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Phase 2a > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are the major functions of the Kidney?

A
  • Filter or secrete waste/excess substances
  • Retain albumin and circulating cells
  • Reabsorb glucose, amino acids and bicarbonates
  • Control BP, fluid status and electrolytes
  • Activates 25-hydroxy vitamin D (by hydroxylating it to form 1,25 dihydroxy
    vitamin D)
  • Synthesis erythropoietin
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2
Q

What is the Glomerular Filtrate rate?

A

The volume of fluid filtered from the glomeruli into Bowman’s space per unit
time (minutes)

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3
Q

What is the normal GFR?

A

120ml/min

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4
Q

What is Nephrolithiasis?

A

Renal Stones (calculi) commonly made from Calcium Oxalate (90%) which form in the CD and can be deposited anywhere from the renal pelvis to the urethra.

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5
Q

What are some other types of renal stone compared to calcium oxalate?

A

Calcium phosphate/oxalate (80%)
Uric Acid (10%)
Cysteine Stones
Struvite (infection often from proteus)

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6
Q

What are the 3 main narrowing’s where renal stones may be found?

A
  • Pelviureteric junction
  • Pelvic brim
  • Vesicoureteric junction
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7
Q

What is the epidemiology of Renal Stones?

A

10-15% lifetime risk
More common in males
Peak age 20-40 yrs
Increasing Incidence

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8
Q

What are the risk factors for renal stones?

A

Chronic Dehydration
Low urine output
Primary kidney disease
HyperPTH/Hypercalcaemia
UTIs
Hx of previous renal stone
Drugs

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9
Q

What are the main causes for renal stones?

A

Anatomical:
Congenital - horseshoe kidney
Acquired - Obstruction, trauma, reflux

Urinary Factors:
Metastable urine
Increased Calcium oxalate, urate, cystine
Dehydration

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10
Q

What is the pathophysiology of renal stones?

A

Excess solute in the collecting duct

Supersaturated urine - favours crystallisation

Stones cause regular outflow obstruction - lead to hydronephrosis

Subsequent dilation of the renal pelvis will lead to lasting kidney damage

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11
Q

What are the 2 key complications of renal stones?

A

Obstruction - leading to AKI

Infection - causing obstructive pyelonephritis

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12
Q

What is the presentation of Renal Stones?

A

Maybe ASx and never cause issue

Renal colic is presenting complain in Symptomatic kidney stones:

Loin to groin pain that is colicky (peristaltic waves leading to fluctuations in severity)

LUTs (dysuria, strangury Urgency, Frequency)

Px cant lie still

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13
Q

What is Colicky Pain?

A

Pain that fluctuates in severity often due to peristalsis causing contaction of gallstones/renal stones which then settles when the contraction stops

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14
Q

What are the symptoms of Renal Colic?

A

Loin to groin pain
Px cannot lie still

Haematuria/dysuria
Nausea or vomiting
Reduced urine output (LUTS)
Symptoms of sepsis, if infection is present

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15
Q

What are the primary investigations for Renal stones?

A

1st Line - KUB (kidney, Ureter, Bladder) XR - 80% specific

Gold Standard - NCCT (non-contrast CT) KUB - 99% specific (diagnostic)

Bloods:
FBC
U&Es - raised creatinine in AKI

Urinalysis -Microscopic haematouria

Pregnancy test

Urine dipstick - UTI

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16
Q

What investigation would be used for hydronephrosis from a suspected renal stone for a Px who is pregnant?

A

Ultrasound as they cannot have CT

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17
Q

How can a kidney be drained if infected?

A

Ureteric stend
Nephrostomy

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18
Q

What is the Treatment for Renal Stones?

A

Sx management:
Strong Analgesic - IV/PR Diclofenac for severe pain (opiates in poor renal function Px)
Hydrate - oral or IV
Anti-emetics

Abx if infection present:
Cefuroxime / IV Gentamicin

Stones normally pass spontaneously if small enough (<5mm)

Elective Surgical Tx if too big to pass

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19
Q

What is a key complication of kidney stones?

A

Pyonephrosis
- Pus filled fluid caused by infection and obstruction together.

Tx with septic six

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20
Q

What Treatment is used if a stone is too large to pass spontaneously?

A

ESWL:
Extracorporeal shockwave lithotripsy - ultrasound that fragments the stones (does not clear the stone so Px still has to pass stone)

Ureteroscopy - laser

PCNL:
Percutaneous nephrolithotomy - keyhole surgery to remove large/complex stones

Nephrectomy - if kidney contributes to less than 15% renal function

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21
Q

What is a big issue once you have had one renal stone?

A

Recurrence is very common and therefore take steps to prevent it:

Overhydration
Low Ca dietary intake
Low sodium diet
Reduce BMI
Active lifestyle

Potassium Citrate and Thiazide diuretics may also help

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22
Q

What are some differential Diagnoses for Loin pain other than Renal Colic?

A

Vascular accident - Ruptured AAA
Bowel Pathology - diverticulitis, appendicitis
Gynae - Ectopic pregnancy
Testicular torsion
MSK pain

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23
Q

What is the treatment for bladder stones?

A

Conservative - asymptomatic
Endoscopic + BOO Tx
Open Laparoscopic surgery - for large stones

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24
Q

What is Acute Kidney Injury (AKI)?

A

Abrupt decline in kidney function that occurs within hrs to days.

This is characterised by a increase serum creatinine and urea and a reduced urine output due to a decline in GFR failing to maintain acid base homeostasis

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25
Q

What is the mortality rate for AKI?

A

25-30%

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26
Q

What are the NICE criteria for AKI

A

Rise in creatinine of ≥ 25 micromol/L in 48 hours

Rise in creatinine of ≥ 50% in 7 days

Urine output of < 0.5ml/kg/hour for > 6 hours

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27
Q

What system is used to classify the stage of AKI?

A

KDIGO:
Rise in creatinine of ≥ 25 micromol/L in 48 hours

Rise in creatinine of ≥ 50% in 7 days

Urine output of < 0.5ml/kg/hour for > 6 hours

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28
Q

What is the old staging classification system for AKI?

A

RIFLE:
* Risk
* Injury
* Failure
* Loss
* End-stage renal disease

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29
Q

What is the epidemiology of AKI?

A

Common - affects 15% of all hospital admissions

25% of Px with sepsis and 50% of Px with septic shock will have AKI

Common in elderly

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30
Q

What are the risk factors for AKI?

A

CKD - acute on chronic kidney disease
Increased age >75yrs
Liver disease
Diabetes Mellitus
Nephrotoxic Drugs
Organ failure - HF
Sepsis

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31
Q

What are the different groups of causes of AKI?

