Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urology > Week 6 > Flashcards

Week 6 Flashcards

1
Q

RFs for bladder CA?

A 
smoking, 2nd hand smoke exposure
chemical/carcinogen exposure
infrequent urination/dec water intake
diet: high beef, pork, fat, coffee
(+) FHx
radiation exposure
low nutrient intake (B6, antioxidants)
advancing age >60 yo
schistosomiasis infxn leading to SCC
cytoxin and opium addiction
artificial sweeteners
chlorinated water
genetics - mutation of p53
high beer consumption 
physical trauma to bladder epithelium
colon CA mets
endometriosis
chemotherapy
chronic cystitis
HPV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MC type of bladder CA?

A

TCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

other types of bladder CA?

A 
adenocarcinoma
SCC
undifferentiated carcinomas
mixed carcinomas 
secondary bladder CA (mets to bladder from melanoma, lymphoma, stomach, breast, KD, and lung)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

presentation of bladder CA?

A

85-90% present with gross microhematuria, usu painless
potentially nocturia, dysuria, urge incontinence
if advanced will see frequency, urgency, dysuria, flank pn, abd pn, bone pain (if mets), anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

dx of bladder CA?

A

labs will show hematuria, possibly pyuria, possibly azotemia when obstruction
anemia of chronic dz on CBC
cytology will show exfoliated cells from neoplastic epithelium, bx will show dysplastic changes
can also do IVP for tumor detection, pelvic CT will show extent of bladder invasion and enlarged nodes
CXR, bone scans, PET for mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ddx bladder CA?

A 
IC
UTI
urolithiasis
neurogenic bladder
endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

naturopathic management and treatment of bladder CA?

A 
eliminate toxins
general multivit
seacure - fish protein
glutamine for gut healing from chemo
B6, Vit C
immunomodulating herbs: rhodiola, mushrooms
hoxsey tea or essiac tea, allium sativa
lactobaccilus casei - increases urinary mutagen excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MC causes of neurogenic bladder?

A 
MS
spinal cord injury
DM
ALS
parkinson's 
spinal or pelvic surgery
degeneration from aging or inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

two types of bladder sphincters?

A

internal involuntary smooth muscle sphincter at the bladder neck (sympathetic innervation)
external voluntary striated-muscle sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the fxn of the uretovesical jxn?

A

prevents backflow of urine from bladder to upper tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ANS innervation of ureterovesical jxn?

A

parasympathetics (S2-4) - cholinergic, enervates bladder base and internal sphincter, allows emptying
sympathetics (T10-12), noradrenergic, enervates bladder base and internal sphincter, maintains sphincter tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CNS innervation of ureterovesical junction?

A

somatic (S2-3) control of voluntary sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

spastic bladder is dt lesion where? too much what type of activity? common causes?

A

spastic bladder dt lesion above sacral micturition center (above S2-4)
too much parasympathetic activity: detrusor hyperreflexia leads to loss of bladder capacity
common lesions above brainstem affecting voiding include dementia, vascular accidents, MS, tumors, inflammation (encephalitis, meningitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ssxs of spastic bladder?

A

voluntary urination, frequent, spontaneous, triggered by spasm, decreased volume, residual urine, recurrent UTIs, increased pressure, bulbocavernosal, knee, ankle or toe reflexes increased
reduced bladder capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

diagnosis of spastic bladder?

A

periodic IVUs and retrograde cystograms will show low bladder volume, bladder wall hypertrophy
U/S or urethral catheterization to determine pos-void residual volume
cystoscopy to evaluate for strictures or stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

where is the lesion with flaccid bladder? injury to what 4 potential areas?

A

lesions at or below the sacral micturation center
injury to detrusor motor nucleus (S2-4, anterior horn damage), afferent feedback pathways, injury causing poor detrusor distensibility (peripheral nerve injury), injury to external sphincter (pelvic fx, radical perineal surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ssxs of flaccid bladder?

A

increased volume, decreased P
retention w/overflow incontinence, lack of erections, loss of sensation in dermatomes
LMN changes: hypoactive reflexes, diminished sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

dx of flaccid bladder?

A

KUB to look for fx, calculi
IVU to look for hydronephrosis, obstruction
cystogram to assess detrusor, vesicoureteral reflux
cystoscopy will show lg capacity with some wall hypertrophy
urodynamic studies will show low bladder filling P, weak detrusor activity, lg vol of residual urine, dec tone of external sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ddx of neurogenic bladder?

