Week 7 - Urinary System Disorders and Female Reproductive System Flashcards

1
Q

Identify the patient groups that are more likely to develop a lower UTI. Can you explain why these patient groups are at greater risk?

A
  • Women (short urethra tract)
    • sexually active (microtrauma)
    • pregnant
    • changes in balance of commensal organisms of perineum tract/genital tract (e.g. antibiotics)
  • Immunocompromised
  • Neonates
  • Diabetes mellitus
  • Bladder instrumentation
  • Lower urinary tract obstruction
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2
Q

Name the organism that is most commonly involved in lower UTIs. What is the source of this organism?

A

E. Coli. Travels from bowel, to perineum, to urethra

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3
Q

Describe the clinical features that might make you suspect the presence of a lower UTI.

A
  • foul-smelling, cloudy urine
  • +/- haematuria
  • SSx of cystitis
    • suprapubic pain
    • inflammation and spasm (intense sensation that bladder is not empty)
    • tenderness on palpation
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4
Q

What factors can lead to the development of a upper UTI?

A

spread of infection further into kidney can occur via two routes:

  • E. coli responsible for 75% of upper UTIs
  • rarely, blood-borne infection can induce acute pyelonephritis
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5
Q

Summarise the pathophysiology of acute pyelonephritis

A

Pyelonephritis describes severe infectious inflammatory disease of the renal parenchyma, calices and pelvis, that can be acute, recurrent, or chronic

Ascending infection begins in the lower urinary tract.

Predisposing factors:

  • urinary tract obstruction, congenital or acquired
  • catheterization of the urinary tract, cytoscopy
  • pregnancy
  • gender and age (young women are more affected than men in ratio of 6:1)
  • diabetes mellitus
  • immunosuppression and immunodeficiency
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6
Q

Compare the clinical features of acute pyelonephritis to those associated with a lower UTI.

A

UUTIs SSx:

    • SSx of LUTIs
  • fever, rigors, nausea and vomiting can occur
  • sudden onset of pain and radiations to iliac fossa/groin
  • tenderness and muscle guarding
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7
Q

Outline the risk factors for renal calculi

A
  • conditions with increased stone-forming minerals e.g. gout
  • dietary intake of stone-forming minerals
  • highly concentrated urine e.g. hot climates, dehydration
  • correlation with chronic diseases e.g. diabetes mellitus
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8
Q

What are the most common types of renal calculi?

A
  • calcium oxalate phosphate (75-85%)

- uric acid stones (5-10%; more common in males)

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9
Q

Describe the pathophysiology associated with a calcium oxalate stone.

A
  1. Begin as deposits of calcium phosphate in the sub-endothelial space around the renal papilla
  2. Deposits are referred to as Randall’s plaques
  3. The plaques extrude into the urinary lumen, acting as nuclei for crystal overgrowth
  4. Aggregation gradually leads to the formation of discrete stones
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10
Q

Summarise the clinical features associated with renal calculi

A
  • +/- pain and tenderness on palpation
  • insidious onset of dull flank pain
  • +/- radiations of pain to the groin
  • blood or stony fragments in urine
  • +/- increased pain with urination
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11
Q

The ureteric impaction of a kidney stone can lead to pain in the groin and genital region. Explain the neurology of this referred pain pathway

A
  • visceral afferents supply the ureter enter the spinal cord at levels T11-L2.
  • this can lead to pain referral from genitofemoral nerve (L1-L2)
  • T11/12 supplies skin in the groin region. Referral of pain can occur here also.
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12
Q

Define the term chronic kidney disease (CKD)

A

Refers to the progressive loss of renal function over a period of months to years. A spectrum of disease ranging from mild (eGFR 60-89mL/min) to renal failure (eGFR <15mL/min).

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13
Q

List some potential causes and risk factors associated with CKD

A

Aetiology:

  • complication of systemic disease e.g. hypertension, diabetes
  • or, can arise secondary to renal disease e.g. chronic glomerulonephritis, chronic pyelonephritis

Risk factors:

  • family history, advanced age (>50 years), ASTI
  • obesity, type 2 diabetes, smoking, hypertension (changing vessels of kidneys)
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14
Q

Summarise the clinical features associated with CKD. Which features are particularly relevant to osteopathic practice?