A

Pre-renal (most common) - due to inadequate blood supply reaching the kidneys reducing filtration of blood.

Renal - where there is intrinsic disease within the kidney that leads to the reduced filtration of blood

Post renal - caused by obstruction to the outflow of urine from the kidney, causing back-pressure into the kidney and reduced kidney function. This is called an obstructive uropathy

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32
Q

What are the commonest causes of AKI?

A

Cardiogenic shock

Major Surgery

Nephrotoxins

Sepsis

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33
Q

Give some Pre-renal causes of AKI?

A

Dehydration
Hypotension (shock)
Heart failure

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34
Q

Give some Renal Causes of AKI?

A

Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis
Nephrotoxic Drugs (DAMN)

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35
Q

What are the DAMN drugs that cause nephrotoxicity?

A

Diuretics
ACEis/ARBs
Metformin
NSAIDs

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36
Q

Give some Post renal Causes of AKI?

A

Kidney stones
Masses such as cancer in the abdomen or pelvis
Ureter or uretral strictures
Enlarged prostate or prostate cancer

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37
Q

Give some examples of drugs that are nephrotoxic

A

NSAIDs
ACEi
ARBs
Aminoglycosides - gentamicin
Diuretics

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38
Q

What is the pathophysiology of AKI?

A

Impaired ability of the kidneys to filter the blood.

This leads to accumulation of substances that are usually excreted

Can lead to damage of the nephron and kidney

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39
Q

What substances will accumulate in AKI?

A

K+ - hyperkalaemia - arrythmias

Urea - Hyperuraemia - Pruritis and confusion

Fluid - oedema - pulmonary and peripheral

H+ - acidosis

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40
Q

What are the symptoms of AKI?

A

Sx of underlying cause:

Sx of accumulation of substances:
Encephalopathy - confusion/drowsiness
Pericarditis
Skin manifestations
Oedema
Dyspnoea
Oligouria
Metabolic acidosis
Arrythmias
Haematuria/proteinuria

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41
Q

What are some clinical signs of AKI?

A

Signs of hypovolaemia may be present:
reduced BP
Reduced skin turgor

Uraemic skin changes

Signs of volume overload may be present:
Bibasal crackles
Raised JVP
Peripheral oedema

Palpable bladder

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42
Q

What are the primary investigations for AKI?

A

Establish cause - Pre/Renal/Post
+ diagnose with KDIGO classification

U&Es + electrolytes

FBC/CRP check for infection

Kidney biopsy - intra renal damage

Uss - post renal obstruction

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43
Q

What is a good way to establish whether AKI is caused by pre/renal/post renal cause?

A

Urea:Creatine Ratio
U:Cr > 100:1 = pre-renal

U:Cr < 40:1 = renal

U:Cr 40-100:1 = Post renal

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44
Q

What is the treatment for AKI?

A

Tx complications:
Hyperkalaemia - Calcium gluconate
Metabolic acidosis- Sodium Bicarbonate
Give IV fluids - if hypovolaemic

Tx underlying cause - STOP nephrotoxic drugs

Last resort - Renal Replacement Therapy (dialysis)

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45
Q

What are the indications for RRT?

A

Acidosis (pH < 7.1)
Fluid overload (oedema)
Uremia that is symptomatic
Hyperkalaemia >6.5 or ECG changes

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46
Q

What are some potential complications of RRT?

A

CVD - MI
Infection

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47
Q

What are the major complications of AKI?

A

Hyperkalaemia
Fluid overload, heart failure and pulmonary oedema
Metabolic acidosis
Uraemia (high urea) can lead to encephalopathy or pericarditis

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48
Q

What is Chronic Kidney Disease (CKD)?

A

Progressive decline in renal Function where GFR <60ml/Min for more than 3 months

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49
Q

What are the common causes of CKD?

A

Diabetes
Hypertension
Age-related decline
Glomerulonephritis
Polycystic kidney disease
Medications such as NSAIDS, proton pump inhibitors and lithium

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50
Q

What are the risk factors for CKD?

A

Older age
Hypertension (most common)
Diabetes (most common)
Smoking
Renal artery stenosis
PKD
Use of medications that affect the kidneys
Nephrotoxic Drugs

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51
Q

What are the stages of CKD?

A

Classified based on eGFR:
G1 = eGFR >90 w/Renal signs
G2 = eGFR 60-89 w/ Renal signs
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15 (known as “end-stage renal failure”)

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52
Q

What are the best readings to quantify CKD?

A

eGFR
Urine Albumin:Creatine Ratio (ACR)

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53
Q

What is the pathophysiology of CKD?

A

Many nephrons are damaged in CKD which reduces GFR

Increased burden on remaining functional nephrons

Compensatory RAAS in response to lower GFR which increases transglomerular pressure.

This leads to shearing and loss of basement membrane selective permeability leading to proteinurea (loss of filtration ability)

Angiotensin II upregulates TGF-B and PAI-1 which leads to increased scarring of functional nephrons

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54
Q

What are the symptoms of CKD?

A

Early - ASx due to lots of nephrons in reserve

Sx of CKD arise secondary to substance accumulation and renal damage:
Pruritus (itching)
Lethargy
Anorexia
Nausea
Oedema
Muscle cramps
Peripheral neuropathy

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55
Q

What are the clinical signs of CKD?

A

Hypertension
Pallor
Fluid Overload
Evidence of underlying aetiology

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56
Q

What is the prognosis of CKD correlated with?

A

Poorly controlled HTN
Proteinuria
Degree of scarring on histology

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57
Q

What are the key complications of CKD?

A

Anaemia - due to reduced EPO
Renal bone disease (osteodystrophy due to lack of Vit D activation)
Cardiovascular disease
Peripheral neuropathy
Dialysis related problems

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58
Q

What are the primary investigations in CKD?

A

U&E - eGFR

Urine Albumin:Creatine Ratio (ACR) - >3mmol/l

Urine Dipstick - Haematuria/Proteinuria

Renal USS - Bilateral atrophied Kidneys

FBC - Normocytic Normochromatic Anaemia (due to Dec EPO)

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59
Q

What are the differences Ix findings between AKI and CKD?

A

Hx:
AKI shorter Sx onset
CKD - 3 month Hx

AKI - Serum Creatine Inc : Urine output Dec
CKD - Decreased eGFR

AKI - no Anaemia
CKD - Anaemia due to EPO

AKI USS - normal
CKD USS - Bilateral atrophied kidneys

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60
Q

What is the aim of management in CKD?