A

cystitis, anterior vaginal wall prolapse, chronic urethritis, bladder outlet obstruction, IC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

goals of treatment of neurogenic bladder?

A

restore low P activity to the bladder, preserve renal fxn, continence, control infxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tx options for spastic bladder?

A

pharm agents such as parasympatholytics and anticholinergics, TCAs, C-fiber afferent neurotoxins

neurostim: bladder pacemaker
instrumentation: indwelling catheter, condom catheter and leg bag
surgical: sphincterotomy, rhizotomy, urinary diversion
naturopathic: tx underlying neuro condition if possible, prevent UTIs and stones, antispasmodics, anticholinergics, neurorestoratives, antioxs, HP remedies

22
Q

tx options for flaccid bladder?

A

suprapubic P (crede’s maneuver) to increase intra-abd P

pharm: acetylcholine derivatives
instrumentation: intermittent catetherization q 3-6 hrs
surgical: implant or TURP
naturopathic: above tx options, support nerve tone and re-growth, neurorestoratives, HP

23
Q

complications of neurogenic bladder?

A

infection
calculus dt low fluids, bed rest, immobilization
renal amyloidosis
sexual dysfxn

24
Q

RFs for urinary incontinence?

A 
female
advancing age
abd or pelvic surgery
pelvic radiation
BPH
25
Q

types of urinary incontinence?

A 
urge
stress
overflow
mixed 
functional
26
Q

ssxs of urge incontinence?

A

abrupt, strong urge, delayed incontinence after cough or increased intra-abdominal P

27
Q

causes of urge incontinence?

A

BPH, stroke, MS, alzheimer’s, parkinson’s, supra sacral spinal cord lesion, neurogenic, aging

28
Q

sxs of stress urinary incontinence?

A

incontinence immediately after cough, sneeze, laugh or increase abd pressure

29
Q

causes of stress urinary incontinence?

A

urethral architecture, pelvic trauma, neurologic lesions, drugs (alpha adrenergic antatagonists)

30
Q

sxs of overflow incontinence?

A

feeling of fullness, frequent dribbling

31
Q

causes of overflow incontinence?

A

drugs (alpha adrenergic agonists, anticholinergics, CCBs, loop diuretics), fecal impaction, diabetic neuropathy, MS, organ prolapse, BPH, PCA, urethral stricture, neurogenic

32
Q

ssxs of functional incontinence?

A

feel urge ok just can’t make it to the bathroom

33
Q

diagnosis of incontinence?

A 
voiding diary
PE: suprapubic tenderness, DRE, male genitalia, pelvic exam
cystometrogram
EMG
stress cystourethrogram
uroflowmetry 
urethral P profilometry
urinary stress test
34
Q

treatment and management considerations of incontinence?

A

pharm: urge - anticholinergics, antimuscarinics; stress - alpha adrenergic agonists, estrogen
surgical
naturopathic: discont causative medications, bladder retraining, pelvic MS exercises, exercise-based behavioral therapy
identify and eliminate food allergies
avoid caffeine, tea, alcohol
anti-inflams: flax, bromelain, vit C, vit E
botanicals: soy, zea mays, gallium, anticholinergic/UR, ephedra, pygeum and serenoa (OR), st. john’s wort (UR)
biofeedback
acupuncture
hypnosis
yoga

35
Q

changes you see in IC? what is seen on cystoscopy specifically? what is IC?

A

changes seen with IC include fibrosis of the bladder wall, loss of bladder capacity, chronic inflam with mucosal disruptions, cellular infiltrates and sub-urothelial hemorrhages
Hunner’s ulcers seen on cystoscopy
hypersensitive bladder syndrome, leaky bladder

36
Q

etiological theories of iC?

A

inflammation
uroepithelial dysfunction
food allergies
deficiency of GAG coating in bladder epithelium
chronic infxn, instrumentation, urinary calculi
toxins from food additives
pathological organisms dormant in bladder
deficiency of NO
trauma
genetics: HLA-DR6, FZD8

37
Q

presentation of IC?

A

urinary frequency, urgency, progressively worsening bladder pn w/filling, better w/voiding
possible non-specific pelvic pn, mb dyspareunia, usu normal PE but mb suprapubic tenderness

38
Q

diagnosis of IC?

