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Medicine phase 1 > Week 11 - Genitourinary System > Flashcards

Week 11 - Genitourinary System Flashcards

1
Q

what is screening

A

A test offered to an asymptomatic person to detect those who have a high probability of having a disease
Not a diagnostic procedure (screening does not diagnose) – those with a positive test need further investigation

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2
Q

important requirements for a screening programme

A
  1. The condition should be an important problem for the individual and the community
  2. There should be an accepted treatment for patients with the disease
  3. Facilities for diagnosis and treatment should be available
  4. There should be a recognisable latent or early stage
  5. There should be a suitable test or examination
  6. The test should be acceptable to the population
  7. The natural history of the condition, including development from latent to declared disease, should be adequately understood
  8. There should be an agreed policy on whom to treat as patients
  9. The cost of the case finding programme should be economically balanced in relation to expenditure on medical care as a whole
  10. Case finding should be a continuing process
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3
Q

describe a cervical smear test

A

Carried out at the GP surgery/sexual health centre
A brush is used to remove cells from the cervix
these are transferred to a pot of preservative
this is then tested for HPV - also cytology test if positive
designed to check cells from cervix for any changes

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4
Q

what is HPV

A

human papilloma virus
very common and is normally asymptomatic - most people clear the infection themselves
high risk HPV can cause changes in cells which can progress to cancer in some people

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5
Q

risk factors for cervical cancer

A

HPV
smoking
poor immune function eg. immunosuppression
multiple sexual partners

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6
Q

how does HPV invade the body

A

enters cervical epithelia at the transformation zone
Micro abrasions or epithelial trauma exposes basement membrane of cervix allowing virus to enter into replicating cells
HPV replicates in maturing squamous cells producing koilocytes

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7
Q

what does HPV do once in the body

A

low risk HPV tend to result in free viral DNA within the cell
high risk subtypes incorporate their DNA into that of the host cell
viral E6 and E7 proteins reactivate the cell cycle in cells that are not normally proliferating - they:
Bind to RB, which results in promoting the cell cycle
Bind to p53 disrupting cell death and prolonging the life of the cell
Induce centrosome duplication and genomic instability
Upregulate telomerase preventing replicative senescence

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8
Q

precursor lesions for cervical cancer

A

CIN and CGIN
CIN is divided into CIN1, CIN2 and CIN3
main purpose of cervical screening is to detect 2 & 3
CIN1 can resolve without treatment

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9
Q

describe cervical cytology

A

Cells from pot are dispersed and put on a slide in a thin layer – looked at through microscope
The cells from the transformation zone are spread out
Abnormal cells have enlarged, irregularly shaped nuclei - This is called dyskaryosis and is graded as mild (CIN1), moderate (CIN2) or severe (CIN3) depending on the size of the nucleus
These roughly equate to CIN1, CIN2 and CIN3 on histology specimens, but a biopsy is needed to confirm the degree of abnormality eg mild might not actually be CIN1

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10
Q

what is a colposcopy

A

place that does the diagnostic work on treatment required
outpatient clinic usually in a hospital
Examination of the cervix using a specialist microscope
Acetic acid is applied to highlight any abnormalities
Patients can have biopsies taken and treatments for abnormalities detected

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11
Q

breast screening process

A

Women 50-70 are invited for mammogram every 3 years - 2 x-rays taken of each breast
Those with abnormal or unsatisfactory results are seen at specialist clinic for triple assessment:
Examination
Radiology – repeated mammogram or ultrasound
Biopsy

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12
Q

bowel screening process

A

Aim is to detect precancerous changes and early cancers
Men and women aged 50-74 are invited to participate every 2 years
A faecal immunochemical test (FIT) is sent in the post for completing at home
One sample of stool is collected and returned in a pre-paid envelope - This is tested for haemoglobin – most bowel cancers cause bleeding which is visible in stool
Results are sent to the patient within 2 weeks
If the level of haemoglobin is above 80ugHb/g faeces, patients are referred for colonoscopy
Bowel polyps can be detected

