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BDS2 BAMS > Renal Outflow > Flashcards

Renal Outflow Flashcards

1
Q

what are the 2 types of renal outflow disease

A

urinary tract infection

obstruction

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2
Q

3 urinary tract disease

A

urinary tract infection

urinary tract obstruction

urinary tract malignancy

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3
Q

3 things that can cause urinary tract obstruction

A

renal stones

tumours

prostatic hypertrophy

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4
Q

what causes a UTI

A

Ascending infection from skin organisms

  • Irritate colonise and destroy superficial layer of epithelium —–Red, hot, swollen
  • Increase permeability of cells
  • Outflow of inflammatory fluid

Girls more than boys
- Distance from outside world is shorter

mainly affecting bladder
- can affect anything from kidney down in urinary tract

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5
Q

what is urine

A

filtrate of plasma

Should have no cells or no protein

  • Get them sign of infection
  • —Kidney disease
  • —Inflammatory or neoplastic changes in the bladder

Urine is sterile
- Most of the time shouldn’t contract as no poisons or bacteria should be present

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6
Q

what organisms cause UTIs

A

E. coli (85%)
- Staph, fungi, virus & TB possible (if in body can spread to bladder)

Urine bacteriostatic to perineal organisms
- Not washed of by urine flow or killed by urine action

immunosuppressed individual are more prone

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7
Q

what is cystitis

A

bladder inflammation

- lining of the bladder wall

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8
Q

how can cystitis be easily managed

A

by watching urine flow

  • Pass urine regularly
  • Wash urine out
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9
Q

what are 2 predisposing factors for cystitis

A

poor bladder emptying

Low urinary flow rates

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10
Q

what is a possible issue of taking a urine sample from first part of urine

A

Skin contamination possible
- Contains organisms washed out that have been trying to climb in
Middle section is sterile

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11
Q

what are signs of bacterial infection in urine

A

detecting any bacteria, white cells or blood

- 30% may be asymptomatic

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12
Q

what type of urine sample is the best to collect

A

mid-stream urine sample (MSSU)

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13
Q

what type of urine collection is needed to assess kidney function

A

24hr urine collection

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14
Q

MSSU

A

mid-stream urine sample

- sterile

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15
Q

out of:

  • random void collection;
  • clean catch collection (or bladder catheter);
  • suprapubic sterile aspiration

which is least likely to have a contaminated urine sample

A

suprapubic sterile aspiration

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16
Q

how to collect a suprapubic sterile aspiration

A

Bladder needs to be rather full

Penetrate the bladder

Catheter in through tummy - rather than urethra

  • Less inconvenient, less likely to be infected
  • And can still pee if necessary
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17
Q

what are 3 illnesses which infected urine can cause

A

cystitis

renal infection

prostate infection

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18
Q

how can you contract a renal infection from infected urine

A

Spread upwards to kidney
- More likely in certain circumstances

Muscle contracts in the bladder close of the ureter

  • Meaning cannot be squashed back up to kidney
  • —Urine reflux
  • As well as voiding out get reflux up ureter
  • Get renal infection
  • Can happen from birth
  • —-May need surgical repositioning of ureter so when bladder contracts can work properly
  • Inherited problem but can also develop

But if infection in bladder, not working well, then can pass up to kidney (infection too)

Renal infection is consequence of UTI

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19
Q

how can urethritis occur in isolation

A

STI link
- gonococcal

without cystitis/UTI prior

discharge is unpleasant

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20
Q

5 UTI symptoms

A

Dysuria

Urinary frequency

  • Less filling before wants to empty
  • Lots of voiding before full

Cloudy urine

  • Should be clear and varying in colours
  • But cloudy due to cells and proteins

Offensive smelling urine

Supra-pubic pain

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21
Q

2 methods of diagnosis of a UTI

A

MSSU only (less contamination)

Microscopy, Culture & Sensitivity
- White cells and RBC in urine are cultured for

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22
Q

3 methods of UTI treatment

A

first step wash organism out, continuously
- build up body defences

frequent micturition (urination)

occasionally antibiotics required (on occasion, if systemic signs and symptoms)
- trimethoprim, amoxycillin
- most of the time E.Coli cause
sensitive to similar antibiotics

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23
Q

4 causes of urinary tract obstruction

A

renal calculi

prostatic disease

urinary tract strictures

external compression

24
Q

what is another name for renal calculi

A

renal stones

25
Q

where are renal calculi formed

A

Form in kidney
- Pass down through ureter into the bladder

Pain when stone in ureter

26
Q

how do renal calculi/stones cause pain

A

Pain when stone in ureter

Expect fluid so peristaltic wave

  • Pointy sharp - contract harder to force down
  • Won’t shift
  • Digging into surface of ureter

Wait until stone in bladder and passed out
- Stones are often formed in pelvis of kidney and sit there - don’t always move

27
Q

2 classes of prostatic disease

A

hypertrophy

prostatic malignancy

28
Q

where is the prostate

A

sits underneath the bladder

- urine has to pass through the prostate to leave

29
Q

how long is the growth period of the prostate

A

grows throughout life
- Gets bigger and bigger with time

Bigger on outside smaller on inside
- Ureter gets squashed so much hard to pass urine through

