Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

RENAL FAILURE: Describe the normal functions of the kidneys. Classify renal failure, outlining the pathology of the common diseases that may cause each type.

A

* indicates most common causes

Pre-renal

  • Hypovolaemia: Haemorrhage, dehydration
  • Heart failure
  • Hypertension*/revovascular disease

Renal

  • Congenital abnormality e.g. PCKD*
  • Diabetes*
  • Infection: Glomerulonephritis*
  • Iatrogenic: Medications

Post-renal

  • Renal calculi
  • Iatrogenic: Medications, surgical damage
  • Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ACUTE RENALFAILURE: Describe the clinical features of ARF and the concept and the causes of ARF leading to AKI

A

Clinical features of ARF

  • Reduced urine output (< 0.5 ml/kg/hr)
  • Elevated serum creatinine
  • Elevated serum urea

AKI: Describes an acute reduction in renal function, over a period of hours to days..

Causes:

  • Pre-renal
  • Renal
  • Post-renal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ACUTE RENAL FAILURE: Discuss the associated electrolyte abnormalities and describe the management of life threatening hyperkalaemia.

A

Electrolyte abnormalities:

  • Hyponatraemia
  • Hyperkalaemia
    • Hypomagn
  • Uraemia
  • Elevated creatinine (CrCl)
  • Acidaemia
  • Low bicarbonate
  • Hypocalcaemia

Management of life-threatening hyperkalaemia:

Potassium levels > 6.5 mmol/L or ECG changes

  • Investigations
    • ECG and continuous cardiac monitoring, bloods, ?urine dip
  1. Calcium gluconate: 10mg calcium gluconate 10% slow IV injection over 5-10 minutes. Repeat at 5 minutes if ECG changes still present or at 30 minutes if K+ is still > 6.5 mmol/L. THEN…
  2. Insulin: Actrapid, with dose dependent on CBG. Repeat serum potassium 30 minutes after each insulin infusion. THEN CONSIDER…
  3. Salbutamol: 5-10mg nebulised. If HR is < 130/min
  4. Dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ACUTE RENAL FAILURE: Describe the assessment of a patient with renal failure, including fluid balance

A
  • Look to correct the underlying cause of AKI
    • Check for any life-threatening complications e.g. PE, hyperkalaemia
    • Examination: HR, BP, JVP, CRT, palpate the bladder (?obstruction)
    • Bolus fluid if hypovolaemic
  • Mangement of acidaemia
    • ​ABG
  • Management of hyperkalaemia
    • ​ECG
    • U&Es
  • Management of fluid balance
    • Hypovolaemia: Reduced urine output and BP, non-visible JVP, poor tissue turgor, increased pulse, daily weight loss
    • Hypervolaemia: Increased BP and JVP, lung crepitations, peripheral oedema, gallop rhythm
    • Check urine output: < 0.5 ml/kg/hr for > 6 hours. Insert urinary catheter to allow for monitoring
    • Fluid bolus as required
    • Monitoring fluid status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACUTE RENAL FAILURE: List the most common causes of AKI

A
  1. Sepsis
  2. Major surgery
  3. Cardiogenic shock
  4. Hypovolaemia
  5. Drugs
  6. Hepatorenal syndrome
  7. Obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACUTE RENAL FAILURE: Outline the investigations of a patient with ARF

A
  • ECG: Hyperkalaemia
  • Urine dip: Protein/blood/nitrites.
  • Bloods: FBC, U&Es, LFT (?hepatorenal syndrome), plts, investigations for intrinsic renal disease (Igs, paraprotein, complement, autoantibodies)
  • Renal USS within 24 hours
  • Sepsis screen
  • Review medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACUTE RENAL FAILURE: Outline the principles of treatment

A
  • Manage fluid balance
    • Monitor urine output with urinary catheter, input:output chart
    • Treat hypovolaemia, if required.
  • Manage acidaemia
    • Fluids
  • Manage hyperkalaemia
    • ​See management of hyperkalaemia card
  • Stop nephrotoxic medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ACUTE RENAL FAILURE: Outline the indications for referral for a specialist opinion/renal replacement therapy

A
  • AKI not responding to treatment
  • AKI with complications: Hyperkalaemia, acidosis, fluid overload
  • Stage 3 AKI
  • AKI due to possible intrinsic renal disease
  • AKI with difficult fluid balance (e.g. hypoalbuminaemia, heart failure, pregnancy)
  • AKI with hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CHRONIC KIDNEY DISEASE: Describe the clinical features associated with chronic renal failure

A
  • Fatigue
    • ​May be due to renal anaemia or uraemia
  • Nausea and vomiting
    • Due to accumulation of urea. May experience a metallic taste in the mouth.
  • Pruritis
  • Renal anaemia
  • Renal osteodystrophy
    • ​Bone pain
  • Fluid overload
    • Peripheral and periorbital oedema, elevated JVP, SOB
  • Loss of urinary concentration
    • Nocturia
  • Electrolyte disturbance
    • Ureamia - pruritis, hyperkalaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CHRONIC KIDNEY DISEASE: List the possible physical signs and investigations of a patient with chronic renal failure

A

Physical signs

  • Pallor
  • Evidence of pruritis
  • Peripheral and/or periorbital oedema
  • Signs of fluid overload: Pulmonary crepitations, gallop rhythm
  • SOB
  • Evidence of previous procedure: AV fistula, renal transplant

Investigations

  • Bloods: U&Es, FBC, Ca2+, PO4-, LFTs, eGFR
  • Urinalysis: Protein, blood
  • Urinary albumin
  • Renal US

Identifying the cause: Biopsy (renal), renal USS (post-renal)

*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CHRONIC KIDNEY DISEASE: List and outline the pathology of the common causes of CKD

A
  • Diabetes
  • Hypertension/renovascular disease
  • Congenital abnormalities/disease e.g. PCKD
  • Autoimmune disease
  • Ischaemic heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CHRONIC KIDNEY DISEASE: Describe the assessment of CKD using eGFR and the 5 stages of CKD

A
  • eGFR and albumin excretion rate (AER) or albumin:creatinine ratio (ACR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CHRONIC KIDNEY DISEASE: Describe the morphology and pathological consequences of pyelonephritis, interstitial nephritis, polycystic kidney disease, hypertensive renal damage and obstructive uropathy to the kidney.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CHRONIC KIDNEY DISEASE: Discuss the effect of chronic renal failure on blood and bone based on disturbance of normal renal function.

A

Blood

  • Acidaemia - due to reduced excretion of hydrogen ions
  • Uraemia
  • Hyperkalaemia
  • Anaemia - due to reduced synthesis of EPO
  • Hyperparathyroidism

Bone

  • Reduced activation of vitamin D leads to reduced absorption of calcium. This in turn causes increased secretion of PTH, in a bid to increase serum calcium. If resorption of calcium from the bone continues renal osteodystrophy may result.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CHRONIC KIDNEY DISEASE: Outline the treatment options and discuss the indications for dialysis

A

Treatment options:

  • Medical:
    • Lifestyle: Weight loss, smoking cessation, diet
    • Pharmacological:
      • ACEi - control BP and reduce proteinuria
      • Statin - cardioprotective
      • Glycaemic control
      • Additional antihypertensive
      • if with anaemia: EPO stimulating agent and iron
      • if with secondary hyperparathyroidism: Phosphate-binding drug, ergocalciferol, active Vitamin D analogue
      • if with metabolic acidosis: oral sodium bicarbonate
  • Transplantation
  • Dialysis

Indications for dialysis:

  • GFR category G5 disease (GFR < 15) and/or
  • Signs of uraemia: Weight loss, anorexia, nausea, vomiting, acidosis, hyperkalaemia, fluid overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CHRONIC KIDNEY DISEASE: Outline the options for anaemia management and the principles of managing renal bone disease

A

Renal anaemia

  • EPO stimulating agents
  • Iron

Renal bone disease

  • Phosphate binding agent and dietary modification to reduce phosphate levels
  • Ergocalciferol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CHRONIC KIDNEY DISEASE: Outline the difference forms of renal replacement therapy

A
  • Peritoneal dialysis
    • Continuous ambulatory peritoneal dialysis
    • Automated peritoneal dialysis
  • Dialysis via vascular access
    • Haemodiafiltration
    • Haemodialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CHRONIC KIDNEY DISEASE: Describe the effect of declining renal function on drug clearance and discuss the need to adjust doses according to BNF guidelines

A
  • Declining renal function → reduced clearance of renally excreted medications
  • Doses should be reduced accordingly
  • This is particularly important when prescribing aminoglycosides, heparin, lithium, opiates and digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

NEPHROTIC SYNDROME: Describe the nephrotic syndrome and describe its relationship to conditions causing abnormal proteinuria

A

Nephrotic syndrome: Defined as the presence of…

  • Proteinuria (>3.5 g/24 hrs)
  • Hypoalbuminaemia (<30 g/L)
  • Peripheral oedema
  • Hyperalbuminuria, hyperlipidaemia and hypercoagulabilty are also features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NEPHROTIC SYNDROME: List the 3 main primary renal causes and outline briefly the key pathological features

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

NEPHROTIC SYNDROME: List secondary causes and outline investigations necessary to confirm the diagnosis

A

Secondary causes

  • Neoplasm: Myeloma
  • SLE
  • Amyloid
  • Infection
  • Diabetes
  • HSP
  • Pre-eclampsia

​

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

NEPHROTIC SYNDROME: Outline the investigation necessary to confirm the diagnosis

A
  • Urine dip: + protein ( > 3g/24hrs)
  • Protein:creatinine ratio (> 300 mg/mmol)
  • Serum albumin (< 30 g/L)
  • Renal USS
  • Renal biopsy
23
Q

NEPHROTIC SYNDROME: Outline the treatment including the need for diuretics and a low salt diet

A

Treatment aims

  • Reduce oedema
    • Fluid and salt restriction
    • Diuresis with loop diuretics
    • Daily weights to monitor weight loss
  • Reduce proteinuria
    • ​ACEi or ARB
    • May not be required in minimal change disease
  • Treat underlying cause
    • ​Renal biopsy allows for underlying cause to be identified
    • Corticosteroids are commonly used for conditions such as minimal change disease
  • ​Management of possible complications
    • ​Hypercoaguability → enoxaparin
    • Infection (due to loss of Igs) - increased risk of varicella following steroid treatment
    • Hyperlipidaemia
24
Q

GLOMERULONEPHRITIS: Describe the clinical presentation of glomerulonephritis

A
  • Haematuria
  • Oedema
  • Hypertension
  • Renal dysfunction e.g. anuria
  • Proteinuria (can be < 3.5g)
25
Q

GLOMERULONEPHRITIS: Outline the main pathological processes affecting the glomerulus

A
  • Anti-GBM disease: Autoantibodies directed against the GBM and alveolar basement membrane.
  • Small vessel vasculitis
    • HSP
    • Churg-Strauss syndrome
    • Microscopic polyangiitis
    • Granulomatosis with polyangiitis
  • IgA nephropathy: *most common cause of GN* Deposition of IgA within the mesangium.
  • Post-streptococcal glomerulonephritis: Occurs ~ 2/52 after a sore throat or 3-6/52 after cellulitis. Streptococccal antigen deposits in the glomerulus, leading to immune complex formation and inflammation
  • SLE
26
Q

GLOMERULONEPHRITIS: Outline the investigation necessary to confirm the diagnosis and outline the treatment options for GN

(For treatment THINK of the symptoms - how can they be resolved?)

A
27
Q

UPPER URINARY TRACT INFECTION: Describe the pathological features and complications of acute and chronic pyelonephritis

A

Pathological features:

  • Urinary symptoms: Dysuria, urinary frequency
  • Renal angle tenderness
  • Rigors
  • Fever
  • Vomiting
  • Urine dip: Nitrites, leucs

Complications:

Acute:

  • Urosepsis
  • AKI

​Chronic

  • Renal abscess
  • ​CKD
28
Q

UPPER URINARY TRACT INFECTION: Describe the symptoms and signs of UTI including the factors which may predispose to UTI

A

Symptoms:

  • Dysuria, urinary frequency, nocturia
  • Cloudy/smelly urine
  • Suprapubic pain
  • +/- rigors, vomiting, septic symptoms if upper UTI
    • pain in the rectum/scrotum/perineum/penis, swollen/tender prostate on PR if prostatitis

Signs:

  • Urine dip: + leucs, nitrites
  • Bladder distension ?obstruction
  • Prostate tenderness on PR ?prostatitis
  • Vaginal discharge ?PID

Predisposing factors:

  • Female gender
  • Poor hygiene practices/incontinence
  • Sexual activity - spermicide use
  • Reduced urinary flow - obstruction, dehydration
  • Catheterisation
  • Extremes of age
  • Immunocompromisation e.g. diabetes
29
Q

UPPER URINARY TRACT INFECTION: Describe the investigation of a patient with a suspected infection