A
  • systemic in nature and reflect a decline in normal renal function:
    • accumulation of nitrogenous wastes and toxins
    • fluid overload, electrolyte imbalances and metabolic acidosis
  • neuromusculoskeletal changes arise due to disturbances in calcium and phosphate metabolism
    • musculoskeletal changes
    • bone pain, increased fracture risk, muscle weakness, myalgia, arthralgia
    • neurological changes
    • peripheral neuropathies (especially sensory in lower limb)
    • cognitive or behavioural effects
    • neuromuscular irradiation: muscle cramps, twitching
  • increased fracture risk is a contraindication for HVLA
  • myalgia and arthralgia may present as a typical musculoskeletal concern, but when taken in context with other SSx, may lead to visceral DDxs
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15
Q

Identify the most common form of bladder malignancy.

A

98% of bladder cancers are primary tumours.

Transitional cell carcinoma (TCC) contributes to 90% of bladder cancer

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16
Q

List the risk factors associated with bladder cancer.

A
  • older male
  • cigarette smoking (including second hand smoking)
  • exposure to chemicals
  • family history
17
Q

What clinical features might make you suspicious of a bladder malignancy? Can you explain why bladder tumours are often asymptomatic in their early stages?

A
  • haematuria
  • urinary symptoms (frequency, urgency or leakage)
  • pain (usually suprapubic or perineal)
  • palpable abdominal mass
  • systemic features (fatigue, weight loss, lack of appetite, but may appear later)
  • hepatomegaly and lymphadenopathy indicates metastatic spread

Bladder tumours can be mistaken for a UTI or a stone, or may be asymptomatic in early stages. WHY??

18
Q

Identify the most common type of kidney cancer. From which cells of the kidney does this malignancy arise?

A

Renal Cell Carcinoma (90% of cases)

These arise from epithelial cells that line the renal tubules

19
Q

List the risk factors for kidney cancer

A
  • male sex
  • cigarette smoking
  • chronic diseases (chronic kidney disease, obesity, hypertension)
  • family history
  • certain genetic conditions
  • exposure to chemicals (asbestos, heavy metals, petroleum products)
20
Q

Outline the possible clinical features of kidney cancer

A
  • many patients lack obvious systems until the advanced stages
  • haematuria is the most consistent symptom
  • flank pain
  • palpable abdominal mass
  • systemic features: weight loss, night sweats, unexplained fever
  • metastatic disease is the presenting feature in up to 30% of patients
21
Q

Name the malignancies that are most likely to metastasise to the kidney

A
  • breast
  • stomach
  • contralateral kidney
  • lymphoma
22
Q

The structures of the female reproductive system can be classified as (i) internal organs, (ii) external genitalia and (iii) accessory glands. List the structures that fall into these categories.

A

Internal Organs

  • located within the pelvic cavity
  • ovaries (primary reproductive organ)
  • accessory ducts (uterine tubes, uterus, vagina)

External Genitalia

  • mons pubis
  • labia
  • clitoris
  • structures of the vestibule

Accessory Glands
- Mammary glands (accessory reproductive role)

23
Q

How would you introduce the ovaries in the setting of a lab exam (structure/function/location)?

A
  • Structure
    • paired almond-shaped glands
  • Location
    • lie in a shallow fossa, in the angle between the internal and external iliac vessels on the obturator nerve
  • Function
    • involved in the production of the female gametes and synthesis of female sex hormones, including oestrogen and progesterone
24
Q

Consider the histological structure of an ovary.

a) Define the term tunica albuginea

A

The thin fibrous capsule that surrounds the ovary, the external aspect is referred to as the germinal epithelium (layer of cuboidal cells that is continuous with the peritoneum)

25
Q

Consider the histological structure of an ovary.

b) What structures are found in the cortex of an ovary?

A

The cortex houses the forming gametes

  • embedded with ovarian follicles: consisting of an oocyte surrounded by somatic cells
  • somatic cells: granulosa cells, theca cells
  • oogenesis: primary follicle to secondary follicle to tertiary (vesicular) follicle
26
Q

Consider the histological structure of an ovary.

c) Define the term ovarian follicle. What cells does it consist of?

A

Fluid-filled sac that surrounds the immature oocyte

27
Q

Consider the histological structure of an ovary.

d) What structures are found in the medulla of an ovary?

A

Contains large vessels and nerves