A

Slow the progression of the disease
Reduce the risk of cardiovascular disease
Reduce the risk of complications
Treating complications

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61
Q

What is the management of CKD?

A

Tx underlying cause to prevent further deterioration

Tx complications:
Oral sodium bicarbonate to treat metabolic acidosis
Iron supplementation and erythropoietin to treat anaemia
Vitamin D to treat renal bone disease
Dialysis in end stage renal failure
Renal transplant in end stage renal failure

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62
Q

How can CKD progression be slowed?

A

Optimise diabetic control
Optimise hypertensive control
Treat glomerulonephritis

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63
Q

How can the risk of CKD complications be reduced?

A

Exercise, maintain healthy weight, stop smoking

Special dietary advice

Offer Atorvastatin for primary prevention of CVD

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64
Q

What is a Urinary Tract Infection (UTI)?

A

Inflammation in response to an infection that occurs anywhere along the Urinary Tract from the kidneys to the urethra

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65
Q

What are the classifications of UTIs?

A

Upper UTI:
Kidneys - Pyelonephritis

Lower UTI:
Bladder - Cystitis
Prostate - Prostatitis
Epidiymo-Orchiditis
Urethra - Urethritis

Uncomplicated Vs Complicated

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66
Q

What are the organisms that generally cause UTIs?

A

KEEPS:
Klebsiella (10% - catheter associated)
E.coli - (UPEC) most common > 50%
Enterobacter
Proteus 10-15%
S.Saprophyticus

P. aeruginosa - recurrent UTI/underlying pathology

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67
Q

What is the most common cause of a UTI?

A

UPEC:
Uropathogenic Escherichia coli (80% of uncomplicated UTIs)

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68
Q

Who are most affected by UTIs?

A

Women - Due to a shorter urethra and closer to the anus therefore it is easier for bacteria to colonise and cause and infection

Post-menopause - Absence of Oestrogen increases risk

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69
Q

What are some pathological mechainisms of getting UTIs?

A

Catheterisation allowing colonisation

Bowel Flora from perineum (often females)

Reduced flow:
Obstruction (prostate, stones)
Low Urinary volume
Stasis during pregnancy

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70
Q

What are the general symptoms of a UTI?

A

Fever may be only Sx

Abdominal pain, particularly suprapubic pain/discomfort
Vomiting
Dysuria (painful urination)
Urinary frequency
Incontinence
Nocturia

Delirium/Confusion in elderly Px

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71
Q

How are UTIs Diagnosed / what would you find?

A

1st Line: Urine Dipstick
+tve Leukocytes
+tve Nitrites (bacterial breakdown product)
+/- Haematuria

Gold Standard: Mid-stream Urine Microscopy, Culture and Sensitivity (MC+S)
This confirms UTI and IDs pathogen

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72
Q

What would you look for on microscopy in a MC + S)?

A

WBC >10^4 wbc/ml
Bacteria >10^5 cfu/ul = infection
RBCs

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73
Q

What are some common Abx used to treat UTIs in the community?

A

Nitrofurantoin (now more commonly used)
Trimethoprim

+ Amoxicillin, Cefalexin

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74
Q

Why is Trimethoprim used less to treat UTIs these days?

A

Due to much higher levels of antibiotic resistance

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75
Q

What is the treatment for someone who is 65yrs + and has asymptomatic bacteriuria?

A

Do NOT treat

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76
Q

What is the treatment for someone who is pregnant and has asymptomatic bacteriuria?

A

Give treatment (Nitro/Trim depending on trimester) as 20-40% will go on to develop pyelonephritis

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77
Q

What is Pyelonephritis?

A

Upper UTI of the renal parenchyma and upper ureter at the renal pelvis

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78
Q

When would you avoid treating a UTI with Trimethoprim?

A

First trimester of pregnancy as it interferes with folic acid synthesis

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79
Q

When would you avoid treating a UTI with Nitrofurantoin?

A

Third trimester of pregnancy as there is a risk of Neonatal Haemolysis

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80
Q

What do UTIs during pregnancy increase the risk of?

A

Pyelonephritis
Premature rupture of membranes
Pre-term Labour

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81
Q

What is a major risk of catheterisation?

A

Become colonised with bacteria within a few days.
Can cause serious UTIs

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82
Q

What are some complications of long term cathetisation?

A

UTIs/Pyelonephritis
Stones
Obstruction
Chronic Inflammation

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83
Q

What are risk factors for Pyelonephritis?

A

Female sex <35yrs
Urine stasis (due to stones)
Catheters
Structural urological abnormalities
Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
Diabetes

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84
Q

What is the most common causative organism of Pyelonephritis?

A

E.coli

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85
Q

What is the pathophysiology of Pyelonephritis?

A
  • Infection is mostly due to bacteria (primarily E.coli) from own patients bowel
    flora
  • Most common via the ascending transurethral route

Other causes can be via Haematogenous/lymphatic spread

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86
Q

What is the classical presentation of Pyelonephritis?

A

Triad:
Loin Pain
Fever
Pyuria - pus in pee

+ nausea/vomiting
Anorexia
Haematuria
Renal angle Tenderness

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87
Q

What is the primary investigation for Pyelonephritis?

A

1st Line: Urine Dipstick

Gold Standard: Urine MC+S

USS - rule out obstructions

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88
Q

What is the management of pyelonephritis?

A

Hydration/fluid replacement
IV antibiotics – broad spectrum e.g. Co-amoxiclav ± Gentamicin
Ciprofloxacin
Pregnancy - Cefalexin
Drain obstructed kidney
Catheter
Analgesia
Complete 7-14 days (depending on choice of antibiotic)

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89
Q

What are some complications for Pyelonephritis?

A

Renal Abscesses (common in diabetics)
Emphysematous Pyelonephritis

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90
Q

What are the main symptoms of lower UTI?

A

Dysuria
Frequency

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91
Q

What is Cystitis?

A

Urinary infection of the bladder
Commonly due to UPEC

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92
Q

Who is affected by Cystitis?

A

More common in women
Can occur in children

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93
Q

What are the risk factors for Cystitis?

A
  • Urinary obstruction resulting in urinary stasis
  • Previous damage to bladder epithelium
  • Bladder stones
  • Poor bladder emptying
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94
Q

What is a classical presentation of Cystitis?

A

Suprapubic tenderness + discomfort
Increased frequency
Increase urgency
Visible Haematuria

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95
Q

What is the primary Investigations to diagnose Cystitis?

A

1st Line: Urine Dipstick

Gold Standard: Urine MC+S

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96
Q

What is the treatment for Cystitis?

