q

what is priaprism

A

erection lasting more than 4 hours

needs aspirating

54
Q

what drugs cause an increase in creatinine in the blood

A 
trimethoprim = antibiotic
cimetidine = stomach ulcer Tx
ritonavir = antiretroviral
55
Q

what can a urine albumin of more than 300mg indicate

A

nephrotic disease

56
Q

what can a urine albumin of more than 3g indicate

A

development of nephrotic syndrome

57
Q

what is erythropoietin

A

produced by kidneys

cause RBC to mature in the bone marrow

58
Q

what is fanconi syndrome

A

= inadequate resorption of PCT
caused by PCT damage
increase Phosphate, Na, glucose, amino acids in urine due to decreased reabsorption

59
Q

what can a lack of phosphate cause

A

osteomalacia

rickets

60
Q

what can cause Fanconi syndrome

A 
tenofovir
cystinosis
paraprotein disease
Wilson's disease
glycogen storage disease
61
Q

how is volume/fluid status assessed

A

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
Q

name 3 causes of dehydration

A

diarrhoea
vomiting
infection

63
Q

what is a typical GFR

A

120ml/min = 7.2L/hr = 170L/day

= 20% of CO

64
Q

describe the stages of CKD

A 
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
Q

what is the key thing that controls blood volume

A

sodium

66
Q

how can NSAIDs and ARB/ACEi cause a fall in GFR

A

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
Q

describe the action of calcitriol (activated vitamin D)

A

increase calcium and phosphate absorption from the gut
suppress PTH
deficiency causes secondary hyperparathyroidism

68
Q

what is renal anaemia

A

erythropoietin deficiency leads to reduced haemopoiesis and anaemia
occurs in advanced kidney disease

69
Q

explain the albumin creatinine ratio

A

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
Q

what is CKD

A

gradual loss of kidney function over time

characterised by a decrease in GFR over time

71
Q

what are the stages of albuminuria in CKD

A 
A1 = <30mg/24h
A2 = 30-300mg/24h
A3 = >300mg/24h
72
Q

what are the complications of CKD

A

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
Q

why does anaemia occur in CKD

A

reduced kidney function = reduced EPO secretion
reduced kidney function = hepcidin buildup = reduced iron absorption = iron deficiency
iron def + reduced EPO = anaemia

74
Q

what drugs should be stopped in unwell CKD patients

A 
ACEi
ARB
diuretics
metformin
NSAIDs
75
Q

what is acute kidney injury

A

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
Q

what are the risk factors for AKI

A

increasing age
comorbidities
nephrotoxic drugs
low water consumption

77
Q

name the pre-renal causes of AKI

A

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
Q

name the renal causes of AKI

A

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
Q

name the post-renal causes of AKI

A

BASICALLY anything that fucks with things leaving the kidney

  1. obstruction = stones/tumour
  2. benign prostatic hypertrophy/enlargment
  3. urethra stricture
80
Q

what is an important complication of AKI and how does it present

A

hyperkalaemia
normal Ka 3.5-5mEq/L
metabolic acidosis + reduced kidney function

81
Q

what are the ECG features of hyperkalaemia

A

tachycardia
tall tented T waves
long PR interval
wide QRS complex

82
Q

name an alpha blocker used to treat BPH

A

tamulosin

83
Q

name a 5 alpha reductase inhibitor used to treat BPH and what does it do

A

finasteride

inhibit conversion of testosterone to dihydrotestosterone

84
Q

what are the side effects of alpha blockers used to treat BPH

A

postural hypotension
dizzy
headaches

85
Q

what are the side effects of 5 alpha reductase inhibitors

A

low libido
erectile dysfunction
retrograde ejaculation

86
Q

how long do alpha blockers take to work

A

will be reviewed 4-6 weeks

87
Q

how long do 5 alpha reductase inhibitors take to work

A

6-12 months before see effect

88
Q

what are urinary stones

A

stones that form within the renal tract

89
Q

what are urinary stones made of

A 
most = crystals of normal urinary constituents
80% calcium based = oxalate, phosphate
10% uric acid
5-10% struvite = infection stones
1% cystine = congenital
90
Q

where do urinary stones occur

A

anywhere from collecting ducts to external urethral meatus
upper tract = renal, ureteric
lower tract = bladder stones, prostatic stones, urethral stones

91
Q

how can urinary stones be prevented

A

overhydration
low sodium diet
BMI reduction/weight loss
healthy dairy/protein intake

92
Q

how can cysteine stones in particular be prevented

A

urine alkylation or captopril and penicillamine = cysteine binders

93
Q

how can uric acid stones in particular be prevented

A

deacidification of urine to pH7-7.5

94
Q

what are randall’s plaques

A

calcium oxalate precipitates form in basement membrane of loops of henle = plaques in the renal papillae

95
Q

what are urinary tract infections

A

combination of symptoms and presence of microorganism in the urinary tract

96
Q

how are UTIs classified

A

asymptomatic bacteriuria
uncomplicated
complicated

97
Q

describe asymptomatic bacteriuria

A

usually in over 65, not treated if over 65

usually women

98
Q

describe uncomplicated UTI

A

must be in lower urinary tract and in non-pregnant woman

99
Q

describe a complicated UTI

A 
any UTI in:
men
child 
pregnant
catheter
recurrent
immunocompromised
in structurally abnormal urinary tract
100
Q

name the most common gram +ve UTI causative organisms

A

staphylococcus saprophyticus
staphylococcus aureus
enterococci

101
Q

name the most common grame -ve UTI causative organisms

A

E.coli
klebsiella
Pseudomonas aruginosa
proteus

102
Q

name the most common UTI causative STI

A

C. trachomatis

N. gonorrhoea

103
Q

describe the treatment of breast cancer

A

no spread = remove tumour/mastectomy
axillary nodes affected = remove axillary nodes
metastases = chemo/radiotherapy

104
Q

describe adjuvant therapy for breast cancer

A

extra Tx after surgery, tries to remove micro-mets:
radiotherapy to breast
anti-oestrogen therapy (tamoxifen)

105
Q

patient with symptoms of urinary tract stones - what is the immediate diagnosis

A

abdominal aortic aneurysm until proven otherwise

106
Q

what are the 3 requirements for AKI (only need 1 out of 3)

A
  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
Q

what can be an effect of renal cancer

A 
kidney secretes:
EPO
ACTH
PTH
renin
108
Q

what is the diagnostic tool in bladder cancer

A

flexible cytoscopy

109
Q

what are the tumour markers for testicular cancer

A

a-FP (alpha feto-protein)

B-hCG

110
Q

where does prostate cancer metastasis to

A 
BLBL
bone
lung
liver
brain
111
Q

describe prostatitis

A

inflammation of prostate gland = 50% men
e.coli/proteus/klebsiella UTI
treated with ciprofloxacin (1) then trimethoprim (2)

112
Q

describe the presentation and diagnosis of prostatitis

A 
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
Q

describe urethritis

A

inflammation of urethra caused by chlamydia or gonorrhoea
chlamydia = Tx azithromycin
gonorrhoea = Tx ceftriaxone and azithromycin

114
Q

describe the presentation and diagnosis of urethritis

A

dysuria
hesitancy
urethral discharge
urethral smear/urinalysis/STI screening

115
Q

describe pyelonephritis

A

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
Q

describe epididymo-orchitis

A

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
Q

what is the management of epididymo-orchiditis

A

pain relief and no sex
antibiotics if STI = ceftriaxone and doxycycline
antibiotics if other = ofloxacin and ciprofloxacin

118
Q

what are the 3 main complications of chlamydia

A
  1. pelvic inflammatory disease in females = chronic pain/infertility
  2. epididymo-orchiditis in males
  3. reactive arthritis
119
Q

what symptom is syphilis until proven otherwise

A

painless ulcer on genitals

120
Q

what is the medical name for viagra and what are its side effects

A 
phosphodiesterase inhibitor (sildenafil)
headache/dizzy/flushing/dyspepsia
121
Q

what is the treatment for hyperkalaemia

A

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
Q

what is trimethoprim contraindicated for/YOU SHOULD NOT GIVE IT IN

A

pregnancy

123
Q

what are the 2 different forms of polycycstic kidney disease

A

autosomal dominant = more common/present after 20s

autosomal recessive = present any time

124
Q

what is the most common cause of nephritic syndrome

A

IgA nephropathy = most common

post-strep glomerulonephritis
anti-GBM (goodpastures)
SLE

125
Q

what is the most common cause of nephrotic syndrome

A

membranous nephropathy
focal segmental glomerulosclerosis
minimal change disease = most common for child

126
Q

nephritic syndrome Tx vs nephrotic syndrome Tx

A

BOTH
= treat underlying cause
= ACEi/ARB to reduce proteinuria/improve renal function
= corticosteroids
nephrOtic = diuretics/fluid salt restriction to reduce oedema

127
Q

what are the complications of nephrotic syndrome

A
  1. thromboembolism
  2. infection
  3. hyperlipidaemia
128
Q

where are the most common sites for urinary stones to get stuck and what is the gold standard for diagnosis

A
  1. pelvic-ureteric junction
  2. pelvic brim
  3. vesico-uteric junction
    non-contact CT KUB = gold!!!
129
Q

a testicular lump is WHAT until proven otherwise

A

cancer!

130
Q

describe the treatment for prostate cancer

A 
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
Q

why is chlamydia more diagnosed in women

A

more common in women 16-25

they notice changes in menstruation

Phase 2a (15 decks)

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