30
Q

benign prostatic hypertrophy occurs in

A

males

31
Q

prostatitis

A

inflammation of the prostate

- sudden narrowing of the urinary passage (overnight)

32
Q

process of prostate disease and effect on urination

A

Bladder outflow through prostate
- Make space inside tube bigger

Change in patency of the urethra

  • Becomes permanent
  • Discomfort when try and pee as inflammation of the bladder

Bladder becomes harder to force urine through
- Urine flow more difficult - last muscle to release urine, narrowing of tube

Cannot do full bladder
partially empty bladder
- More prone to infection
due to urine sitting for more in bladder

33
Q

what is benign prostatic hypertrophy

A

Hyperplasia of the prostate
- Over 10-15 years

Can completely block urinary tract (full obstruction)

Change in gland (as supposed to inflammatory change)
Specific
- Whole gland gets bigger

Compresses urethra

  • Can get bigger but not cause compression
  • —Screen for prostate cancer
34
Q

incidence of benign prostatic hypertrophy

A

Almost normal
- 80% of men over 80

100% if they live long enough – usually die of other cause first

35
Q

2 treatment options for benign prostatic hypertrophy

A

Initially drug based

Surgery – prostatectomy

36
Q

drug treatment for benign prostatic hypertrophy

A

ά-blocking drugs

shrink prostate down –> symptoms of obstruction fade

37
Q

surgery treatment for benign prostatic hypertrophy

A

TURP –transurethral prostatectomy

  • Slurping a tube through – like apple corer
  • Cuts away prostate gland which is touching surface of urethra

Open prostatectomy
- Taking prostate gland out
Underneath other parts, can damage sphincters and reflexes -Difficult operation

38
Q

damage to sphincter of bladder causes

A

incontinence

39
Q

how can benign prostatic hypertrophy be treated by endoscopic surgery procedures

A

Heated up and coagulate blood vessels
- Chops of flecks
Enough capacity in tube to allow flow

40
Q

6 symptoms of urinary outflow obstruction

A

Slow stream

Hesitancy

Frequency (smaller volumes as cannot fully empty)

Urgency

Nocturia

Incomplete voiding

41
Q

what type of tumour is prostatic cancer

A

adenocarcinoma

happens in one focal area in prostate
- squash and stop urinary outflow

42
Q

what age group are commonly affected by prostatic cancer

A

starts after 45
- 90% men >90yrs have this at autopsy

Fairly common tumour

  • Most asymptomatic – not cause of death
  • 10% men have symptomatic disease

2nd commonest male cancer in the USA

89% 5yr survival

63% 10yr survival

43
Q

why is prostatic cancer not easily detected

A

Not a good screening process - unlike cervical

No association with viruses at the moment

May not present early as may not cause UTI

44
Q

what is prostatic specific antigen

A

a blood test carried out when males turn 50 years old
- not always diagnostic

Problems with Specificity and sensitivity excludes using PSA for screening
- Normal person can have high result without having tumour

45
Q

what does a high prostatic specific antigen (PSA) indicate

A

send for more tests as indication of tumour

- not diagnostic

46
Q

what is a good use for prostatic specific antigen (PSA)

A

monitoring disease activity in those known to have the disease
- Once cancer is known and prostate cancer diagnosed

47
Q

what is a better diagnosis tool for prostate cancer than prostatic specific antigen blood test

A

MRI scan around 50 is better for diagnosis

48
Q

4 treatment options for prostate cancer

A

Surgery – radical prostatectomy

Radiotherapy

Hormone treatment

Widespread bone metastasis
- osteosclerosis (on radiograph – black is area of no bone however, bone is condensing/forming around prostate tumour
dense, white appearance on radiograph)

can spread to soft tissue (less likely than other tumours)

49
Q

what is radical prostatectomy for prostate cancer treatment and what is a disadvantage of this

A

Get rid of the gland

Morbidity and mortality in some pt
- Can lead to chronic disease problem

50
Q

how can radiotherapy help treat a prostate adenocarcinoma

A

help slow the progression

51
Q

what are the hormone treatment options for prostate cancer

A

Anti-androgens & LHRH analogues

block hormone-dependent tumour growth

  • testosterone – make cancerous tumour grow
  • —-remove then slow down tumour progression

chemical castration – switch of maleness via hormones

tumour can develop resistance to hormone sensitivity so no longer work

52
Q

what % of population develop renal calculi

A

5%

- in kidney or bladder (ureter= pain)

53
Q

what are 2 different renal calculi stone types

A

calcium and oxalate (radiopaque – see on radiograph)

uric acid (not radiopaque)

54
Q

how to deal with a renal calculi if an incidental finding on a radiograph

A

tell pt but do nothing if not causing bother

55
Q

how to treat a renal calculi causing pain to pt

A

LITHOTRYPSY

56
Q

what is lithotrypsy treatment of a renal calculi

A

Break into small parts to pass through with no trouble or harm

Ultrasound energy to kidney stone from outside the body

  • Like US scaler, Many vibrations 25000/sec
  • Energy from vibration pass onto object

Through skin to kidney

Soft tissues (kidney) Move with US wave

Stone cannot so will break

More than one generator from different angles converge on where stone is in Renal pelvis
- Less forces on one particular area

BDS2 BAMS (54 decks)

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