A

First line:
Trimethoprim/Nitrofurantoin
Cefalexin

Second Line:
Co-amoxiclav/Ciprofloxacin

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97
Q

What is Urethritis?

A

Inflammation in the urethra due to infection

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98
Q

What is the most common cause of Urethritis?

A

Sexually acquired condition:

Non-Gonococcal (Chlamydia) - More common
Gonococcal - Less common

Non infective - trauma

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99
Q

What are the risk factors for Urethritis?

A

Male Gay sex
Unprotected sex

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100
Q

What is the presentation of Urethritis?

A

Dysuria +/- urethral discharge (blood/pus)

Urethral pain

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101
Q

What is the diagnostic test for Urethritis?

A

NAAT (Nucleic Acid Amplification Test) - detects STI pathogen (NG/CT)

Urine Dipstick + Urine MC+S if UTI

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102
Q

What is the treatment for urethritis?

A

N.G - IM Ceftriaxone + Azithromycin

C.T - Azithromycin (or Doxycycline)

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103
Q

What is Epididymo-Orchitis?

A

Inflammation of the epididymus which extends to the testes often secondary to urethritis (STI) or Cystitis.

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104
Q

What are the symptoms of Epididymo-Orchitis?

A

Unilateral scrotal pain and swelling
Pain relieved when elevating testes

(DDx - testicular Torsion which is much more acute and N+v)

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105
Q

What diagnostic investigations are done for Epididymo-Orchitis?

A

NAAT
Urine Dipstick
Urine MC+S

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106
Q

What is the treatment for Epididymo-Orchitis?

A

Depends on underlying cause:

STI/UTI to determine Abx

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107
Q

What is an uncomplicated UTI?

A

A UTI in a healthy NON-PREGNANT women with a normally functioning urinary tract

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108
Q

What is a complicated UTI?

A

Most other UTIs (not in non-preggo women)
A UTI in a man
A Px who has abnormal urinary tract (eg. stones)
Systemic disease involving the kidney

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109
Q

What is significant about complicated UTIs?

A

Treatment failure is more likely

Complications are more likely:
Renal papillary necrosis
Renal Abscesses

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110
Q

What is Benign Prostatic Hyperplasia (BPH)?

A

A common urological condition in elderly men

where there is increased size of the prostate gland

without the presence of malignancy

that results in lower urinary tract symptoms

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111
Q

What are the risk factors for BPH?

A

Increased age
Afro-Caribbean (increased testosterone)
Castration is protective

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112
Q

What is the pathophysiology of BPH?

A

Inner transition zone of the prostate gland proliferates

This can lead to compression on the urethra to narrow/block it leading to urinary Symptoms

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113
Q

What are the typical Symptoms that occur in BPH?

A

Lower Urinary Tract Symptoms (LUTS):

  • Nocturia (>30% voided volume at night)
  • Frequency
  • Urgency
  • Post-micturition dribbling
  • Poor stream/flow
  • Hesitancy
  • Overflow incontinence
  • Haematuria
  • Delay in initiation of micturition
  • Incomplete emptying of bladder
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114
Q

What are symptoms of Urinary Storage?

A

Fequency
Urgency
Nocturia (>30%)
Incontinence

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115
Q

What are symptoms of urinary Voiding?

A

Poor stream
Dribbling
Incomplete emptying
Straining
Dysuria

116
Q

What complications may arise in BPH if the urethra is completely occluded?

A

Auria - no urination

Retention
Hydronephrosis
UTI
Stones

117
Q

What is PSA?

A

Prostate Specific Antigen

serine protease responsible for liquefaction of semen

Prostate specific but not condition specific (essentially any condition affecting the prostate will cause a rise in PSA)

118
Q

What are the Diagnostic investigations of BPH?

A

DRE - Digital Rectal exam:
Smooth and enlarged (hard/irregular = cancer)

PSA - may be raised but also raised in cancer

Abdo Exam - enlarged bladder

Urine Dipstick - assess for other pathology

119
Q

What is the treatment for PBH?

A

If Sx minimal - Watch and Wait

Lifestyle advice:
Reduce caffeine
Relax when voiding

Medication:
1st Line - alpha blocker - Tamsulosin
2nd Line - 5-alpha Reductase inhibitors - Finasteride

Surgery (last resort)
Transurethral resection of prostate

120
Q

What is the mechanism of action of Tamsulosin?

A

Alpha blocker that will relax the bladder neck increasing urinary flow rate and improving obstructive Sx of BPH

121
Q

What is a side effect of Tamsulosin?

A

Postural Hypertension

122
Q

What is the mechanism of action of Finasteride?

A

5-alpha reductase inhibitor that will block conversion of testosterone to dihydrotestosterone to reduce prostatic growth

123
Q

What is a common complication of transurethral resection of prostate surgery?

A

Retrograde ejaculation.

124
Q

What is Glomerular Disease?

A

Glomerulonephritis refers to groups of parenchymal kidney diseases that all result in the inflammation of glomeruli and nephrons

125
Q

Explain the Structure of the glomerulus?

A

Tuft of capillaries that has 3 components:
Epithelium – composed of podocytes which only makes contact with GBM via foot processes
Glomerular BM
Fenestrated endothelium – lining of capillaries
Mesangial cells holding it all together

126
Q

What are the classifications of Glomerulonephritis?

A

Nephrotic Syndrome
Nephritic Syndrome (acute GN)
Rapidly Progressive GN

127
Q

What is Nephritic syndrome?

A

inflammation of the blood vessels of the glomerulus leads to blood leaking out but Px does not have a specific underlying cause.

128
Q

What are the features of a patient with Nephritic Syndrome?

A

Haematuria
Proteinuria - <3g/24
Oliguria
Oedema - due to Fluid overload
Hypertension

Reduced GFR - (hypercellular glomeruli 🡪 decreased blood flow and leaky BM 🡪 reduced filtration rate)

129
Q

Give some conditions that present with a clinical picture of nephritic syndrome?

A

IgA Nephropathy
Post Strep Glomerulonephritis
Good Pasture’s Syndrome
SLE Nephropathy
Haemolytic Uremic Syndrome

These are all examples of TYPE 3 Hypersensitivity reactions (except good pasture’s Syndrome). They are the result of immune complex deposition

130
Q

What is the most common cause of Nephritic Syndrome?

A

IgA Nephropathy

131
Q

What is the pathophysiology of Nephritic/Nephrotic Syndrome?

A

They are often caused by an immune response that is triggered from another disease leading to glomerulonephritis.

These then present with Nephritic or Nephrotic syndrome features

If not treated then these can lead to AKI/CKD.

132
Q

What is IgA Nephropathy?

A

(also called Berger’s Disease)
Commonest cause of glomerulonephritis worldwide

IgA levels rise 1-2 days after a viral infection (tonsilitis, gastroenteritis etc).

These IgA deposit in the mesangium (part of glomerulus) activating C3. A Type 3 hypersensitivity Rxn occurs and this causes Glomerulonephritis.

Presents with Nephritic Syndrome

133
Q

What is Glomerulonephritis?

A

umbrella term used to describe inflammation of the Glomerulus/nephrons of the kidney.

Conditions causing glomerulonephritis typically present with either a nephritic or Nephrotic syndrome picture which are a group of symptoms.

134
Q

What is Nephrotic Syndrome?

A

Inflammation of Podocytes leads to protein leaking out of kidneys.
Nephrotic syndrome has a set criteria to fit to be classified as NEPHROTIC.

135
Q

What are the features of Nephrotic Syndrome?

A

Proteinuria (>3.5g/day) – damaged glomerulus more permeable 🡪 more protein come across from blood into nephron 🡪 proteinuria

Hypoalbuminaemia – albumin leaves blood

Oedema (periorbital and arms) – oncotic pressure falls due to less protein in blood 🡪 lower osmotic pressure 🡪 water driven out of vessels into tissues

Hyperlipidaemia and lipiduria – loss of protein = less lipid synthesis 🡪 more lipids in blood 🡪 more in urine

136
Q

What is the criteria for Nephrotic syndrome?

A

A Px must Fulfil:

Peripheral oedema - due to 3rd spacing
Proteinuria more than 3g / 24 hours
Serum albumin less than 25g / L
Hypercholesterolaemia

137
Q

What is the main Difference between Nephritic and Nephrotic syndrome?

A

In Nephritic syndrome - Haematuria predominates

In Nephrotic Syndrome - Proteinuria Predominates

138
Q

What is the characteristic Presentation Nephritic Syndrome?

A

Visible Haematuria
(Ribena/coke coloured Pee)

139
Q

What are the primary investigations for IgA nephropathy?

A

Immunofluorescence - staining for IgA and C3

Microscopy shows IgA complex deposition

140
Q

What is the Treatment for IgA nephropathy?

A

Rapid progression of condition with approx 30% developing ESRF.

ACEi/ARB to control BP and reduce the damage to kidneys.

(can be tried on corticosteroids but doesnt always work)

141
Q

What is Post strep Glomerulonephritits (PSGN)?

A

Immunologically-mediated delayed consequence of pharyngitis or skin infections caused by streptococcus pyogenes that leads to glomerulonephritis and consequential Nephritic Syndrome

142
Q

How long does it take to develop PSGN after infection?

A

2 weeks after pharyngitis from S. pyogenes

143
Q

How is PSGN Diagnosed?

A

Light microscope - hypercellular glomeruli

Immunofluorescence staining - IgG, IgM and C3 deposits along glomerular basement membrane.

Low C3 levels compared to Berger’s Disease which has normal.

144
Q

What is the treatment of PSGN?

A

Only Sx management
Self limiting usually
May progress to rapidly progressive GN

Could Use furosemide for HTN

145
Q

How can SLE cause Nephropathy?

A

Cause Lupus nephritis secondary to SLE

Deposition of Antigen-antibody complexes and ANA in the kidneys leads to nephritis and a nephritic picture

146
Q

How is Lupus Nephritis diagnosed?

A

GS:
renal Biopsy - showing diffuse proliferative glomerulonephritis

Light Microscopy - Hypercellular glomerulus

147
Q

What is the most common form of Lupus Nephritis?

A

Diffuse proliferative glomerulonephritis

148
Q

How is Lupus Nephritis treated?

A

Lifestyle - stop smoking, exercise, dietary advice

Medication:
Corticosteroids -
Immunosuppressive agents - Azathioprine

Hydroxychloroquine

149
Q

What is good Pasture’s Syndrome?

A

Autoimmune disease where there are anti-GBM antibodies that target the lungs and the kidneys causing pulmonary haemorrhage and glomerulonephritis

150
Q

What is the diagnosis of good pasture’s Syndrome?

A

Light microscopy may show crescentic glomerulonephritis

Immunofluorescence staining shows linear deposition of IgG along glomerular capillaries

151
Q

What is the treatment for Goodpasture’s Syndrome?

A

plasmapheresis,
steroids and cyclophosphamide.

152
Q

What conditions lead to a nephrotic syndrome clinical pitcutre?

A

Primary:
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous Nephropathy

Secondary:
Diabetic Nephropathy

153
Q

What is Minimal Change disease?

A

Most common cause of nephrotic syndrome in children:

often due to a benign excessive response to steroids

154
Q

What is the diagnostic findings for Minimal change disease?

A

Light microscopy - normal/no change

Electron Microscopy - Podocyte effacement + fusion

155
Q

What is Focal Segmental Glomerulonephritis (FSG)?

A

Most common cause of nephrotic syndrome in adults:

Associated with HIV, heroin use, sickle cell

156
Q

What are the diagnostic findings for focal segmental glomerulonephritis?

A

Light Microscopy - Segmental sclerosis

157
Q

What is Membranous Nephropathy?

A

The most common cause of nephrotic syndrome in the elderly:

Associated with malignancy, hepatitis B, NSAIDs, SLE

158
Q

What are the diagnostic Findings of Membranous Nephropathy?

A

Light microscopy - Thickened Glomerular BM

Electron Microscopy - Sub epithelial immune complex deposition
Spike + Domeappearance.

159
Q

What is the characteristic clinical picture of Nephrotic syndrome?

A

Frothy urine (proteinuria)

Facial and peripheral oedema

Predisposition to thromboembolic disease

+ specific nephrotic signs

160
Q

How nephrotic syndrome generally treated?

A

Corticosteroids w/ variable response

Minimal change - very responsive

FSG - responds well generally

Membranous Nephropathy - less responsive

161
Q

What conditions can cause both a Nephritic and Nephrotic syndrome clinical picture?

A

Diffuse Proliferative glomerulonephritis

Membranoproliferative Glomerulonephritis

162
Q

What is obstructive uropathy?

A

Blockage of urine flow that can affect one or both kidneys depending on the level/site of the blockage

163
Q

What conditions can cause obstructive uropathy?

A

BPH and stones

164
Q

What is the pathogenesis of obstructive uropathy?