A

diagnosis of exclusion
hx, pelvic pain/urgency/frequency
variable tenderness of abd wall, buttocks, pelvic floor, urethra
labs show no sxs of infxn, possibly hematuria, normal renal function unless obstruction or reflux
run cytology if high risk for bladder CA
imaging shows normal urogram
cystoscopy w/hydrodistention under anesthesia to visualize bladder - shows chronic wall inflammation, edema, small mucosal disruptions, cellular infiltrates, glomerulations, punctate hemorrhages

39
Q

special test to run for IC?

A

potassium sensitivity test or Parson’s test - infiltration of KCl solution causes pain from epithelial leakage

40
Q

NIH diagnostic criteria for IC?

A

pts must have either glomerulations on cystoscopic exam OR hunner’s ulcers AND either pain assoc w/the bladder or urinary urgency

41
Q

when do you start to consider IC?

A

pts tx for overactive bladder who continues to experience persistent urge w/ associated suprapubic/pelvic discomfort or pn
pt who does not respond to empirical abx therapy for “recurrent UTI”
female pt who cont to have pelvic pn after endometriosis therapy
male pt who has been tx for prostatitis w/multitude of therapies but cont to have pelvic pn perceived to be associated with the bladder and possibly irritative voiding sxs

42
Q

DDX of IC?

A

TB of bladder, schistosomiasis, cystitis, urethritis, spastic urogenic bladder, anxiety d/o, colorectal CA, bladder CA
drug effects
F: vaginal wall prolapse, endometriosis, uterine fibroids
M: prostate CA, prostatitis, pelvic floor hypertonicity

43
Q

tx options for IC?

A

pharm: prednisone, anti-histamines, general or vesical sedatives, abx, CCBs, TCAs, gabapentin, LDN
procedures to increase bladder size, irrigation, intravesical tx options
surgery: to augment bladder capacity
naturopathic: psychosocial support, avoid activities that flare, guided imagery, avoid allergens, decrease EtOH, coffee, soda, tomato, citrus, MSG, chocolate, bananas, beer, cheese, GACs, quercetin, cystoprotek, melatonin, EFAs, buffered vit C, estriol suppositories, arginine, anti-inflam diet, anxiolytics, immuno-modulators, antispasmodics, vitanica supplement, physical therapy, sitz baths, HP

44
Q

in both men and women, inquisitive, self-exploration, contraception –> cystitis, often hematuria
dx via plain fill or cystoscopy, stone may form rapidly in alkaline pH
tx: cystoscopic or suprapubic removal

A

foreign bodies introduced into the bladder and urethra

45
Q

secondary to either obs distal to the vesical neck or UMN neurogenic bladder
inc intravesical P cz vesical mucosa to push between hypertrophied muscle bundles leading to vesicoureteral reflux and urine retention, risk of CA
tx: may need surgical removal

A

diverticula

46
Q

from diverticulitis, Colon CA, Crohn dz, vesical irritability, passage of feces adn gas through urethra, change in bowel habits, sxs of intestinal obstruction and abd tenderness
dx via barium enema, cystoscopy and cystograms
tx: proximal colostomy, defect closure

A

vesicointestinal fistula

47
Q

secondary to obstetric, surgical or radiation injury, or invasive CA of the cervix, constant urine leakage

dx: pelvic exam w/cystoscops, radiopaque dye w/x-ray, bx may show carcinoma
tx: electrocautery of the opening, direct surgical repair

A

vesicovaginal fistula

48
Q

primarily in 20-40 yo A.A. men, no pathognomonic sxs - soe dysuria, mild obstruction, enlarged pear-shaped bladder

dx: excretory urograms and cystoscopy show dilation of both upper tracts and upward displacement and lateral displacement of the bladder
tx: surgical removal of fat
prognosis: progression to hydronephrosis in most cases; surgery for urinary diversion

A

perivesical lipomatosis

49
Q

complete ventral defect of the urogenital sinus and the overlying skeleton
lower central abd occupied by the inner surface of the bladder, whose mucosal edges are fused with the skin
urine spurts onto abd wall
renal infxn and hydronephrosis common
staged surgical reconstruction (may lead to incontinence)

A

exstrophy

50
Q

embryonic canal connecting bladder to allantois (umbilicus) persists, becomes a cyst
leakage of urine through umbilicus
adenocarcinoma may occur in the persistent urachal cyst
tx: surgical excision

A

persistent urachus (cyst)

Urology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions