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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
where are renal calculi formed
Form in kidney - Pass down through ureter into the bladder Pain when stone in ureter
26
how do renal calculi/stones cause pain
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
2 classes of prostatic disease
hypertrophy prostatic malignancy
28
where is the prostate
sits underneath the bladder | - urine has to pass through the prostate to leave
29
how long is the growth period of the prostate
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
benign prostatic hypertrophy occurs in
males
31
prostatitis
inflammation of the prostate | - sudden narrowing of the urinary passage (overnight)
32
process of prostate disease and effect on urination
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
what is benign prostatic hypertrophy
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
incidence of benign prostatic hypertrophy
Almost normal - 80% of men over 80 100% if they live long enough – usually die of other cause first
35
2 treatment options for benign prostatic hypertrophy
Initially drug based Surgery – prostatectomy
36
drug treatment for benign prostatic hypertrophy
ά-blocking drugs shrink prostate down --> symptoms of obstruction fade
37
surgery treatment for benign prostatic hypertrophy
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
damage to sphincter of bladder causes
incontinence
39
how can benign prostatic hypertrophy be treated by endoscopic surgery procedures
Heated up and coagulate blood vessels - Chops of flecks Enough capacity in tube to allow flow
40
6 symptoms of urinary outflow obstruction
Slow stream Hesitancy Frequency (smaller volumes as cannot fully empty) Urgency Nocturia Incomplete voiding
41
what type of tumour is prostatic cancer
adenocarcinoma happens in one focal area in prostate - squash and stop urinary outflow
42
what age group are commonly affected by prostatic cancer
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
why is prostatic cancer not easily detected
Not a good screening process - unlike cervical No association with viruses at the moment May not present early as may not cause UTI
44
what is prostatic specific antigen
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
what does a high prostatic specific antigen (PSA) indicate
send for more tests as indication of tumour | - not diagnostic
46
what is a good use for prostatic specific antigen (PSA)
monitoring disease activity in those known to have the disease - Once cancer is known and prostate cancer diagnosed
47
what is a better diagnosis tool for prostate cancer than prostatic specific antigen blood test
MRI scan around 50 is better for diagnosis
48
4 treatment options for prostate cancer
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
what is radical prostatectomy for prostate cancer treatment and what is a disadvantage of this
Get rid of the gland Morbidity and mortality in some pt - Can lead to chronic disease problem
50
how can radiotherapy help treat a prostate adenocarcinoma
help slow the progression
51
what are the hormone treatment options for prostate cancer
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
what % of population develop renal calculi
5% | - in kidney or bladder (ureter= pain)
53
what are 2 different renal calculi stone types
calcium and oxalate (radiopaque – see on radiograph) uric acid (not radiopaque)
54
how to deal with a renal calculi if an incidental finding on a radiograph
tell pt but do nothing if not causing bother
55
how to treat a renal calculi causing pain to pt
LITHOTRYPSY
56
what is lithotrypsy treatment of a renal calculi
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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