A

Obstruction causes retention of urine.
This increases KUB pressure leading to reflux of backlogged urine into the renal pelvis.

This will lead to hydronephrosis which is more prone to infection

165
Q

What is the treatment of obstructive uropathy?

A

Relieve kidney pressure:
Catheterise / ureteral stent

Tx BPH or stones.

166
Q

What are the main types of GU cancer?

A

Renal Cell Carcinoma
Bladder Cancer
Prostate Cancer
Testicular Cancer

167
Q

What is Renal cell Carcinoma?

A

Renal cell carcinoma (RCC) is the most common type of kidney tumour.
It is a type of adenocarcinoma that commonly arises from the epithelium of the PCT

168
Q

What is Wilms Tumour?

A

A specific renal mesenchymal stem cell tumour that affects children typically under 5 years old

(A.K.A Nephroblastoma)

169
Q

What are the main subtypes of Renal cell carcinoma?

A

Clear cell (80%)

Papillary (15%)

Chromophobe (5%)

170
Q

What are the risk factors for Renal cell carcinoma?

A

Smoking
Obesity
Hypertension
End-stage renal failure
Von Hippel-Lindau Disease
Tuberous sclerosis

171
Q

How does Renal cell carcinoma typically present?

A

Often ASx - 25% metastasised at Dx

Typical Triad of Sx:
Flank pain
Haematuria
Abdominal palpable mass

172
Q

What are the primary investigations for renal cell carcinoma?

A

1st Line: USS
Gold Standard: CT CAP - Diagnostic

Bloods:
U&Es - renal dysfunction
LFTs - liver mets
LDH - if increased = poor prognosis

173
Q

What is the treatment for Renal Cell carcinoma?

A

25% have Mets at Presentation

Partial/Full Nephrectomy

174
Q

What is the the most common type of kidney cancer in adults?

A

Renal Cell Carcinoma

175
Q

What is bladder cancer?

A

Often a transitional cell carcinoma of the bladder due to the transitional epithelium that lines the renal pelvis, bladder, ureter and urethra

176
Q

When is a patient more likely to have squamous cell carcinoma of the bladder?

A

If they have Schistosomiasis infection

177
Q

What is the most common Transitional cell carcinoma?

A

Transitional urothelium cancer (bladder cancer)

This lines the renal pelvis and bladder

178
Q

What are the risk factors for Bladder cancer?

A

Age >40yrs
Male
Smoking
Occupational Exposure - Dyes/paints/rubber
FHx

179
Q

What are the symptoms of Bladder cancer?

A

PAINLESS haematuria (macro/microscopic)

Dysuria (occasionally)

Constitutional Symptoms - weight loss

180
Q

What are the primary investigations for bladder cancer?

A

Gold Standard:
Flexible Cytoscopy + biopsy

CT AP - for staging

181
Q

What is the treatment of bladder cancer?

A

Conservative - support
Surgical:
Transurethral Resection of Bladder Tumour (TURBT)
Cystectomy - last resort

Medical:
Chemotherapy
Radiotherapy

182
Q

What is the most common cancer in males?

A

Prostate cancer

183
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma that arises from the peripheral prostate.

These are often neoplastic and malignant which spread to bones

184
Q

What are the risk factors for prostate cancer?

A

Environmental
Genetics
Increasing age
Afro-Caribbean ethnicity
FHx - accounts for 8% of cases

185
Q

Why is there an increase in the prevalence of prostate cancer?

A

Ageing population
Increased detection

186
Q

What genetic factors increase a patients risk of prostate cancer?

A

BRCA2
HOXB13

187
Q

What is the presentation of prostate cancer?

A

LUTs (Frequency, Hesitancy, terminal dribbling)

Systemic Cancer Sx (weight loss, fatigue night pain)

Bone pain - suggests metastasised to bone (typically lumbar back pain)

188
Q

What are the investigations for prostate cancer?

A

DRE + PSA in community

New First Line:
Multiparametric MRI

Previously Gold Standard:
Transrectal USS + biopsy - Diagnostic

189
Q

What is the grading system used for prostate cancer?

A

Gleason Score
High = worse prognosis

190
Q

What area of the prostate is commonly affected by prostate cancer?

A

Peripheral zone

191
Q

What are the common metastatic sites for prostate cancer?

A

Bones - sclerotic lesions
Brain
Liver
Lungs

192
Q

What are the primary prevention methods for Prostate cancer?

A

Screening? - PSA test (benefits dont necessarily outweigh harms of screening)

Chemoprevention - 5 alpha reductase inhibitors

Diet and Supplements

Exercise and weight control

193
Q

What is the treatment for Prostate cancer?

A

Local - Prostatectomy/radiotherapy

Advanced- Hormone therapy

Metastatic - surgical/medical castration

194
Q

What is the purpose of Hormone Therapy in prostate cancer?

A

Reduce testosterone - reduce cancer growth

195
Q

What are some options for hormone therapy for prostate cancer?

A

Surgical:
Bilateral Orchidectomy - Testicular removal (castration)

Medical:
GnRH receptor agonists - Goserelin
Androgen Receptor Blockers - Enzalutamide

196
Q

How do GnRH receptor agonists work?

A

Goserelin:
Agonist GnRH and therefore these increase LH and FSH

but this leads to exogenous suppression of the HPG axis

197
Q

What is the treatment for metastatic prostate cancer?

A

Surgical Castration
Medical castration (GnRH agonists)
Palliative care

198
Q

What is the most hormone sensitive cancer?

A

Prostate cancer

199
Q

What are the two classes of testicaular tumour?

A

Germ cell (90%):
Seminoma - most common
Teratoma

Non-Germ Cell (10%):
Sertoli
Leydig
Sarcoma

200
Q

What is the most common cancer in young men (20-40yrs)

A

Testicular Cancer

201
Q

What are the risk factors for testicular cancer?

A

Cryptorchidism - undescended teste
Infertility
FHx

202
Q

What is the presentation of Testicular Cancer?

A

Painless lump in testicle which does NOT transilluminate

May also have:
Sx of hyperthyroidism - BhCG mimics TSH

Bone pain - if bone Mets

Breathlessness - if Lung Mets

203
Q

What are the primary investigations for testicular cancer?

A

Urgent (doppler) USS testes (90% diagnostic)

Raised tumour markers:
AFP
BhCG
LDH (Raised non-specifically in tumours)

204
Q

What is the treatment of Testicular cancer?

A

ALWAYS 1ST LINE:
Urgent orchidectomy
offer sperm storage

Adjuvant chemotherapy/radiotherapy

205
Q

What is Polycystic Kidney Disease (PKD)?

