Urinary System/Male Repro D/O's

Question 1

Examples of acid-base imbalance: metabolic acidosis versus respiratory acidosis; metabolic alkalosis versus respiratory alkalosis.

Answer 1

Acidosis:

* Metabollic = 1.) KD not working properly 2.) Exercise bc of lactic acid 3.) Protein based diet 4.) Diabetes Mellitis or 5.) Infection

* Respiratory = CO2 will be expelled more avidly (LU XU - COPD, asthma, acute illness). LU’s help KD restore homeostasis. KD will absorb more CO3 (Bicarbonate) & remove more hydrogen.

Alkalosis:

* Metabollic = Too may tums or veggie diet, Most freq. resistent to Tx. & too much vomiting (Cancer Pts., pregnant Pts., alcoholics, GI poisoning) stored in ST as HCL breathing slows bc less acid

*Respiratory = hyperventilate, anxiety, change in altitude

Question 2

Major risk factors, leading to acute tubular necrosis - AKA MI of the KD’s

Answer 2

ATN - It is most common cause of acute renal failure. two major causes * tubules can’t concentrate urine so no urine 1. severe ischemia - interruption of blood supply 2. drugs, chemical exposure - nephrotoxic drugs - anti- cancer, anti etc…

** It is reversible if caught and removed ischemia, nephrotoxic drugs and chemicals (antimicrobial drugs, organic solvents, pesticides, myoglobin, heavy metals as mercury, lead, gold

compounds tubules disabled ==> glomeruli disabled ==> tubules compressed ==> the outcome could be either massive tubular necrosis with anuria or reverse to normal function

Initial stage - 36 hrs - toxin damage

Oliguric phase - 10 days - decreased urine output

Diuretic phase - dangerous stage - can lead to more infections Recovery phase - around week 3

Question 3

Vulnerable population for UTIs?

Answer 3

Children & elderly are vulnerable populations. And pregnant women - must be monitored closely and can lead to miscarriage or preclampsia.

Question 4

Two syndromes of glomerulonephritis (nephrotic versus nephritic). Post-streptoccal glomerulonephritis as nephritic syndrome: etiology, pathogenesis, clinical presentations, diagnosis and treatment….

Answer 4

Glomerulonephritis is AUTO-IMMUNE infection of the KD 1.) Nephritic Syndrome = damage of fenestration/inner membranes of the glomeruli - blood cells try to leave blood compartment and appears in urine - hematuria. Mild-moderate albumin uria. • Presents with hematuria, hypertension, slight proteinuria, periorbital & PARTIAL edema, petechial skin hemorrhages, fever, flank pain, & malaise.

If post-streptococcal, usually occurs 2-3 weeks after either strep. throat or (most commonly) impetigo (strep. skin infection). - comes with Nephritic syndrome

2.) Nephrotic syndrome = Mainly due to further massive damage of both fenestration & basement membranes of the glomeruli. Inner & outer membranes (odocytes) damages. Albumns leak like crazy. SEVERE albumin urea and SEVERE edema. Most common causes are food allergies in children, drug toxicities, blood cancers. • Accompanied by massive leakage of albumins (proteinuria), severe edema, hyperlipidemia, loss of albumins in blood compartment (hypoalbuminemia).

Question 5

Varicocele?

Answer 5

The swelling of the veins inside the scrotum. These veins are found along the cord that holds up a man’s testicles (spermatic cord).

Varicoceles develop slowly most of the time. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum.

* A varicocele in an older man that appears suddenly may be caused by a kidney tumor, which can block blood flow to a vein. The problem is more common on the left side than the right.

* Sperm count will increase post Sx. but not necc fertility

Question 6

Hypospadias

Answer 6

A birth (congenital)/defect in which the opening of the urethra is on the underside of the penis. The urethra is the tube that drains urine from the bladder. In males, the opening of the urethra is normally at the end of the penis.

Question 7

What parts of the MRS and FRS constitute primary gonads?

Answer 7

Ovaries are primary gonads in Females & Testes are the primary gonads in Males

Question 8

Structure and Function of the scrotum and the cremasteric reflex. What nerve is responsible for this reflex? What is the significance of this reflex for reproduction?

Answer 8

Genitofemoral Nerve is responsible for the reflex. Causes contraction of ipsilateral cremaster muscle drawing the testes upward when the inner aspect of the thigh is stroked longitudinally. Keeps temperature for sperm.

Question 9

Structure and function of the testis. Sequence of the seminiferous tubules. What is the function of Sertoli cells? Leydig cells? Which ones constitute testis-blood barrier, and produce androgen-binding protein? Which ones produce testosterone?

Answer 9

Sertoli cells are located within seminiferous tubules – they create the hemato-testicular barrier & for the nourishment of spermatozoa. Leydig cells produce testosterone in the presence of LH.

Question 10

What is the significance of tunica vaginalis and what is hydrocele?

Answer 10

Consist if an inner and outer serous membrane layer surrounding the testes and epididymis. Hydrocele is the accumulation of serous fluid in a body sac causing swelling in the scrotum. Usually a sign of inflammation or injury but normal in babies until age 1 or so.

Question 11

Where do spermatogenic cells mature?

Answer 11

In the seminiferous tubules

Question 12

Endocrine control of the testes: what are the functions of FSH, LH inhibin, DHT?

Answer 12

Follicle Stimulating Hormone (FSH) - produced in pituitary gland, stimulates production of sperm by stimulating sertoli cells to secrete androgen-binding proteins, which then allows access of testosterone to developing spermatogonia. Luteinizing hormone (LH) – also from pituitary gland, stimulates leydig cells to produce & secrete testosterone.

Inhibin - provides negative feedback to the pituitary to stop the secretion of follicle stimulating hormone.

Dihydrotestosterone is testosterone converted by the prostate gland, & is responsible for growth and development of sexual organs, pubic and body hair growth, and masculine behaviors.

Question 13

What are the structure and the function of the epididymis?

Answer 13

Epididymus is a long tubule that sits behind the testicle & is site for the maturation of sperm.

Question 14

What is the difference between ductus deferens and spermatic cord?

Answer 14

Ductus Deferens transport sperm from the epididymis behind the testicle to the ejaculatory duct, while the spermatic cord includes the ducuts deferens as well as nerves and arteries, protecting them with layers of fascia.

Question 15

What glands generate seminal fluid?

Answer 15

The prostate gland & seminal vesicle generate seminal fluid.

Question 16

What are three parts of male urethra?

Answer 16

1.) Prostatic urethra, 2.) Membranous urethra, and 3.) Spongy urethra

Question 17

What is the major function of Cowper’s glands?

Answer 17

They protect the semen by creating an alkaline environment through secretions that make up part of the seminal fluid.

Question 18

Semen characteristics:

Answer 18

Semen consists of sperm, seminal fluids secreted by the cowper’s glands & prostate gland. The volume of semen, the motility of the sperm (flagella), as well as the concentration of the sperm in semen are characteristics tested to help determine male fertility. The shape (morphology) of the sperm, the pH, and the semen’s ability to liquefy within a specific amount of time are also important to male fertility.

Question 19

Structure of the penis. What are the three cylindrical structures, which constitute penile body? What is erectile tissue composed of?

Answer 19

Two corpora cavernosa and one corpus spongiosum make up the penis body. The erectile tissue is composed of smooth muscle, collagen fibrous tissue, and cavernous sinuses

Question 20

What is the division of the autonomic nervous system, which controls erection? Ejaculation? What is a neurotransmitter, responsible for an erection?

Answer 20

The Parasympathetic nervous system (PNS) controls erection, while the Sympathetic nervous system controls ejaculation. Nitric oxide is responsible for an erection.

Question 21

The best index of GFR (Glomerular Filtration Rate)?

Answer 21

Serum creatinine - if it stays in blood then less filtration if higher in urine then filtrating

Question 22

What is BUN?

Answer 22

It stands for Blood Urea Nitrogen. It reflects cumulative amount of ammonia in blood compartment. This index is less specific than creatinine for identification of GFR. However, it reflects as well on filtrating and excreting ability of the kidneys (Human Physiology of the Urinary System). - BUN depends on ht, lv urea cycle & how KD discards ammonia

Question 23

Topographic kidney anatomy (where are the kidneys situated relevant to peritoneum and spinal column?).

Answer 23

Retroperitoneal

Question 24

Definition of specific gravity of urine

Answer 24

Osmolarity of Urine – relevant to concentration – should be more concentrated then plasma; 1.002 – 1.035 is normal range . Normal urinary output in 24 hours and within one hour – 700 mL – 2L

Question 25

What is the Renin cascade for HTN?

Answer 25

Renin – → Angiotensin I→ Angiotensin II→Aldosterone→ NA+ retention→ADH→ Water retention→ HTN

Question 26

What are normal versus abnormal constituents of urine? Are proteins, glucose, formed elements of blood permitted into the urine? Do bilirubin (urobilinogen), electrolytes, ammonia, hormones, creatinine constitute normal urinary findings? Normal pH range of the urine?

Answer 26

Protein urea is NOT acceptable in urine - no RBC or WBC unless inflamm, no bacteria - however, in 1st portion always present esp in women urine & urinary bladder are sterile yellow bc of bilirubin – urobilinogen - the more concentrated the more yellow; 4.5-8.0 – side note: blood pH is 7.4 (7.35 = Acidosis & 7.45 = Alkalosis. can be alkaline or acidic - depends on nutrition * more acidic in diabetes patients and meat eaters,, post exercise bc of lactic acid * more alakaline if vomit or high veggie eaters * Ph is algorythym for collecting numbers - reflection of concentration of hydrogen atoms - higher more acidic - lower more alkaline

Question 27

Dysuria:

Answer 27

pain upon urination

Question 28

Hematuria:

Answer 28

blood in urine - red flag for urinary system cancer, esp when painless

Question 29

The more ______ lost the more edema - _______ attract fluids in extracellular compartment of blood

Answer 29

Albumins - swollen symmetrical eyes = kidney peri-orbital edema - if more partial edema kidney is involved & ankles swollen - hands is partial edema

Question 30

Hyperlipidemia:

Answer 30

swampy/not clear urine - usually foreign component more lipids bc albumins are abnormal and proteins carry lipids (lipoproteins) can’t move them

Question 31

Skin bruising, petechiae, purpura, palor, jaundice:

Answer 31

palor due to less erythropoeitin,

patechial hemorraghe, skin bruising because of glomerular compromised

itching/pruritis - KD & Liver - bc of salts of bilirubin - irritating receptors for itching at thalamus & parietal lobe

jaundice bc bilirubin not being removed

Question 32

Types of imaging used to find Urinary System D/O’s? Blood Tests?

Answer 32

Imaging: CT, US, MRI, MRA, cystography, angiography (ultrasound is most effective & least costly)

Blood test: CBC - neutrophils = bacterial if lymphocytosis = viral, Hb, ESR/ CReactive Protein - will suggest inflammation, creatinine = GFR, immunology tests, Chem 7 (electrolytes, BUN = ammonia in blood, glucose), urinary pH, ABG (arterial blood gases)

Question 33

PKD/PCKD vs. ADPKD?

Answer 33

(PKD) Childhood - large cysts in kidney & stops filtration - leads to death - AUTOSOMAL RECESSIVE - one gene dominant is healthy but recessive is not. children die or PCKD is AUTOSOMAL DOMINANT - some cysts develop in utero & will follow 1st part of life & slow diminution - child will survive & reach adulthood - around 30 years of age they start to gradually decompensate polycysteine gene 1 or 2 (PKD)

** ADPKD are autosomal dominant gene. Mutations in the PKD-1 gene on chromosome 16 (ADPKD-1) account for 85% of cases, whereas mutations in the PKD-2 gene on chromosome 4 (ADPKD-2) represent the remainder.

Question 34

Presenting S&S include ABD discomfort, hematuria, urinary tract infection, incidental discovery of hypertension, abdominal mass, elevated serum creatinine, or cystic kidneys on imaging studies, patients usually have renal pain, & develop renal insufficiency, possible diagnosis?

Answer 34

ADPKD - Patients with ADPKD have a risk of cerebral hemorrhage from a ruptured intracranial aneurysm as compared to the general population.

Question 35

Leading cause of UTI’s?

Answer 35

stagnant urine in any part of Urinary system

Question 36

Types of Urinary Stones: 1.) A Staghorn Calculus is a _______ stone - usually affecting Calyx. 2.) Struvite caused by GI bacteria & produce ______-_____ stones. Urea splitting bacteria 3.) Cystine caused by ____ acid and caused by high animal protein diet

Answer 36

1.) Staghorn = Calcium and are very large - ONLY radio-opaque type 2.) Struvite = ammonia-magnesium-phosphate stones 3.) Cystine = Uric acid

Question 37

pyelonephritis =

Answer 37

ACUTE bacterial infection/inflammation of the KD - results when a UTI progresses to involve the upper urinary system (the kidneys and ureters). DOES NOT affect glomerulus

Question 38

Most forms of KD cancers generate in the _________ and mostly generate in ______

Answer 38

KD cancer generates in pyramids and mostly in males

Question 39

Most common Renal Cancer?

Answer 39

Renal Cell Carcinoma - more common in males * No clinical findings in early stages usually diagnosed late with painless hematuria ** Chemotherapy is not considered effective but immunotherapy can extend life

Question 40

Bladder Cancer/Transitional cell carcinoma is very ________ cancer by nature. ______ most common cancer in males.

Answer 40

Chemical cancer; Tumor tends to recur after on same or opposite side after tx. - Usually originates from transitional epithelium of the UB (urothelium) - only exists in Bladder. 4th most common cause of cancer in males - deletion of p53 gene

Question 41

Orchitis? What is a common cause? What is a complication?

Answer 41

Inflammation of the testes; commonly caused by Mumps virus.

* POST-PUBERTAL males could lead to partial or complete sterility.

* Pre-Pubertal males sperm will not be affected bc not yet generated

Question 42

Priapism? What is the most common cause? And 2nd most common?

Answer 42

A painful erection UNRELATED to sexual arousal; most common cause is Ischemia.

* 2nd most common cause is use of drugs for ED. spinal cord trauma could also contribute.

Question 43

Cryptorchidism

Answer 43

Undescended testis/es. Both testes originate from the POSTERIOR ABD wall & expected to descend via inguinal canal into scrotum before birth.

* even if surgery or descent - accounts for more prevalence of testicular cancer & male infertility

Question 44

Prostate might undergo benign gradual enlargement due to its glandular tissues being primed by ______

Answer 44

DHT - active form of testosterone

Question 45

______ is a very sensitive test for prostate growth. Will it help determine between malignant or benign? What type of Symptoms?

Answer 45

PSA - Prostate Specific Antigen test - tissues can grow either due to BPH or prostate cancer. levels in blood are a redflag for screening for cancer or effectiveness of Tx.

NORMAL RANGE IS - .1-4.0 ng per mL. 6 or higher is reason for Biopsy

* NO - Trans-Rectal needle or surgical biopsy followed by cytology investigation is needed to determine malignancy.

* Prostate Cancer is ASYMPTOMATIC until late - due to slow development from peripheral regions - in late stage it usually affects bones of the spine

Question 46

Fixed lower back pain, NOT relieved by pain killers and worse in supine position at night, especially in a male patient over 50 years old with obstruction of urination…Red flag for?

Answer 46

Prostate Cancer

Question 47

Testicular Cancer/Seminoma is most prevalent in _______ males. If diagnosed early, 95% could be successfully treated.

Answer 47

YOUNG males - ages 15-34

Question 48

Hormone responsible for Major metabollic effects of the Males?

Answer 48

Testosterone -

DHT responsible for -

1. growth of long bones in appropriate density & closure of epipheseal plates - close during puberty (short stocky build male had an early puberty)
2. 2ndary sexual characteristics which includes everything except testes (primary sexual characteristic)
3. masculine features in psychology - aggressiveness
4. sexual drive
5. fertility - differentiation of spermatogenisis

Prostate converts Testosterone into DHT - prostate has 5 alpha reductase for conversion

Question 49

_____ (basically a misnomer) refers to the increase in size of the prostate in middle-age & elderly men.

• It is characterized by:

Answer 49

BPH - Benign Prostatic Hyperplasia or Benign Prostatic Hypertrophy/misnomer

• Hyperplasia of prostatic stromal & epithelial cells, resulting

in formation of large, fairly discrete nodules in the periurethral region of the prostate.

• STORAGE & VOIDING Symptoms - urinary hesitancy, freq. urination, dysuria (painful urination), increased risk of urinary tract infections, & urinary retention. 50% of men will have by age 50 & 75% will have by age 80.

Question 50

What is the secnd most common type of cancer in male population?

Answer 50

• Prostate cancer
• occurs after age 50
• Mostly in black men & less often in asian men
• Pathogenisis include elevated levels of active testosterone - DHT & estrogen, fat diet, smoking, obesity, genetics, possible viral influences, chronic prostatitis (to amlesser degree) are discussed

Question 51

_____ will transilluminate but a testicular mass will be opaque.

Answer 51

• hydrocele
• Clear fluid accumulates in a sac of tunica vaginalis lined by a serosa with a variety of inflammatory & neoplastic conditions
• benign masses will disappear in supine position & cancer masses will be fixed & changing of position will not make it disapear on palpation or supine position

Question 52

BPH & Prostate cancer in many cases will ______. Many patients in advanced age will die with prostate cancer rather than from it.

Answer 52

coexist; slow development and mostly asymptomatic until late stages

Question 53

Differences between BPH & Prostate Cancer?

Answer 53

Prostate cancer = grows from outside in & will have fixed lower back pain especially at night in supine position. Asymptomatic until late stage.

BPH = grows from inside out. More clinical presentations of obstruction. (Hypertrophy is a misnomer/Hyperplasia is better).

Order of Examination: - Rectal Palpation - discomfort & texture of prostate - if enlarged will protrude into rectum. If Rough and nodular more cancerous, if smooth and movable than benign.

• Ultrasound - will help determine weight or prostate & enlargement, residual volume of urine will determine degree of obstruction.
• Blood test - PSA - will determine degree of growth of prostate tissue that convert DHT. Will NOT determine if malignant or benign. .1 - 4.0 ng per mL is normal range.