A

For non-pregnant women:

  1. Urine dip2
  2. If systemically unwell consider FBC, U&Es, CRP and blood culture. Fasting glucose

For pregnant women1, men and children. Also, for non-pregnant women in whom empirical treatment fails or with suspected upper UTI:

  1. MC&S
  2. Antibiotic therapy

For men with upper UTI, failure to respond to treatment, recurrent UTI , pyelonephritis, unusual organism or persistent haematuria

  1. Imaging (renal USS) and referrral to urology.

?obstruction - ?cause (BPH)

​1: For pregnant women presenting with ?UTI referral to assessment unit it required to do the risk of preterm delivery and IUGR associated with infection.

2: Be aware that TB can cause sterile pyuria, where symptoms are present but MC&S is negative

30
Q

UPPER URINARY TRACT INFECTION: Discuss the general treatment measures and suitable antibiotic regimens for treatment

A

Conservative measures:

  • Adequate hydration
  • Analgesia: Paracetamol, ibuprofen
  • Rest

Pharmacological treatment:

*Refer to local abx policy*

  • Broad spectrum e.g. co-amoxiclav
  • Nitrofurantoin
  • Trimethoprim
31
Q

OBSTRUCTIVE AND NEOPLASTIC CONDITIONS OF THE KIDNEY AND URETER: Describe the causes, symptoms and signs of acute and chronic ureteric obstruction and discuss their management

A
32
Q

OBSTRUCTIVE AND NEOPLASTIC CONDITIONS OF THE KIDNEY AND URETER: Discuss the aetiology and presentation of calculi in the kidney and ureter

A

Aetiology:

  • Usually form in response to elevate levels of urinary solutes or reduced levels of stone inhibitors
  • Low urinary volume and abnormal urinary pH can all contribute to the formation of renal calculi
  • RFs include dehydration, obesity, previous Hx of nephrolithaisis, FHx and anatomical abnormalities.
  • 80% are calcium stones
  • Uric acid stones (due to low urinary pH), cystine stones (inborn error of metabolism) and struvite stones (follow infection and present as staghorn calculi. May be magnesium, ammonium or phosphate. Associated with urea-splitting organisms - E.coli is not one)

Presentation:

  • Acute, severe flank pain (renal colic). Radiation to the ipsilateral groin (loin → groin pain)
  • Nausea and vomiting
  • Urinary frequency/urgency (as the stone causes bladder irritation)
  • Haematuria
33
Q

OBSTRUCTIVE AND NEOPLASTIC CONDITIONS OF THE KIDNEY AND URETER: Describe how renal stones are treated, including use of non-operative methods of treatment

A

Initial treatment - conservative management

  • Hydration
  • Analgesia - NSAIDs are first line, particularly IM diclofenac
  • Antiemetic
  • Abx therapy - If there is bacteriuria, but no sign of obstruction or sepsis

​! Urgent surgical decompression is required when there is fever/other signs of infection - a ureteric stent or percutaneous nephrostomy may be used.

90% of stones < 5mm in diameter pass spontaneously.

For stones > 5mm in diameter which are not resolving:

  • Medical expulsive therapy (MET): Nifedipine or alpha blockers (e.g. tamsulosin)
  • Extracorporeal shock wave lithotripsy (ESWL)
  • Ureteroscopy
  • Percutaneous nephrolithotomy
34
Q

OBSTRUCTIVE AND NEOPLASTIC CONDITIONS OF THE KIDNEY AND URETER: Describe the clinical features of renal cell carcinoma, Wilm’s tumour, transitional cell carcinoma of the renal pelvis and renal cysts. Outline management.

A
35
Q

THE BLADDER AND PROSTATE: Discuss the management of trauma to the bladder (accidental and surgical)

A

Trauma includes blunt injury (bruise) and penetrating injury (tear).

Extraperitoneal bladder rupture is the most common type of bladder injury. It typically follows pelvic fractures.