A

Cyst formation throughout the renal parenchyma often leading to bilateral enlargement and damage

206
Q

Why may a patient have left sided varicocele in renal cell carcinoma?
(and not Right sided)

A

Left testicular vein drains into the left renal vein; a left RCC can invade the renal vein causing backpressure and varicocele formation

Right testicular vein drains directly into the IVC, therefore a right RCC does not cause a varicocele

207
Q

What are the types of PKD?

A

Autosomal Dominant PKD (ADPKD)

Autosomal Recessive PKD (ARPKD)

208
Q

When does ADPKD typically present?

A

Often presents in later life/adults

209
Q

When does ARPKD typically present?

A

Often presents in neonates and is found on antenatal uss

210
Q

Which is more common ADPKD or ARPKD?

A

ADPKD is more common

211
Q

What are the genetic factors leading to ADPDK?

A

Mutated PKD1 (85%) or PKD2 (15%) on chromosome 16 and chromosome 4 respectively

212
Q

Who is typically affected by ADPKD?

A

More males

213
Q

What are some features of ARPKD?

A

Much less common that ADPKD
A disease of infancy/prebirth
High mortality rate
Many congenital abnormalities

214
Q

What are the genetic factors leading to ARPKD?

A

Mutation in PKHD1 on chromosome 6

215
Q

What is the pathogenesis of ARPKD?

A

Mutation in PKHD1 on chromosome 6

Encodes for Fibrocystin/polyductin protein complex (FPC) which is responsible for the creation of tubules.

Also responsible for maintenance of healthy kidneys liver and pancreas

216
Q

What are some consequential features of ARPKD?

A

affects birth development leading to potters syndrome:
Dysmorphic features such as a flattened nose and Clubbed feet

Most Px with ARPKD develop ESRF before adulthood

217
Q

What is the pathophysiology of ADPKD?

A

Mutation in PKD1/PKD2 which encode for polycystin Ca channel.

In normal circumstances:
Cilia move when filtrate passes and this causes polycystin to open and allows Ca influx to inhibit excessive growth.

In ADPKD the mutation does not open polycystin so Ca cannot inhibit excessive growth leading to cyst formation

218
Q

What is the presentation of ADPKD?

A

Bilateral flank pain
Back or Abdo pain
+/- HTN and Haematuria

Can also cause extra-renal cysts - berry aneurysms

219
Q

What is the diagnostic investigation of PKD?

A

Kidney Uss - Enlarged bilateral kidneys with multiple cysts

Genetic testing for PKD mutations
FHx of PKD

220
Q

What is the management of PKD?

A

Non-curative

Manage Sx:
HTN - ACEi
ESRF - RRT

221
Q

What are some ongoing problems throughout life that Px with PKD may have?

A

Liver failure due to liver fibrosis
Portal hypertension leading to oesophageal varices
Progressive renal failure
Hypertension due to renal failure
Chronic lung disease

222
Q

What are the common STIs?

A

Chlamydia
Gonorrhoea
Syphilis

223
Q

What is Chlamydia?

A

Chlamydia Trachomatis is a gram negative obligate intracellular parasite.

It is responsible for the STI chlamydia which is the most common STI in the UK

224
Q

What are risk factors for Chlamydia?

A

Age < 25
Multiple Sexual partners
Unprotected Sex
Sharing unwashed sex toys

225
Q

What are the symptoms of Chlamydia?

A

Commonly ASx (70% of women and 50% of men)

Can present with:
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)

226
Q

What is the primary investigation for chlamydia?

A

NAAT
looks for DNA/RNA of chlamydia

227
Q

What is the treatment for Chlamydia?

A

doxycycline 100mg twice a day for 7 days.

228
Q

What are some complications of Chlamydia?

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

229
Q

What is Gonorrhoea?

A

Caused by Neisseria Gonorrhoea (a gram -tve diplococci) it is the second most common STI in the UK.

It infects columnar epithelium lined mucous membranes of the urethra, rectum, conjunctiva and pharynx and endocervix

230
Q

What are the risk factors for Gonorrhoea?

A

Frequent uprotected sex
MSM (men who have sex with men)
multiple sexual partners

231
Q

What are the symptoms of Gonorrhoea?

A

More commonly Symptomatic (90% males and 50% females)

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain
Testicular pain or swelling (epididymo-orchitis)

232
Q

What are the primary investigations for gonorrhoea?

A

NAAT

Charcoal endocervical swab and microscopy and culture

233
Q

What is the treatment for gonorrhoea?

A

High levels of Abx resistance - why culture is important:

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known

A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

234
Q

What is Syphilis?

A

An STI caused by the bacteria Treponema Pallidum.

This can get into the mucous membranes and then disseminate throughout the body

235
Q

How can Syphilis be contracted?

A

Oral, vaginal or anal sex involving direct contact with an infected area

Vertical transmission from mother to baby during pregnancy

Intravenous drug use

Blood transfusions and other transplants

236
Q

What are the stages of syphilis infection?

A

Primary:
a painless ulcer called a chancre at the original site of infection (usually on the genitals).

Secondary: Systemic Infection
Fever, headaches, maculopapular skin rash and damage to mucous membranes

Tertiary:
Affects many organs of the body and develops gummas, CVD and neurological complications

237
Q

What are gummas?

A

granulomatous lesions that can affect the skin, organs and bones

238
Q

What are the primary diagnostic investigations of syphilis?

A

Treponemal Antibody testing

Dark Field Microscopy

PCR

239
Q

What is the treatment for Syphilis

A

Full screening for other STIs
Advice about avoiding sexual activity until treated
Contact tracing
Prevention of future infections

A single deep intramuscular dose of benzathine benzylpenicillin (penicillin) is the standard treatment for syphilis.

240
Q

What are some non-cancerous scrotal diseases?

A

Varicocele
Testicular Torsion
Epididymal Cyst
Hydrocele

241
Q

What is a Hydrocele?

A

A hydrocele is a collection of fluid within the tunica vaginalis that surrounds the testes

242
Q

What are the Examination findings of a Hydrocele?

A

The testicle is palpable within the hydrocele

Soft, fluctuant and may be large

Irreducible and has no bowel sounds (distinguishing it from a hernia)

Transilluminated by shining torch through the skin, into the fluid (the testicle floats within the fluid)

243
Q

What is the definitive diagnostic Ix for Hydrocele?

A

USS scrotum

244
Q

What is the management of Hydrocele?

A

Exclude serious causes

Surgery/aspiration to remove fluid

245
Q

What are some causes of Hydrocele?

