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MBBS - Year 3 > Urology - Haematuria, Infection and Incontinance > Flashcards

Urology - Haematuria, Infection and Incontinance Flashcards

1
Q

when are kidney stones most common

A

aged 20-50

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2
Q

once yoube had a stone what are the chances of having another stone in the next 5 years

A

50%

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3
Q

what is the most common cause of stones

A

calcium oxulate

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4
Q

who is more likely to have a kidney stone male or female

A

men
testosterone increases oxalate production

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5
Q

what foods help inhibit stone formation

A

citrate (lemons, oranges etc)

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6
Q

how much water should be drunk daily to stop stones

A

2 for women
2.5L for men

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7
Q

what colour should the urine be

A

clear or pale yellow

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8
Q

what diet is worst for stones

A

high animal protein and high salt

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9
Q

what are other types of less common stones

A

uric acid stones - gout
calcium phosphate
infection stones - soft branching stones
cystine - inherited form - cystine urea

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10
Q

what is an issue for uric acid stones

A

cant see on x ray

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10
Q

why do kidney stones form

A

get saturation of salt and waste production - precipitates out (crystals)

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11
Q

how do you increase the amount of salt a volume can take

A

add heat
more alkaline - dissolves more calcium oxulate, uric acid and cystine

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12
Q

what are specific risk factors for stones

A

overactive parathyroid gland - hyperparathyroidism - releases calcium form body (bone) - increase in excreted calcium

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13
Q

what symptoms do you get with kidney stone

A

loin to groin pain - loin cholic only if in the kidney
in/visible haematuria
nausea vomiting
recurrent UTI
sepsis

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14
Q

why do you get loin to groin pain

A

ureter innervated by the same dermatomes

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15
Q

what is a stone emergency

A

infection behind stone
infected obstruction
complete blockage (swollen) and sepsis risk
- needs draining (nephrostomy tube)

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16
Q

what are the 3 ways to view stones and which is best and where can they see stones

A

USS – in kidney, bladder NOT ureter ureter is deeper and near bone
Xray – 80-90% stones can be seen
CT – BEST – all stones visible – see size, placement and density

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17
Q

what is the best pain killer for stones

A

diclophenec anti-inflammatories (IV or rectal)

or IV paracetamol

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18
Q

do all kidney stones need to be removed

A

no 2/3 of people can have stones in a kidney and it stays and doesnt grow

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19
Q

what are treatments for kidney stones

A

Lithotripsy - sound waves crack stone into smaller pieces
operation - ureteroscpe - then laser

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20
Q

what do you do for large stones?

A

PCNL
staghorn stones - likely to be infection struvite stones

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21
Q

how do you prevent further chance of stones

A

Investigations
Serum calcium and urate - hyperparathyroidism
Lifestyle
Fluids - 2-3L add lemon or lime
Occupational adjustment
Diet
Animal proteins - reduce
Salt - reduce
Oxalate rich foods - chocolate, nuts etc
Calcium - recommended intake

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22
Q

what are the 4 types of epithelium

A

Cuboid epithelium
Columnar epithelium
Transitional cell epithelium
Squamous epithelium

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23
Q

what parts of the renal system are made up of transitional epithelium

A

urinary tract lining
renal pelvis
ureter
bladder
urethra - up to fossa navicularis

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24
Q

what can cause haematuria

A

Cancer
- Bladder
- Kidney
- Ureter
- Urethra
- Prostate
Stones
Infection
- Lower UTI
- Pyelonephritis
Others - trauma, anticoagulants

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25
Q

what do you want to know in a history

A

Onset and duration
Associated symptoms
causes
Risk factors
Occupation
Family history
Fitness

26
Q

what are some risk factors associated with bladder cancer

A

Age - 60-70
Sex - male
**Smoking - MAIN ONE
Occupational exposure
Drugs
- Cyclophosphamide, Phenacetin
Chronic irritation
- Stones
- Catheter
- Schistosomiasis
Pelvic radiotherapy

27
Q

what are some occupations associated with TCC

A

Rubber manufacture
Dye manufacture
Fine chemicals
Retort houses of gas works
Rope and textile manufacture
Hairdressers
Leather workers
Plumbers
Painters
Drivers- Diesel exhaust

28
Q

what is the examination

A

Abdomen
External genetalia
DRE- digital rectal examination
Urine diptick
MSU - mid stream urine - to stop contamination
Cytology

29
Q

how do you diagnose TCC

A

Investigation over age 50
Upper tracts
Ultrasound
IVU
CT scan
Bladder, urethra
Cystoscopy
MSU
Cytology
90% sensitive in high grade TCC
False negative 40-70%

30
Q

how does bladder cancer present

A

Haematuria
LUTS
Storage symptoms
Recurrent UTI
Others
Pneumaturia
Pain
Lower lib swelling
Bone pain, anorexia, weight loss
Anuria

31
Q

how common is bladder TCC

A

4TH Commonest Ca
2nd commonest urological cancer
13000 new cases in UK/ year
5000 deaths
Majority have curable disease

32
Q

what is bladder caner staging

A
33
Q

what is treatment and staging of bladder cancer

A

TURBT - transurethral resection of bladder tumour
MRI/ CT pelvis and abdomen
Chest x ray
Bone scan

34
Q

how is bladder cancer staged

A
35
Q

how is the cancer classed

A

Number
Single
Multifocal

Appearance
Papillary 70% - Ta
Solid 10% - T2
Flat 10%
Mixed 10%

36
Q

what is urinary diversion and what are the procedures

A

Ileal conduit -
Orthotopic Neobladder
Ileal
Ileo colic
Colonic
Continent pouch
Ureterosigmoidostomy

37
Q

what is the survivability of different stages of bladder cancer

A
38
Q

pain followed by haematureia

A

cancer

39
Q

haematuria followed by pain

A

stone

40
Q

what is staging of TCC

A
41
Q

how des TCC spread

A

Usually papillary
Direct extension to
Renal vein
Vena cava
Lymphatic spread to
Para aortic
Para caval
Pelvic
Blood spread to
Liver
Lung
bones

42
Q

what is treatment of TCC

A

Curative
Nephro-ureterectomy - remove ureter as it will likely develop cancer
Uretero-renoscopic laser ablation
Palliative
Systemic chemotherapy
Palliative surgery
Arterial embolisation

43
Q

what is 5 year survivability of TCC

A

5 year survival
Organ confined 60-100%
Locally advanced 20-50%
Node positive 15%
Pulmonary bone metastasis 10%

44
Q

Why is kidney cancer increasing

A

More searching radiography
We are living longer

45
Q

What are common risk factors for cancer

A

Obesity and smoking

46
Q

What is the most common type of kidney cancer

A

Clear cell (75-80%)

47
Q

what is the 2nd most common type of kidney cancer

A

Papillary (type 1 and 2) (10-15%)

48
Q

What is the 3rd most common renal cancer

A

Chromophobe (young females)

49
Q

what are the rarest types of renal cancer

A

Medullary - sickle cell - very aggressive
Collecting duct

50
Q

What are other types of renal cancers

A

Urothelial - urothelium cancer - common
Sarcomas
Wilms - kids - surgery and chemo
Benign and inflammatory lesions
- oncocytomas surgery at 6-7cm
- angiomyelolipoma - blood, fat and muscle - 4cm can spontaneously rupture - females in pregnancy - progesterone
-

51
Q

What are the 4 Bosnian classification of renal cysts

A
  1. Benign simple cyst
  2. Minimally complex cyst
    2F - 2 follow in up - monitor for 5 years can become cancer (thick wall)
  3. Indeterminate cyst mass - surgery maybe
  4. Clearly malignant - surgery
52
Q

Which cancers are associated with con Hipple-Lindau

A

Clear cell RCC
Retinal angiomas
Pheochromocytosis - adrenal gland
Hemangioblastomas of the central nervous system

53
Q

Why can you get a cough with renal cancer

A

Mass hits the bottom of the diaphragm and causes irritation

54
Q

What is Stauffers syndrome

A

paraneoplastic presentation due to hepatomegaly

55
Q

what endocrine does the kidney produce

A

1,25-
dihydroxycholecalciferol, renin, erythropoietin, and various prostaglandins

56
Q

What is poly cystic kidneys

A

Autosomal dominant- resulting I’m multiple cysts in the kidneys

57
Q

How does PCK present

A

Pain, size (abdomen distended), haematuria (they pop), asymptomatic, hypertension,

58
Q

Effect of ketamine on kidneys

A

Very dangerous - destroys kidneys - no major surgery

59
Q

Diversion of urine methods

A

Nephrostomy
Ilial conduit - use a bit of the ilium and similar to stoma
Neobladder - continence system (retains urine - may need to self catheterise)

60
Q

TURBT — when is it used

A

All bladder tumours - to have tissue to determine the staging of the bladder cancer

61
Q

How do you determine the stage of bladder cancer

A

MRI
CT
TURBT - tissue to see the layers

62
Q

What is urethral syndrome

A

Symptoms of a UTI without the UTI

63
Q
A

MBBS - Year 3 (13 decks)

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