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Nursing Science 3 > WEEK 3 - Renal Calculi & Prostate Cancer > Flashcards

WEEK 3 - Renal Calculi & Prostate Cancer Flashcards

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1
Q

What are the four main types of renal calculi?

A
  1. Calcium stones
  2. Struvite stones
  3. Uric acid stones
  4. Cystine stones
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2
Q

Which form of stone is most common?

A

Calcium stones

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3
Q

What leads to calcium stone formation?

A

High levels of Ca in blood and urine - may lead to decreased Ca in the body

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4
Q

What are the four causes of Calcium stones?

A
  1. Idiopathic
  2. Intestinal hyperabsorption of calcium
  3. Hyperparathyroidism
  4. Bone demineralisation
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5
Q

How do struvite calculi form?

A

Form in alkaline urine and in the presence of urease-producing bacteria such as Klebsiella or Pseudomonas

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6
Q

Struvite calculi are more common in?

A

People who frequently have infections - women are more prone to UTIs and so are more prone to having struvite calculi

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7
Q

When do uric acid calculi develop?

A

In gout and when there is a high concentration of uric acid in urine (genetic disorder of amino acid disorders)

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8
Q

Are uric acid calculi visible on imaging? Why or why not?

A

NOP

This is because uric acid calculi form in the urinary epithelium

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9
Q

What period of time in the lifespan are cystine calculi most common?

A

Childhood

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10
Q

Cystine calculi are due to?

A

Genetic defect in the renal transport of cystine, leads to cystinuria

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11
Q

List some risk factors for renal calculi development

A
  1. Being male
  2. Being old
  3. Being indigenous Australian
  4. Having a family history of kidney stones
  5. Living in tropical, hot weather
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12
Q

What are three factors influencing calculus growth?

A
  1. Crystal growth-inhibiting factors
  2. Crystal particle retention
  3. Tissue damage from urea-splitting pathogens
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13
Q

Primary manifestation of renal calculi?

A 
Renal colic (pain that comes and goes) due to peristalsis of the ureters in an attempt to remove calculi
Pain is also associated with nausea and vomiting
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14
Q

Sign of renal calculi mid ureter?

A

Flank pain or pain in the groin or lower abdomen

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15
Q

Sign of renal calculi in the lower ureter?

A

Urinary urgency and incontinence

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16
Q

What is non colicky pain caused by?

A

Renal calculi distending the renal calyces or renal pelvis

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17
Q

Two tests for diagnosis of renal calculi?

A
  1. Urinalysis

2. Intravenous pyelography

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18
Q

Treatment for renal calculi?

A
  • Calculus removal via surgery

- Prevention via increased fluid intake and increased dietary fibre

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19
Q

Risk factors for prostate cancer?

A
  • Age (older than 65)
  • Race (African men more susceptible)
  • Family Hx (causes 8x increase in risk)
  • Hormones (increased [T])
  • Diet (high fat intake increases sex hormones and growth factors)
20
Q

Protective factor against prostate cancer development?

A

Diet rich in selenium, vitamin E, lycopene.

Delays development of PCa until 75-85 years of age.

21
Q

What is degree of differentiation and how is it related to cancer?

A

Degree of differentiation = degree to which cancer cells are developed

  • Poorly differentiated cells = more aggressive cancer cells
  • Well differentiated = less aggressive cancer cells
22
Q

Metastasis is most likely to occur in which areas of the body?

A
  1. Bone, followed by
  2. Lung
  3. Liver
  4. Pleura
23
Q

Where is testosterone found and what are its effects?

A

Found in circulation - primary circulating androgen

Effects = increased muscle tone, increased libido (desirable effects)

24
Q

Where is DHT found and what are its effects?

A

Found in the prostate - primary prostatic androgen

Effects - decreased muscle tone, decreased libido, increased acne (undesirable effects)

25
Q

What enzyme catalyses the reaction forming DHT from T?

A

T ——–5 alpha reductase——-> DHT

26
Q

What receptors do T and DHT bind to, and which binds more potently?

A

Both bind to androgen receptors (ARs), DHT binds more potently

27
Q

What are the functions of the glandular epithelium and fibromuscular stroma in the prostate?

A
  • Glandular epithelium = produces secretions for sperm

- Fibromuscular stroma = smooth muscle that houses PICs that contract and mix secretions for sperm

28
Q

Other than DHT, T can also be converted to what hormone via which enzyme?

A

T can also be converted to oestogen via aromatase

29
Q

DHT can be converted to which oestrogenic metabolite?

A

3-beta-diol

30
Q

What happens to male sex hormones with age that can lead to prostate cancer?

A

With age - decreased activity of 5-alpha reductase = decreased DHT. Leads to T being converted to oestrogen instead and causes elevated levels of oestrogen and testosterone
Oestrogen and testosterone together are carcinogenic

31
Q

How do elevated E and T levels together cause cancer?

A

Via:

  • ROS generation
  • DNA toxicity
  • Stimulation of IGF (insulin-like growth factor)
  • Stimulation of TGF-beta (transforming growth factor beta)
32
Q

What is the first sign of PCa?

A

Obstruction of the upper urinary tract = slow urinary stream, nocturia, incomplete emptying, urinary frequency

33
Q

In prostate cancer, what does the prostate feel like upon digital rectal examination?

A

Nodular and fixed

34
Q

Signs of late stages of PCa?

A
  • Bone pain (occurs when cancer metastasises in bones)
  • Low back pain
  • Oedema in the lower extremities (indicative of liver congestion)
  • Enlarged lymph nodes and liver
  • Mental confusion when cancer spreads to the brain
35
Q

Tests for prostate cancer screening?

A
  • Transrectal ultrasound
  • Digital rectal exam
  • Prostate-specific androgen testing
36
Q

How is prostate cancer confirmed?

A

Via biopsy ONLY

37
Q

Outline the three categories of PCa?

A
  • T1 = asymptomatic, may or may not be palpable on DRE
  • T2 = palpable on DRE and confined only to the prostate
  • T3 = extended beyond the prostate
38
Q

Which grading system is used to classify prostatic cancer?

A

The Gleason grading system

39
Q

What is radical prostasectomy (RP)?

A

The complete removal of the prostate and seminal vesicles, pelvic lymph nodes may or may not also be removed.

40
Q

What is a TURP?

A

Transurethral resection of the prostate - complete removal of the prostate via the urethra

41
Q

How is metastatic disease treated in prostate cancer?

A

With androgen ablation or androgen deprivation therapy

42
Q

What is an orchiectomy?

A

Surgical removal of the testicles, effective for symptom reduction and extends survival

43
Q

What do GnRH analogues do?

A

Block LH and FSH = decrease testosterone production

44
Q

What do anti-androgens do?

A

Block testosterone uptake by the prostate

45
Q

Why is metformin used in treatment for metastatic disease as a result of PCa?

A

Metformin is used for its antineoplastic properties - eg. prevents cellular proliferation

46
Q

How is bone pain associated with late-stage PCa treated?

A

With bisphosphonates (eg. Pamidronate) - inhibit osteoclastic activity

Nursing Science 3 (21 decks)

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