A

Idiopathic
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma

246
Q

What is an Epididymal Cyst?

A

An extra-testicular cyst found above and behind the testes that WILL transilluminate.

247
Q

What is the Presentation, Diagnosis and Treatment of an Epididymal Cyst?

A

Sx - often asymptomatic

Dx - Scrotal Uss

Tx - none (they are harmless). Removal considered if painful

248
Q

What is a varicocele?

A

A varicocele occurs where the veins in the pampiniform plexus become swollen. They are common, affecting around 15% of men

249
Q

What is the pathophysiology of a varicocele?

A

Varicoceles are the result of increased resistance in the testicular vein.
Incompetent valves in the testicular vein allow blood to flow back from the testicular vein into the pampiniform plexus.

250
Q

What may a left sided Varicocele suggest?

A

Renal Cell Carcinoma
therefore check for this.

251
Q

What are the examination findings of a varicocele?

A

A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle

252
Q

What is the diagnostic investigation for a varicocele?

A

Clinical Dx

Doppler USS of Scrotum

253
Q

What is the management of a Varicocele?

A

Conservative Mx

Can be surgically treated if painful

254
Q

What are some potential complications of a Varicocele?

A

Testicular atrophy
Infertility

255
Q

What is Testicular Torsion?

A

Twisting of the spermatic cord with rotation of the testicle.

Can lead to occlusion of the testicular artery leading to ischaemia and necrosis of the testicle

It is a urological emergency, and a delay in treatment increases the risk of ischaemia and necrosis of the testicle, leading to sub-fertility or infertility.

256
Q

Who is typically affected by Testicular Torsion?

A

Typical patient is a teenage boy but can occur at any age

257
Q

What are the symptoms of Testicular Torsion?

A

Acute rapid onset unilateral testicular pain

abdominal pain

vomiting

258
Q

What are the examination findings for testicular torsion?

A

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

259
Q

What are risk factors for testicular torsion?

A

Bell clapper deformity:

260
Q

what is a bell clapper deformity?

A

A bell-clapper deformity is where the fixation between the testicle and the tunica vaginalis is absent.

the testicle can the rotate within the tunica vaginalis causing twisting of the spermatic cord

261
Q

What is the diagnostic Ix of testicular torsion?

A

if suspected the medical emergency and surgical exploration is always first line

USS doppler can confirm diagnosis but this will delay treatment

262
Q

What is the treatment for Testicular torsion?

A

Surgical treatment within 6hrs:

Viable testicle - orchioplexy (untwisting and fixing to scrotal sac)

Unviable testicle - Orchiectomy

263
Q

What is a testicular appendage torsion?

A

Twisting of a vestigial appendage (remnant of Mullerian duct) that is located along the testicle.

This appendage has no function, yet more than half of all boys are born with one.

Torsion of this small bit of tissue can cause intense pain that mimics testicular torsion and characteristically causes a ‘blue-dot’ sign, but is often managed conservatively

264
Q

What are the classifications of lower urinary tract symptoms (LUTS)

A

Storage Symptoms: FUNI
Frequency
Urgency
Nocturia
Incontinence

Voiding Symptoms: SHIT
Stream poor
Hesitancy
Incomplete Emptying/Straining
Terminal Dribbling

Post Micturition:
Sensation of incomplete voiding.
Post micturition Dribbling

265
Q

When do storage symptoms and voiding symptoms occur

A

Storage Sx:
Occur when bladder should be storing urine and therefore Px needs to pee

Voiding Sx:
Occur when bladder outlets obstructed and therefore its hard for Px to pee

266
Q

What is generally affected by incontinence?

A

Females

267
Q

Who is generally affected by Urine retention?

A

(overflow incontinence)
Males

268
Q

What are the different types of Incontinence?

A

Stress (sphincter weakness from pregnancy/trauma) - pee leaks with increased abdo pressure

Urge - detrusor muscle overactivity

Spastic paralysis - UMN lesion

269
Q

What is the treatment for incontinence?

A

surgery
Anticholinergic drugs

270
Q

What are the causes of urinary retention?

A

Obstruction:
Stones
BPH
Neurological flaccid paralysis

271
Q

What is the treatment for Urinary retention?

A

Tx underlying cause
Catheterise

272
Q

What are the Red flags LUTS?

A

Haematuria
Proteinuria

273
Q

What is Detrusor overactivity

A

urodynamic observation characterized by involuntary detrusor contractions during the filling phase that may be spontaneous or provoked

274
Q

What drug class are used to treat overactive bladder?

A

Anti-Cholinergics (inhibit Detrusor contraction)
Oxybutynin
Solifenacin

Mirabegron (beta 3 agonist that Activate relaxation of the detrusor muscle)

275
Q

What surgical procedure could be used for overactive detrusor muscle?

A

Cystoplasty

276
Q

What are the 3 classifications for for neuro-urophysiological dysfunction?

A

Brain Problems
Supra-sacral spinal problems
Sacral Spinal Problems

277
Q

What are the 3 spinal reflexes involved in bladder function?

A

Reflex Bladder Contraction - Sacral micturition centre
Guarding - Onuf’s Nucleus
Receptive relaxation (sympathetic)

278
Q

Where does co-ordination of voiding occur?

A

Pontine micturition centre
Allows for completion of voiding.
(However there is a Higher cortical control to decide when to void.)

Peraquductal grey

279
Q

What is Detrusor Sphincter Dyssynergia?

A

When there is a supra-sacral spinal cord injury that means that the innervation to the detrusor muscle and external urethral sphincter is lost.

This means the bladder with automatically contract when it fills.
The sphincter will go into the guarding reflex which also leads to contraction of the sphincter

This means that the bladder is contracting whilst the sphincter contracts which can lead to increased pressures and potential serious kidney damage.

280
Q

What are the aims of management of a neurogenic bladder

A

Prevent autonomic dysreflexia
Bladder safety
Continence and Sx control.

281
Q

What is autonomic dysreflexia?

A

Occurs lesions above T6
Overstimulation of sympathetic NS below level of lesion in response to noxious stimulus

Sx are headache, Severe HTN, Flushing

282
Q

What is the most common cause of Autonomic Dysreflexia

A

A full Bladder

283
Q

How is Autonomic Dysreflexia treated?

A

Catheterise and the bladder will drain reducing the dysreflexia

284
Q

What is an Unsafe bladder?

A

A bladder that will damage the kidneys most commonly due to prolonged high bladder pressure.

285
Q

What is the target urine output for an adult?

A

0.5-1.5ml/kg/hr

Phase 2a (24 decks)

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