Urinary- Conditions and Pathology

Question 1

What is hypertension?

Answer 1

A sustained increase in blood pressure

Question 2

What defines hypertension?

What is severe hypertension?

Answer 2

140 over 90 plus

Over 180/100

Question 3

Causes of hypertension

Answer 3

95% Unknown- Primary - Can have genetic/environmental factors
5% Secondary- Cushings, CRD, Aldosteronism

Question 4

Describe Conns/Cushings Syndrome and how it causes hypertension

Answer 4

Conns syndrome- aldosterone secreting adenoma
Cushings syndrome - excess cortisol, act on aldosterone receptors

They retain Na+/H2O (Aldosterone)

Question 5

What is renalvascular disease? How does it cause hypertension?

Answer 5

Occlusion of the renal artery, perfusion pressure of kidney is lower, so baroreceptors detect lower stretch, release renin then RAAS.
Hypertension due to Na+ retention and vasoconstriction

Question 6

What is Renal Parenchymal Disease? How does it cause hypertension?

Answer 6

It leads to loss of vasodilator substances in the early stages
In later stages it leads to Na+/H20 retention
(Volume dependent hypertension)

Question 7

How does a tumour of the adrenal medulla cause hypertension?

Answer 7

It releases Nor/adrenaline.

Sympathetic effects on the kidney.

Question 8

Why is it important to treat hypertension?

Answer 8

It is a silent killer
Increasing afterload can lead to heart failure from LV hypertrophy and myocardial ischaemia (increase O2 need)

Arterial damage can lead to athrosclerosis and vessel weakness -> Stroke, Aneurism, Renal Failure, Retinopathy

Question 9

How do we treat hypertension?

Answer 9

Target factors which affect blood pressure

BP = SV x HR x TPR

Question 10

Which drugs lower TPR?

Hypertension

Answer 10

ACE Inhibitors or Angiotensin II receptor antagonists

Prevent production of Angiotensin II
So doesn’t vasoconstrict, lowers TPR

Vasodilators - Ca2+ channel blockers (relax SM) and a1 adrenoceptor blockers (reduce sympathetic tone)

Question 11

Which drugs lower Stroke Volume?

Hypertension

Answer 11

Diuretics - inhibit NaCl co-transporters (Thiazides)

- aldosterone antagonists (Spironolactone)

Question 12

What are the Non-Pharmocological treatments of Hypertension?

Answer 12

Low Na+ diet
Exercise
Reduce Alcohol

Question 13

What are the types of Urinary Incontinence?

Answer 13

SUMO!
Stress
Urge
Mixed
Overflow- retention of urine so bladder swells)

Question 14

Risk Factors for UI?

Answer 14

Race
Family
Anatomical/Neurological abnormalities

Question 15

What factors can promote UIs?

Answer 15

Pregnancy/Childbirth- weaken pelvic muscles
Higher Intra-abdominal Pressure- Obesity, Surgery, Prolapse
Age
Drugs
Menopause
UTIs
Cognitive Impairment

Question 16

How do you investigate UIs?

Answer 16

History- precipitating events, how often, when, amount
Examination - height/weight, abdominal, digital rectal, vaginal and stress test
Investigations- Dipstick - UTIs, Blood, Glucose, Protein
- Frequency-Volume Chart - polyuria
- Bladder Diary
- Residual Volume (Post Micturition)

Question 17

Conservative Management of UIs?

Answer 17

General Lifestyle Changes
Exercise
Modify Fluid Intake
Weight Loss
Stop Smoking and reduce caffeine
Timed Voiding (fix schedule- UUIs)
Avoid Constipation

Question 18

Contained Management of UIs

Answer 18

Indwelling catheters - urethral/suprapubic
Sheath device
Pads

Question 19

Specific Management of UIs

Answer 19

Pelvic floor muscle training (SUIs)
Schedule Voiding (UUIs)