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13
Q

problems that can occur if homeostasis is not maintained

A

haemorrhage
Unusual eating or drinking behaviour.
Severe dehydration, rapid fluid loss from gut (cholera etc) or after burns etc.
Unintended consequences of drug actions
(eg diuretics like Lasix can cause potassium depletion)

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14
Q

recommended uk salt intake

A

should eat no more than 6g of salt/day. Many adults exceed this

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15
Q

typical renal blood flow

A

625ml/100g/min

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16
Q

describe the two types of nephron

A

Superficial – have short loops that dives into medulla
Juxta-medullary – longer loops
Water reabsorption is more effective in the longer juxta-medullary nephrons

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17
Q

parts of a nephron

A 
renal corpuscle (glomerulus and bowman's capsule)
renal tubules (proximal convoluted tubule, loop of henle and distal convoluted tube)
collecting duct (different origin so sometimes is said it is not part of nephron)
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18
Q

describe the cortex of a kidney

A

the body/supporting tissue

Contains glomeruli, bowman’s capsule and convoluted tubules

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19
Q

describe the medulla of a kidney

A

where most filtering happens

organised into renal pyramids

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20
Q

renal hilum components

A

renal vein
renal nerve
renal artery

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21
Q

main blood supply to kidney

A

renal artery which arises from the abdominal aorta

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22
Q

which renal artery is longer

A

right renal artery is longer as it has to pass behind the IVC to reach the right kidney

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23
Q

normal glomerular filtration rate

A

90-140ml/min

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24
Q

describe glomerulus ultrafiltration

A

force of hydrostatic pressure in glomerulus pushes out water and small molecules through slits between podocytes
filtrate is passed into bowman’s capsule

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25
Q

describe reabsorption

A

reabsorbtion mainly in PCT
complete reabsorption of glucose and amino acids
water and solutes driven through epithelial cells of tubule wall and are taken up by peritubular capillaries
Na+ reabsorption is important as it creates osmotic pressure that drives water and an electrical gradient that drives negative ions out into capillaries

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26
Q

describe the loop of henle

A

main function is to create and maintain an osmolarity gradient in the medulla that enables the collecting duct to concentrate urine
descending limb is thinner - highly permeable to water so water leaves by osmosis making filtrate more concentrated - some Na+ loss
thicker ascending limb actively pumps out Na+ making medulla salty - no water loss here

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27
Q

absorption and secretion in DCT

A

absorbs ions including sodium, chloride and calcium but is impermeable to water
aldosterone and parathyroid hormone control the process - PH causes more calcium channels to be inserted, increasing Ca absorption
similar structure and function to PCT but it does less

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28
Q

describe secretion

A

active pumping into tubules
secretes molecules out of the blood and into the urine
pumping rates controlled by hormones – aldosterone can adjust rate of N+ and K+ secretion

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29
Q

describe collecting duct function

A

Main function is to concentrate urine and preserve water – this is made possible by the osmolarity gradient generated by loop of henle
As collecting duct descends deeper into the medulla it gets saltier and the filtrate loses water
Antidiuretic hormone (ADH) controls amount of water that is reabsorbed by controlling amount of aquaporin channels (duct permeability)
When dehydrated – more water is reabsorbed back to blood and excreted urine is more concentrated
Collecting duct cells are permeable to water, then water moves out of the duct to concentrate filtrate to form urine

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30
Q

max and min urine output

A

max is ~20ml/min

min is ~1ml/min

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31
Q

describe what happens in the collecting ducts when excess water is consumed

A

plasma osmolarity falls
Hypothalamus secretes less ADH/AVP
Collecting Duct walls loose permeability to water
Dilute urine is produced

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32
Q

describe the renin/angiotensin/aldosterone system

A

if formation of glomerular filtrate is reduced, the renin/angiotensin/aldosterone system reads the reduction in filtration as a reduction in bp
If juxtaglomerular apparatus detects low Na+ in distal tubule it reads this as hypo-filtration and so low bp
Hypo-filtration initiates secretion of Renin by the Juxtaglomerular apparatus
Renin splits Angiotensinogen to make Angiotensin I which is converted to Angiotensin II, a powerful vasoconstrictor.
This system regulates renal blood flow and glomerular filtration rate

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33
Q

function of aldosterone

A

aldosterone increases when electrolyte concentrations fall
aldosterone increases reabsorption of Na+ and Cl- ions from Loop, Distal Tubule and Duct cells. It also ↑ K+ secretion
when electrolyte reabsorption increases, water reabsorption also increases

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34
Q

describe the structure of the bladder

A

bladder wall is smooth muscle called detrusor - SM allows large volume changes
bladder neck is a triangular region of smooth muscle - internal urinary sphincter is here

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35
Q

ureter function

A

transports urine from kidney to bladder

there are two - one from each kidney

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36
Q

describe bladder filling

A

the bladder fills when sphincter pressures or urethra pressures > vesicle pressures - No flow out
Bladder empties when vesicle pressures > sphincter pressures or urethra pressures - Fluid pushes past sphincter to escape

37
Q

describe how a catheter works

A
  1. Place one opening in the bladder to allow direct filling and measure bladder pressure
  2. Inflate balloon to close off urethra
  3. Position second opening in the urethra to measure the sphincter pressure
  4. Then fill the bladder and record the pressure to establish bladder compliance.
  5. As bladder fills watch for signs of bladder wall contraction and sphincter contraction
38
Q

describe the difference between a sphincter urethrae in a male and female

A

in males - very strong band of skeletal muscle sitting around the urethra that is able to deliver high pressures
females have a weaker external sphincter with less skeletal muscle and it has the potential for damage during natural childbirth

39
Q

what is the urethra

A

a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males

40
Q

describe the pressure and volume changes in the storage phase

A
  1. Early filling phase, low pressure in bladder, bladder wall and ext sphincter relaxed, both sphincters have low pressure but higher than in bladder – smooth muscle stretches to accommodate extra volume
  2. No flow in urethra: urethral pressure > bladder pressure
  3. Sensations develop, then sphincter contracts to maintain continence – bladder keeps filling and there is a second sensation which is the first urge to micturate
41
Q

describe the pressure and volume changes in the voiding phase

A
  1. ‘Urge’ sensation then ‘Voluntary voiding’ (VV)
  2. Bladder contracts,
    urethra and sphincters relax - bladder pressure increases - Flow in urethra: bladder pressure > urethral pressure.
  3. ‘Voluntary’ stop flow - sphincters can stop the flow, bladder wall continues to contract so pressure keeps rising - then a 2nd voiding phase which is accompanied by a drop in sphincter activities and a later rise in bladder pressure
42
Q

describe the innervation to the bladder and sphincters

A

Sympathetic: from L1, L2 – go through autonomic ganglia and fibres continue to bladder wall and internal sphincter - hypogastric nerve
Parasympathetic: from S2, S3 and S4 – fibres go through a different route but still go to Bladder wall - pelvic nerve
Somatic: from S2, S3 and S4 - Sensory and motor fibres to external sphincter - pudendal nerve
- Sympathetic NS responsible for urine retention
- Parasympathetic NS is responsible for voiding phase (peeing)

43
Q

describe the positioning of the afferent and efferent nerves at the bladder

A

Afferents:

  1. Sensory fibres sense the stretch of the bladder wall - These afferents run in the hypogastric nerve and enter cord in the upper lumbar roots.
  2. Other sensors near the urethra sense flow of urine (not shown below)
  3. Skeletal muscle sensors in the external sphincter

Efferents:

  1. Parasympathetic to detrusor
  2. Sympathetic to detrusor and internal sphincter
  3. Somatic to external sphincter
44
Q

describe the role of sympathetic and parasympathetic fibres at the bladder

A

Storage Phase -
Sympathetic effects dominate during bladder filling.
Fibres in the hypogastric nerve suppress contraction of the detrusor.
Somatic fibres in the pudendal nerve control the external sphincter

Voiding Phase
Parasympathetic actions dominate during emptying.
Fibres in the pelvic splanchnic nerve cause the detrusor to contract.

45
Q

compare the normal bladder pressure relationship to a neurogenic and atonic bladder

A

Normal pressure–volume relationship, fills slowly to ~375 ml, then reflex contractions start, then stop
Neurogenic bladder, contraction starts at lower volume – increased reflex activity – can be result of disease
Atonic bladder: pressure rises slowly as bladder fills – no active reflexes – may have to use catheter to empty bladder

46
Q

what is the affect of a partially obstructed urethra on urine flow rates

A

If urethra is narrowed, flow rate is reduced.
Time of flow is increased.
Volume voided may be reduced, leading to increased frequency of voiding.

47
Q

which gender have separate urinary and reproductive tracts

A

women

males have combined tracts at the urethra

48
Q

function of vas deferens

A

takes sperm upwards from testis to the urethra

in spermatic cord

49
Q

structure of the peritoneum

A

there is a parietal and visceral layer

it is a serous membrane

50
Q

describe parietal peritoneum

A

lines the internal surface of abdominopelvic wall
derived from the somatic mesoderm in the embryo
 It receives the same somatic nerve supply as the region of the abdominal wall that it lines; therefore, pain from the parietal peritoneum is well localised. Parietal peritoneum is sensitive to pressure, pain, laceration and temperature

51
Q

describe the visceral peritoneum

A

derived from the splanchnic mesoderm and invaginates to cover the majority of the abdominal viscera
same autonomic nerve supply as the viscera it covers
pain from the visceral peritoneum is poorly localised and the visceral peritoneum is only sensitive to stretch and chemical irritation

52
Q

intraperitoneal organ examples

A

intraperitoneal organs - spleen, stomach and liver

53
Q

retroperitoneal organs

A

oesophagus, rectum and kidneys - initially were in peritoneum in embryo
part of duodenum, descending colon, middle third rectum, pancreas, adrenal glands, proximal ureters, renal vasculature

54
Q

functions of the kidneys

A

filter waste – produces urine
regulates blood - pressure, ions, pH, osmolarity, volume, glucose level
hormone production - calcitriol (active vitamin D) - raises blood calcium levels by increasing absorption from the gut, kidney and stimulation of release from bones - also produces Erythropoietin – secreted in response to hypoxia or low blood glucose

55
Q

components of the hilum

A

renal artery, renal vein, renal nerve and ureter

56
Q

describe the medulla

A

functional tissue where main filtering happens

organised into renal pyramids

57
Q

structure of the cortex

A

body of the kidney

contains glomeruli, bowman’s capsule and convoluted tubules

58
Q

what does a renal corpuscle and renal tubules make up

A

nephrons

59
Q

components of a renal corpuscle

A

glomerulus and bowmans capsule

60
Q

components of renal tubules

A

PCT, loop of henle and DCT

61
Q

where does the filtered fluid go

A

comes in through renal corpuscle and then is filtered and passed into PCT, loop of henle, DCT, collecting duct and then into ureter

62
Q

what are diuretics

A

medicines that promotion urination - increases salt and water excretion
used to to treat conditions like heart failure, cirrhosis or high blood pressure (hypertension)

63
Q

what is horseshoe kidney

A

Condition where the 2 kidneys fuse at the lower end of the abdomen/upper pelvis and occurs in utero
1 in 500 people
Most cases are asymptomatic
More common in boys, and most cases are asymptomatic but sometimes it can lead to urinary tract infections (UTIs)

64
Q

describe the structure of pyramids (in medulla)

A

Papilla are at the top of the pyramids and these link to form a minor calyx which drains the pyramids – minor calyx join to form major calyx
Renal pelvis is where major calyx come together – RP takes urine down through ureter

65
Q

describe the breakdown from the renal artery

A

breaks down into arteries that supply the lobes
Interlobar artery – supply the renal lobes – goes into cortical blood vessels
Cortical blood vessels – supplying the cortex
Arcuate blood vessels - found at the border with the cortex and medulla and are shaped in arcs and come from the interlobar arteries

66
Q

which renal vein is longer

A

left

67
Q

where do renal veins drain to

A

IVC

68
Q

effects of polycystic kidney disease

A

high level of cysts leads to destruction of parenchymal leading to loss of nephrons
raised bp
headaches
abdominal pain

69
Q

function of ureter

A

transports urine to bladder from kidneys

70
Q

peristalsis

A

is contraction of smooth muscle in ureter to allow urine to pass from kidney to bladder

71
Q

describe the bladder

A

The urinary bladder is a muscular organ comprised of specialised smooth muscle called the detrusor. This organ helps store the urine and also helps in its removal from the body. This muscle is oriented in many directions to help in its contraction and relaxation in expanding and shrinking dependent on the amount of urine present

72
Q

why are the testes external

A

External due to being temperature sensitive - The testes help maintain the temperature of the sperm a couple of degrees centigrade less than the rest of the body

73
Q

what is the cremaster muscle

A

it is what controls whether testes are lower or higher – when it contracts it raises testes towards body, raising temp of sperm

74
Q

describe the development of testes

A

begins in abdomen

descend into scrotum around 7th month in utero

75
Q

sperm production

A

seminiferous tubules produce spermatozoa (sperm cells) - immature sperm cells
mature in epididymis

76
Q

structure of testes

A

covered by tough fibrous layer called tunica - tunica vaginalis is the outer layer and tunica albuginea is the inner layer
tunica albuginea forms 200-200 lobules which contain 1-4 seminuferius tubules

77
Q

describe cryptorchidism

A

maldescent of testis/testes 0 improper or incomplete descent of testis into scrotum
bilaterally (both sides) can result in infertility
spontaneous descent occurs in most cases in first year

78
Q

describe varicocoele

A

dilation of pampiniform venous in testicle which may be due to obstruction of the testicular vein
pampiniform venous plexus usually drains the testes so it can look like a bag of worms

79
Q

describe hydrocoele

A

accumulation of fluid within the tunica vaginalis

examination with a penlight reveals a translucent scrotum

80
Q

parts of the male urethra

A

prostatic
membranous
pendulous (penile)

81
Q

describe the prostatic urethra

A

contains:
urethral crest - long fold in the posterior wall of urethra - can stop passage of sperm into bladder when distended
prostatic utricle – blind ended structure and represents the origin of where the vagina and uterus would have developed in a female
Sphincter urethrae is an external sphincter - controls urine expulsion and is a second sphincter as well as the internal urethral sphincter - internal one is under involuntary control whereas the external one is under voluntary control

82
Q

describe the membranous urethra

A

Contains Cowper glands – secrete glycoproteins in mucous during sexual arousal - This fluid produced by these glands lubricates the urethra and penis, helps remove debris and dead cells and neutralizes acidity within the urethra

83
Q

structure of prostate

A

biggest accessory gland
Two thirds are glandular and remaining third is fibromuscular in structure
central zone - surrounds the ejaculatory ducts - the ducts here indirectly empty into prostatic urethra
transitional zone - surrounds urethra
peripheral zone - main body - ducts here vertically empty into prostatic urethra

84
Q

prostate function

A

Secretes proteolytic enzymes into the semen which break down clotting factors in the ejaculate – allows semen to remain in a fluid state
Muscles of the prostate also ensure that semen is forcefully pressed into urethra during ejaculation

85
Q

gonads in males and females

A

testes and ovaries

86
Q

ligaments at uterus

A

Round ligament – maintains anteflexion of uterus i.e. fundus pointing forward
Broad ligament – acts as a mesentery and has a minor role in keeping the uterus forward

87
Q

positionings of uterus

A 
Anteverted – orientated forward
Anteflexed – fundus forward relative to cervix
Retroverted – orientated backward
retroflexed – fundus points backward
normal is anteverted, anteflexed
88
Q

what is the normal positioning of a baby in pregnancy

A

External cephalic version

89
Q

ectopic pregnancy

A

implantation of fertilised egg outside the uterus

mainly occurs in fallopian tube

Medicine phase 1 (14 decks)

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