Urinary system & male genital tract Flashcards
Risk factors of urinary tract infections
Females>males Sexual intercourse Pregnancy Diabetes Urinary tract obstructions e.g. stones or catheters
Define a UTI
the presence of pure growth of >10^5 organisms in fresh urine
in urethra = urethritis
in bladder = cystitis
in prostate = prostatitis
in kidney = pyelonephritis
E.coli is the most common causative organism, staphylococcus and proteus also
What is bacteruria?
bacteria in the urine, may be symptomatic or asymptomatic
Cystitis
Frequency, dysuria, urgency haematuria, suprapubic pain
Pyelonephritis
fever, vomiting, loin pain and tenderness
Prostatitis
flu-like symptoms, few urinary problems, swollen and tender prostate
Manage of UTIs
drink plenty of fluids urinate often antibiotics imaging severe cases may require hospital admission
The kidneys
Maintenance of water, electrolyte and acid-base homeostasis
Excretion of toxic metabolic waste products (urea and creatinine)
Hormonal function:
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.
- functional unit is the nephron (glomerulus and renal tubule)
- filtration of most small molecules from the blood in the glomerulus.
- selective reabsorption in the renal tubule of most of the water and some molecules
- maintenance of the acid-base balance
Acute renal failure
A significant deterioration in renal function occurring over hours or days
low urine volume (<400ml/24 hours i.e oliguria)
rising plasma urea and creatinine levels
usually occurs in the setting of other severe illnesses
Stages of renal failure
Causes:
- Pre-renal
hypoperfusion, sepsis
- Renal
ATN damage to tubules due to ischaemia or nephrotoxins
- Post-renal
Renal tract obstruction (eg stones, tumours)
Acute renal failure management
find and treat the cause
treat exacerbating factors (hypovolaemia, sepsis)
stop nephrotoxic drugs (NSAIDs, ACE-I, gentamycin and Vancomycin)
may need renal replacement therapy (haemofiltration/dialysis)
Chronic renal failure
5 stages depending on GFR (volume of fluid from the glomerular capillaries into the Bowman’s capsule per unit time)
symptoms usually occur by stage 4 - GFR 15-29
Causes of chronic renal failure
Diabetes Renovascular disease Hypertension Glomerulonephritis Polycystic disease
Glomerulonephritis
A group of disorders where there is damage to the glomerular filtration apparatus = leak of protein or blood into the urine.
Kidney stones
Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.
Peak age 20-40 years.
Male: female = 3:1
Risk factors: dehydration, dietary factors, drugs (loop diuretics, antacids, corticosteroids, theophylline and aspirin), renal tract abnormalities, recurrent UTIs, metabolic abnormalities
management of kidney stones
imaging
prompt pain relief
stones <5mm able to pass spontaneously within 48 hours
if >5mm = intervention
Renal cancer
Renal cell carcinoma -
- 85@% of all renal cancers
- 50-70yrs, 2;1 male predominance
- smoking an important risk factor, obesity, hypertension, hereditary
presents as haematuria, loin pain, abdo mass, hypercalcaemia, hypertension
treatment = radical nephrectomy +/- chemo
Transitional cell carcinoma of the bladder
Presentation:
-painless haematuria
-frequency, urgency and dysuria can occur
Tests:
-urine for cytology
-cystoscopy and biopsy
Treatment = depends on stage and ? spread
early stage - diathermy, cystoscopy
late stage - radical cystectomy, palliative chemo/radiotherapy
Prostate
located at the base of the bladder and around the first part of the urethra.
normal adults weighs around 20gm
helps in the secretion and maintenance of semen and spermatozoa.
Benign prostatic hyperplasia
increase in number of cells formation of nodules
prostate weighs 60-100gm
signs and symptoms: increased frequency, hesitancy, nocturia, terminal dribbling
increased risk of infection
enlarged prostate on PR
Treatment = alpha blockers , Transurethral Resection of the Prostate
Prostate cancer
risk factors: age, race, family history, hormone levels, diet (increased risk with fat consumption)
signs and symptoms: nocturia, hesitancy, poor stream and terminal dribbling, examination shows a hard irregular prostate
Diagnosis = raised PSA, biopsy
Treatment = radical prostatectomy, hormonal therapy, radiotherapy for advanced cases
Testicular torsion
Sudden onset of pain in 1 testis Pain in abdomen, nausea and vomiting Testis is hot, swollen and tender The testis may lie high and transversely Most common 11-30 years old Tests: USS with Doppler, exploratory surgery Treatment = surgery, urgent!!!
Testicular tumours
Most common malignancy in males aged 15-44 years old
Risk factors: undescended testis, infant hernia and infertility
Presentation: painless testicular lump often noted after trauma or infection
Treatment = orchidectomy, radiotherapy/chemo
What is dysuria?
Pain or discomfort when urinating