Treatment

Intraperitoneal bladder rupture → laparotomy and suturing of the bladder

Extraperitoneal bladder rupture → prolonged catheterisation (urethral or suprapubic)

36
Q

THE BLADDER AND PROSTATE: Describe the diagnosis and management of bladder calculi

A

Diagnosis

  • Clinical features: Lower abdominal pain, dysuria, polyuria, cloudy/dark urine and haematuria
  • Bladder USS
  • X-ray
  • Cystoscopy

Management

  • Cystolitholapaxy: A cystoscope is inserted into the bladder. Crushing devices, lasers or US is then used to break up the stones.
37
Q

THE BLADDER AND PROSTATE: Describe the pathology, clinical presenting features, diagnosis, management and follow-up of transitional cell carcinoma of the bladder

A

Presenting features:

  • Painless haematuria +/- clots (may be intermittent)
  • Voiding symptoms - frequency, urgency
  • Recurrent UTIs
    • ​Secondary to urinary tract obstruction
  • Pain from local invasion

Diagnosis:

  • Urine cytology: TCC cells may be present. Should be used to complement the findings on cystoscopy.
  • Bladder USS
  • Bloods: FBC, bone markers (ALP, Ca2+),
  • Cystoscopy with biopsy
  • Imaging - CT, MRI

Management:

  • Non-invasive
    • Transurethral resection of a bladder tumour (TURBT)
    • BCG chemotherapy every 6 months
  • ​Invasive
    • ​Radical cystectomy with ileal conduit
    • Radiotherapy as neoadjunct/primary treatment/palliative
    • Chemotherapy as neoadjunct or palliative

Follow-up:

There is lifelong risk of tumour reoccurence and therefore lifelong monitoring is required, primarily by cystoscopy. Frequency of monitoring depends on the level of risk.

Should be offered at 3, 6, 9 and 18 months.

38
Q

THE BLADDER AND PROSTATE: Discuss outlet obstruction of the bladder and list the main causes (including mechanical and neurological causes)

A

Causes (THINK luminal, mural and extramural)

  • BPH
  • Malignancy
  • Bladder calculi
  • Spinal cord lesions
  • Constipation
  • Urethral stricture
  • Neurological: MS
  • Obstructed catheter
  • Pelvic injury or trauma

​Clinical features

  • Suprapubic pain
  • Hesitancy and diminished force of stream
  • Terminal dribbling
  • Overflow incontinence
  • UTI due to urinary stasis​
39
Q

THE BLADDER AND PROSTATE: Describe the clinical presenting features, diagnosis and management of BPH and outline possible complications

A

Clinical presenting features:

  • Urinary symptoms1 (storage and voiding): Hesitancy, terminal dribbling, frequency
  • Nocturia
  • Recurrent UTIs
  • Incontinence

Diagnosis:

  • Rule out infection and malignancy: Urine dip, urinalysis, MC&S
  • Bloods: PSA, FBC, U&Es, bone profile (ALP, Ca2+, PTH)
  • International Prostate Symptom Score and global bother score
  • Volume charting of voiding volume and frequency
  • PR examination: Enlarged prostate
  • Bladder USS
  • CT abdo/pelvis

Management:

For patients with mild symptoms or which are not bothersome then ‘watchful waiting’ may be employed.

For ‘bothersome’ symptoms:

Conservative/lifestyle

  • Fluid avoidance after evening meal, limit caffeiene, bladder training, treatment of constipation, avoidance of diuretics/medications causing urinary retention

Pharmacological

  • ​​Relaxation of the urethra: alpha-blockers
  • Reduce prostatic enlargement: 5-alpha-reductase inhibitor
  • PDE-5 inhibitor

​Surgical *refractory to pharmacological therapy, complications of BPH*

  • TUIP, TURP

Possible complications:

  • Recurrent UTI
  • Bladder obstruction
  • Renal insufficiency (due to urinary obstruction)
  • Bladder stones (due to urinary stasis)
  • Recurrent haematuria

1: Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).

40
Q

THE BLADDER AND PROSTATE: Discuss the diagnosis of bladder infection outline the importance of confirming significant bacteriuria and the importance of white cells in the urine

A

Diagnosis of bladder infection (cystitis):

  • Urinalysis (urine dip): +leucs, +nitrites
  • Urine MC&S
  • Symptoms suggestive of lower UTI

Significant bacteriuria: > 105 cfu/mL is thought to represent evidence of UTI

Importance of WCs in the urine: If there are only leucocytes present in the urine treatment should only be given if there are clinical symptoms of UTI. Nitrites are a better indicator of infection than leucocytes (suggest bacteria within the urine). If either nitrites or leucocytes are present then a MSU should be sent for MC&S.

41
Q

THE BLADDER AND PROSTATE: Discuss the management of bladder infection

A

Lifestyle advice:

  • Plenty of fluids
  • Rest
  • Analgesia PRN

Pharmacological:

  • Abx therapy: Nitrofurantoin, trimethoprim BUT consult local guidelines

​Safety-net: Worsening symptoms/symptoms suggestive of systemic illness then seek further medical advice

42
Q

THE BLADDER AND PROSTATE: Discuss the clinical presenting features, staging, pathology, natural history and clinical management of carcinoma of the prostate including description of hormonal manipulation.

A

Presenting features:

  • Often asymptomatic - incidental finding on PR or histology for BPH
  • Urinary symptoms: Voiding or storage as per BPH
  • Nocturia
  • Back pain/bone pain
  • Weight loss

Staging:

  • Gleason score: Used to grade prostate tumours obtained from biopsy.
  • TNM via MRI

Pathology:

Malignancy tends to begin in the peripheral region of the prostate.

Natural Hx:

Due to growth beginning peripherally, presentation is often late.

Clinical management:

*Dependent upon duration of projected survival, with less intervention recommended for pts with reduced predicted survival, and the ‘risk’ associated with the disease*

  • Brachytherapy
  • Radiotherapy
  • Radical prostatectomy
  • Androgen deprivation therapy

Hormonal manipulation

  • Looks to reduce the level of androgens within the body, thereby reducing growth of the malignancy
  • Luteinising hormone releasing hormone agonist/antagonist or non-steroidal anti-androgen
43
Q

THE URETHRA, PENIS AND SCROTUM: Discuss the clinical presenting features, diagnosis and management of urethritis and the urethral syndrome.

A
44
Q

THE URETHRA, PENIS AND SCROTUM: Outline the management of trauma to the urethra

A
  • Most commonly iatrogenic e.g. catheterisation, instrumentation and surgery. Also, radiotherapy can lead to strictures.
  • Management is based around the type of trauma.
  • Urethral or suprapubic catheterisation should be performed - with the aim being the maintenance of continence and reduction in the occurence of strictures.
45
Q

THE URETHRA, PENIS AND SCROTUM: Describe the aetiology, clinical presenting features and management of a urethral stricture

A

Aetiology:

  • Urethral injury (accidental, iatrogenic)
  • Infection

Clinical presentation:

  • Voiding symptoms
  • UTI
  • Retention

Management:

  • Internal urethrotomy - incision of the stricture using endoscopic equipment
  • Stent - incorporate themselves into the wall of the urethra, keeping the lumen open
46
Q

THE URETHRA, PENIS AND SCROTUM: Describe the pathology, presentation and management of: Phimosis, pharaphimosis, priapism, Peyronie’s disease, carcinoma of the penis, varicocele, hydrocele and epididymal cyst

A
47
Q

THE URETHRA, PENIS AND SCROTUM: Outline the causes of non-descent and mal-descent of the testis plus the risks and management of this condition

A

3% of boys are born with an undescended testis but this drops to 1% after 1 year old.

Unilateral testicular non-descent is x4 more common than bilateral.

Causes of non-descent of the testis:

  • Crypto-orchidism - complete absence of the testis
  • Testicular agenesis
  • Retractile testis

Causes of mal-descent of the testis: (usually unilateral)

  • Underdeveloped scrotum
  • Anatomical abnormality
  • Reduced secretion of testosterone
  • Ectopic testis (most commonly in the superior inguinal pouch)

Risks

  • Infertility
  • Increased risk of testicular torsion
  • Increased risk of testicular trauma
  • Increased risk of testicular malignancy (x40 increased)

Investigations

Laparoscopic exploration (both diagnostic and therapeutic)

Management

  • Surgical: After 6 months of age.
  • Hormonal therapy (hCG) if the undescended testes is in the inguinal canal
48
Q

THE URETHRA, PENIS AND SCROTUM: Discuss the pathology, clinical presenting features, diagnosis and management of torsion of the testis and epididymo-orchitis

A
49
Q

THE URETHRA, PENIS AND SCROTUM: Outline the pathological classification of common tumours of the testes and their biological behaviour

A
50
Q

THE URETHRA, PENIS AND SCROTUM: Outline the investigation and management of seminoma and teratoma of the testis

A

Seminoma

Investigation:

  • USS of testis
  • CXR and CT AP to check for metastasis
  • Evaluation of tumour marker levels:
    • beta-hCG: Elevated in some patients with pure seminoma
    • AFP: Not elevated in seminoma. Can be elevated in teratomas
    • LDH: May be the only elevated marker in some cases of seminoma
    • Gamma-GT: Elevated in 1/3 of cases of seminoma
    • ALP: Elevated if mets are present

Management:

  • Orchidectomy and radiotherapy1

Teratoma

Investigation:

SEE ABOVE

Management:

  • Orchiectomy
  • Surveillance for reoccurence

1: Seminomas are highly radio sensitive

51
Q

THE URETHRA, PENIS AND SCROTUM: Outline the causes of male erectile dysfuncion, list screening investigations and list the available treatments

A

Erectile dysfunction: Inability to achieve or maintain an erection sufficient for sexual performance

Causes:

  • Congenital
  • Acquired
    • ​Vascular (40%): PAD
    • Endocrine: Diabetes (30%), hypo/hyperthyroidism, hypogonadism, hyperprolactinaemia
    • Secondary to medications
    • Pelvic surgery/radiation/trauma
    • Psychological
    • Neurogenic

Investigations:

  • Hx: Ever has an erection? Experienced morning erections? Hx of PAD e.g. claudication, critical ischaemia? Arterio-path e.g. hypertension, stroke/TIA, ACS?
  • International Index of Erectile Dysfunction: Assesses ED, orgasmic function, sexual desire, ejaculation, intercourse and overall satisfaction
  • Lipid levels
  • BP
  • Fasting blood glucose/Hba1C
  • Endocrine screen: TFTs, prolactin, testosterone

Available treatments:

  • Conservative:
    • Treatment of underlying condition
    • Psychosexual therapy
  • Medical:
    • PDE-5 inhibitors e.g. sildenafil
    • Injections (if above fails)
52
Q

KIDNEY TRANSPLANTATION: Outline the indications for transplantation in patients with chronic renal failure

A

Indications for renal transplantation:

  • CKD stage 5 eGFR < 15 ml/min
  • CKD stage 4 (eGFR 15 - 29 ml/min) with progressive disease
  • Symptoms of uraemia:
    • Asterixis1
    • Lethergy/prolonged confusion
    • Hyperreflexia
    • Uraemic flush (metallic/bitter taste in the mouth)
    • Serositis, especially pericarditis
    • Hypothermia
    • Hypotension
    • Nausea and vomiting
    • Colour change to the tongue

1: Other causes of asterixis include T2RF and hepatic failure

53
Q

KIDNEY TRANSPLANTATION: Outline the complications of the procedure and the need for immunosuppressive therapy following surgery

A

Complications:

  • Bleeding
  • Infection
  • Failure
  • Damage to surrounding structures

​Renal transplant specific:

  • Delayed graft function (DGF): The need for dialysis in the first 1/52 following transplant. Most go on to function but DGF is associated with increased rejection rates amd decreased graft survival rates.
  • Rejection
  • Short term complication - Renal artery thrombosis
  • Short term complication - Renal vein thrombosis
  • Long term complication - Renal artery stenosis: Usually presents several months after transplant with uncontrollable hypertension and worsening graft function. Angiography is used to confirm the diagnosis
  • Uretral complications: Leaks, obstruction
  • Long term complication - CVD: Most common cause of mortality post-operatively
  • Most other long term complications are related to the use of immunosuppressive agents e.g. recurrent infections, DM and malignancy

Need for immunosuppressive therapy:

  • Therapy used depends on the immunological risk of the recipient and the type of donated kidney
  • Prevents recipient immune system from recognising the tranplant as foreign and mounting an immune response
  • Monoclonal Igs, calcineurin inhibitors, antimetabolites and glucorticoidsteroids may be used in varying combinations.
54
Q

HAEMATURIA: State key questions to consider in Hx, state possible causes of haematuria

A

Key Questions

  • Whether haematuria is persistent throughout urination or seen only at the beginning or end of the stream (e.g. bleeding at the end of micturation suggests a distal problem)
  • Any blood present on the penis - could be the cause
  • Use of anticoagulants
  • Urinary symptoms
  • Red flags - weight loss, change in urinary habits
  • Any symptoms suggestive of prostatitis e.g. tednerness, fevers, pus on the urethral meatus

Ddx

  • Renal cacluli
  • UTI: Pyelonephritis, cystitis
  • Malignancy of the urinary tract - renal, ureters, bladder
  • Nephritis
  • Prostatitis (as the ejaculatory duct connects to the urethra)
  • Prostate cancer

CP3 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions