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Phase 2a Annabel > GU > Flashcards

GU Flashcards

1
Q

What are 3 functions of the kidney?

A

Filter or secrete waste
Retain albumin
Reabsorb glucose, bicarbonates
Control BP and electrolytes
Erythropoietin synthesis
Activates 25-hydroxy vitamin D

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2
Q

Define golmerular filtration rate (GFR)

A

Volume of fluid filtered from glomeruli to Bowman’s space per minute

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3
Q

What is normal GFR?

A

120ml/min
7.2L/hour
170L/day

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4
Q

What percentage of CO does each kidney receive?

A

20%

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5
Q

What part of the kidney is most vulnerable to damage?

A

PCT

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6
Q

What is reabsorbed in the Loop of Henle?

A

25% Na+

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7
Q

What transporters are most active in the ascending LOH?

A

Na2KCl

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8
Q

Where do loop diuretics mainly work?

A

Ascending LOH

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9
Q

Where do thiazide diuretics work?

A

Distal convoluted tubule

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10
Q

What detects high solutes/low GFR?

A

Juxtaglomerular apparatus

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11
Q

What is released in response to low GFR?

A

Renin

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12
Q

Outline the angiotensinogen pathway

A

Angiotensinogen -> angiotensin -> angiotensin II -> aldosterone release

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13
Q

Where is renin released from?

A

Kidney

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14
Q

What is the function of renin?

A

Converts angiotensinogen -> angiotensin

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15
Q

Where is ACE released from?

A

Lungs

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16
Q

What is the function of ACE?

A

Converts angiotensin -> angiotensin II

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17
Q

What are the effects of angiotensin II?

A

Aldosterone production
Vasoconstriction

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18
Q

What is the function of aldosterone?

A

Sodium and water absorbed
Potassium excreted

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19
Q

Where does aldosterone primarily act?

A

Collecting duct

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20
Q

What occurs in the collecting duct?

A

Secretes K+ and H+ into urine
Water handling
Salt handling

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21
Q

What regulates water handling in the collecting duct?

A

Vasopressin

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22
Q

What is water absorbed through in the collecting duct?

A

Aquaporin 2 channels

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23
Q

Where is K+ mostly reabsorbed?

A

PCT/LOH

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24
Q

What 2 organs make up the upper urinary tract?

A

Kidneys
Ureters

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25
Q

What 4 parts make up the lower urinary tract?

A

Bladder
Bladder neck
Prostate gland
Urethra

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26
Q

What muscle controls urinating (bladder contraction)?

A

Detrusor muscle contraction

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27
Q

What nerves control voiding?

A

Parasympathetic
S3, S4, S5

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28
Q

What nerves control urine storage?

A

Sympathetic
T10, L1, L2

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29
Q

What lines the bladder?

A

Urothelium

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30
Q

Why are women more likely to develop incontinence?

A

Shorter urethra with lower resistance

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31
Q

What is the other name for nephrolithiasis?

A

Renal stones

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32
Q

Define nephrolithiasis

A

Calculi form in collecting ducts and can be deposited anywhere from renal pelvis to urethra

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33
Q

What are the 3 MC sites of stones?

A

Pelvic brim
Pelviureteric junction (PUJ)
Vesicoureteric junction (VUJ)

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34
Q

What are 5 types of renal stones?

A

Calcium oxalate (MC)
Calcium phosphate
Uric acid
Struvite- infection
Cysteine

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35
Q

Who affected by renal stones?

A

10-15% of people
20-40
Males>

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36
Q

What is the recurrence rate of renal stones?

A

> 50%

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37
Q

What are the risk factors of renal stones?

A

Dehydration
Obesity
Primary renal disease
Infection
Recurrent UTI

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38
Q

Outline the pathophysiology of renal stones/nephrolithiasis

A

Excess solute in CD -> supersaturated urine -> crystallisation -> outflow obstruction -> may cause hydronephrosis

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39
Q

What are the symptoms of renal colic?

A

Rapid onset
Comes in waves (colicky) of extreme pain
Groin to loin pain
Often can not lie still

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40
Q

What are the symptoms of nephrolithiasis?

A

Renal colic
Fluid/diuretics make it worse
Haematuria
Dysuria (hard to wee)
FEVER IS RED FLAG (infection)

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41
Q

What are 2 differential diagnoses of renal stones?

A

Vascular incident (AAA)
Diverticulitis
Ectopic pregnancy or ovarian cyst torsion
Testicular torsion

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42
Q

How is nephrolithiasis diagnosed?

A

GS: NC-CT of KUB
Urinalysis, FBC, U+E

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43
Q

How are renal stones/nephrolithiasis treated?

A

Small = diclenofac (NSAIDs)
Larger stones = medical expulsion therapy (tamulosin)
Not working = ESWL (small) /PCNL (large)

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44
Q

What is ESWL?

A

Extracorporeal shockwave lithotripsy

Ultrasound waves break up stone

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45
Q

What is PCNL?

A

Percutaneous nephrolithotomy

Keyhole surgery to remove large stones

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46
Q

How are renal stones/nephrolithiasis prevented?

A

Low sodium diet
Overhydrate
Reduce BMI
Reduce animal protein
Increase citrus
Thiazides for hypercalcuria

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47
Q

What are the complications of nephrolithiasis?

A

Hydronephosis (outflow obstruction)
Abcess
Chronic damage
Pyonephrosis

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48
Q

What occurs when renal stones are infected?

A

Pyonephrosis

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49
Q

How is pyonephrosis treated?

A

IV Abx
Drain
Oxygen

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50
Q

Define acute kidney injury/AKI

A

Abrupt (hour-days) decline in kidney function characterised by a rise in serum creatine and urea and decline in urine output

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51
Q

How is AKI classified?

A

KIDIGO classification

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52
Q

What are the 3 criteria for AKI diagnosis?

A

Rise in creatine >26 micomol/L in 48 hours
Or
Rise in creatine >1.5x baseline
Or
Urine output <0.5ml/kg/h for > 6 hours

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53
Q

What are 3 risk factors of AKI?

A

Increased age
Comorbidities
Hypovolaemia
Nephrotoxic drugs

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54
Q

How common is AKI?

A

18% hospital patients
1/4 with sepsis and 50% with septic shock

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55
Q

What are the 3 classifications of causes of AKI?

A

Prerenal (MC)
Renal
Postrenal

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56
Q

What are 3 Prerenal causes of AKI?

A

Renal hypoperfusion
Hypovolaemia
Shock
Hypotension
Low CO

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57
Q

What are 3 renal causes of AKI?

A

Glomerulonephritis
Renal parenchymal damage
Necrosis (MC)
Thrombosis

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58
Q

What are 3 post-renal causes of AKI?

A

UT obstruction at ureter, bladder, prostate
Luminal (eg stones)
BPH
Occluded catheter
Malignancy

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59
Q

What are the symptoms of AKI?

A

Can be asymptomatic
Hyperkalaemia: arrhythmia, muscle weakness
Oilguria
High urea/uraemia: fatigue, weakness, N+V, confusion
Oedema
Acidosis

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60
Q

How is AKI diagnosed?

A

Intrarenal = biopsy
Postrenal = renal USS
Urea:creatine ratio
Exclude infection
Check for infection
ECG for hyperkalaemia

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61
Q

What are the signs of hyperkalaemia on ECG?

A

Tall tented T wave
Flat P wave
Wide QRS
Prolonged PR

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62
Q

How is AKI treated?

A

Treat complications (hyperkalaemia, fluid excess, acidosis)
Treat underlying cause
Stop nephrotoxic drugs
Last line= RRT

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63
Q

How is hyperkalaemia in AKI treated?

A

Calcium gluconate
Insulin

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64
Q

How is acidosis treated in AKI?

A

Sodium bicarbonate

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65
Q

How is excess fluid managed in AKI?

A

Diuretics

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66
Q

What are 2 nephrotoxic drugs?

A

NSAIDs
ACE-inhibitor
Gentamicin
Amphotericin

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67
Q

What are 3 indications for RRT in AKI?

A

AEIOU

Acidosis
Electrolyte imbalance (persistent hyperkalaemia)
Intoxication (poisoning)
Oedema (refractory pulmonary oedema)
Uraemia (encephalopathy or pericarditis).

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68
Q

What does a urea:creatine ratio of >100:1 indicate in AKI?

A

Prerenal cause

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69
Q

What does a urea:creatine ratio of <40:1 indicate in AKI?

A

Renal cause

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70
Q

What does a urea:creatine ratio of 40-100:1 indicate in AKI?

A

Postrenal cause

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71
Q

Define CKD

A

Gradual progressive irreversible decline in kidney function present for >3 months

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72
Q

Define CKD in terms of GFR

A

<60ml/min/1.73m^2 for 3+ months

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73
Q

What is used to stage CKD?

A

eGFR

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74
Q

What eGFR indicates stage 1 CKD?

A

> 90 with renal signs

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75
Q

What eGFR indicates stage 5 CKD?

A

<15
Worst- not working or close to failure

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76
Q

What unit is used for eGFR?

A

mL/min/1.73m2

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77
Q

What are 3 risk factors of CKD?

A

DM
HTN
Old age
CVD
SLE
Recurrent UTI
BAME
Chronic NSAID use

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78
Q

What are 3 causes of CKD?

A

Idiopathic
DM
HTN
Polycystic kidneys
Tuberous sclerosis
AKI
FHx

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79
Q

What 4 parameters are used to stage CKD?

A

Creatine
Age
Gender
Ethnicity

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80
Q

Outline the pathophysiology of CKD

A

Nephrons fail -> filtration done by fewer functional nephrons -> increased flow in remnant nephrons -> increased pressure causes nephron failure -> can be detected as increased proteinuria -> ESRF

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81
Q

What are the symptoms of CKD?

A

Asymptomatic for a while
Accumulation of metabolites (eg urea)
Anaemia
Haematuria
Nephropathy

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82
Q

What are 4 complications of CKD?

A

Anaemia of chronic disease
Bone disease
Neurological issues (postural HTN, weakness)
CVD

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83
Q

How is CKD diagnosed?

A

Anaemia of chronic disease
Low eGFR
USS usually shows small kidneys (bilateral atrophy)

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84
Q

How is CKD treated?

A

Irreversible so prevent progression and prevent complications
BP: ace inhibitor, angiotensin blocker, CCB
Calcitrol and Ca2+
Lower cholesterol

ESRF: RRT or transplant

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85
Q

What type of dialysis is usually used for CKD?

A

Peritoneal

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86
Q

Define UTI

A

Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteriuria and pyuria

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87
Q

What level of organisms defines UTI?

A

> 10^5 organisms/ml fresh mid stream urine

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88
Q

What 5 pathogens cause UTI?

A

KEEPS

Klebsiella
E.coli (MC)
Enterococcus
Proteus
Staph Saprophyticus

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89
Q

What are the 2 classifications of UTI location?

A

Upper urinary tract = kidneys
Lower urinary tract = bladder onwards

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90
Q

What is one upper UTI?

A

Pyelonephritis

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91
Q

What causes 80% of UTIs?

A

Uropathogenic strains of E.coli (UPEC)

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92
Q

Why are UTIs more common in females?

A

Shorter urethra
Closer to anus so easier for bacteria to colonise

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93
Q

What are 4 host defence mechanisms against UTI?

A

Antegrade fushing of fluid (forward flushing)
Tamm-Horsfall protein (antimicrobial)
Low urine pH and high osmolality
Urinary IgA

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94
Q

What are 4 lower UTIs?

A

Cystitis
Prostatitis
Epididymo-orchitis
Urethritis

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95
Q

What is the 1st line test for UTI?

A

Urine dipstick
- positive leukocytes
- positive nitrites
- positive/ negative haematuria

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96
Q

Define uncomplicated UTI

A

UTI in healthy, non-pregnant woman with functionally normal urinary tract

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97
Q

Define complicated UTI

A

Infection in patients with abnormal urinary tract (eg. Stones, DM, virulent organism)
Complications and treatment failure more likely
Most UTIs in men are complicated

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98
Q

What is the GS of UTI diagnosis?

A

Midstream microscopy, culture, and sensitivity

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99
Q

Define pyelonephritis

A

Infection of the renal parenchyma and upper ureter

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100
Q

How is pyelonephritis contracted?

A

Ascending transurethral spread
Usually UPEC

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101
Q

Who is primarily affected by pyelonephritis?

A

Women <35
Associated with sepsis or systemic upset

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102
Q

What are 3 risk factors of pyelonephritis?

A

Calculi
Pregnancy
Catheter
DM
Structural abnormalities

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103
Q

What are the symptoms of pyelonephritis?

A

Classic triad:
- Loin pain
- Fever
- Pyuria (pus in urine)

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104
Q

What additional investigation is carried out for pyelonephritis?

A

Urgent ultrasound to detect stones or obstruction

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105
Q

How is pyelonephritis treated?

A

Analgesia
Ciprofloxacillin or co-amoxiclav (IV if severe)

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106
Q

What is given to pregnant women with pyelonephritis?

A

Cefalexin

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107
Q

Define cystitis

A

Urinary infection of the bladder

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107
Q

What are the risk factors of cystitis?

A

Urinary obstruction -> urinary stasis
Damage to bladder epithelium
Bladder stones
Poor emptying
Catheter

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108
Q

What are the symptoms of cystitis?

A

Suprapubic pain and discomfort
Increased frequency and urgency
Offensive smelling/ cloudy urine
Incontenence

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109
Q

How is cystitis treated?

A

Trimethoprim or nitrofurantoin (3 weeks to 7 if complex)

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110
Q

What is given to pregnant women with cystitis?

A

Amoxicillin

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111
Q

Define prostatitis

A

Infection and inflammation of the prostate gland

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112
Q

Who is affected by prostatitis?

A

Mc UTI in men <50
Usually presents >35

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113
Q

What are the MC causes of prostatitis?

A

Strep. Faecalis
E. Coli
Chlamydia

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114
Q

What are 3 risk factors of prostatitis?

A

STI
Indwelling catheter
Post biopsy
Increased age

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115
Q

What are the symptoms of prostatitis?

A

Systemically unwell
Fever, rigours, malaise
Pain on ejaculating
Can be chronic (>3 months)

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116
Q

How is prostatitis diagnosed?

A

Prostate tender and hard
Dipstick
PSA
TRUSS

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117
Q

How is prostatitis treated?

A

Gentamicin+ co-amoxiclav

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118
Q

Define urethritis

A

Urethral inflammation due to infectious or non-infectious causes

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119
Q

How is urethritis usually transmitted?

A

Sexually transmitted

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120
Q

What are the 2 main causes of urethritis?

A

Gonococcal (nessiseria gonorrhoea)
Non gonococcal: MC chlamydia trachomatis

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121
Q

What are 3 risk factors of urethritis?

A

Sexually active
Unprotected sex
Male-male sex

122
Q

What type of bacteria is chlamydia?

A

Obligate intracellular gram negative aerobic bacillus

123
Q

What type of bacteria is Neisseria?

A

Gram negative diplococcus

124
Q

How is urethritis diagnosed?

A

NAAT (Nucleic Acid Amplification Test)
- female = self collected vaginal swab, male = first void
Dipstick and other normal stuff

125
Q

How is chlamydia (CT) treated?

A

doxycycline and azithromycin

126
Q

How is gonorrhoea treated?

A

IM Ceftriaxone

127
Q

Define epididymo-orchitis

A

Pain, swelling and inflammation of the epididymis that can extend to the testes usually due to urethritis or cystitis

128
Q

What condition is associated with urethritis?

A

Reactive arthritis

129
Q

What is the MC cause of epididymo-orchitis in men <35?

A

Chlamydia
N. Gonorrhoea

130
Q

What is the MC cause of epididymo-orchitis in men >35?

A

KEEPS
Elderly= catheter

131
Q

What are the risk factors of epididymo-orchitis?

A

Previous infections
Catheter
Anal intercourse

132
Q

What are the symptoms of epididymo-orchitis?

A

Unilateral scrotal pain and swelling
Positive Pren’s sign
Cremaster reflex intact

133
Q

What is Pren’s sign?

A

Pain relieved by elevating testes

134
Q

How is epididymo-orchitis diagnosed?

A

NAAT
Normal stuff

135
Q

How is epididymo-orchitis treated?

A

Ceftiaxone and doxycycline

136
Q

How is testicular torsion differentiated from epididymo-orchitis?

A

epididymo-orchitis = positive Phrens sign
TT = negative

Pain elevated by lifting testes

137
Q

Define glomerulonephritis

A

Group of parenchymal diseases resulting in inflammation of the golmeruli and nephrons

138
Q

What percentage of CKD is caused by glomerulonephritis?

A

25%

139
Q

What is injured in nephrotic syndrome?

A

Podocyte food processes

140
Q

What is injured in nephritic syndrome?

A

Disruption of glomerular basement membrane due to inflammation

141
Q

What are the symptoms of nephrItic syndrome?

A

Haematuria
Oliguria
HTN

142
Q

What are 2 conditions that can present as both nephrotic and nephritic syndrome?

A

Diffuse proliferative glomerulonephritis
Membrane proliferate glomerulonephritis

143
Q

What are the symptoms of nephrOtic syndrome?

A

Proteinuria (frothy urine)
Hypoalbuminaemia
Oedema

Also usually severe Hyperlipidaemia

144
Q

What is the MC cause of nephritic syndrome?

A

IgA nephropathy

145
Q

What are 3 primary causes of nephrotic syndrome?

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

146
Q

What is the MC cause of nephrotic syndrome in children?

A

Minimal change disease

147
Q

What is the MC cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

148
Q

What is the MC secondary cause of nephrotic syndrome?

A

Diabetes

149
Q

How is minimal change disease (nephrotic) diagnosed?

A

Biopsy then E-microscopy shows podocyte effacement and fusion

150
Q

How is focal segmental glomerulosclerosis diagnosed?

A

Biopsy and microscopy shows scarring (segmental sclerosis)

151
Q

How is membranous nephropathy diagnosed (3 things)?

A

Biopsy shows BM thickening
Subpodocyte immune complex deposition
Anti phospholipase A2 receptor antibodies present

152
Q

How is nephrotic syndrome treated?

A

Treat oedema: thiazide diuretics, loop diuretics
ACEi/ARB
Immunosuppressants
Steroids

153
Q

Which cause of nephrotic syndrome responds best to steroids?

A

Minimal change disease

154
Q

What is the major clinical difference between nephrotic and nephritic syndrome?

A

Nephritic = Inflammation
Nephrotic = oedema

155
Q

What are 5 causes of nephritic syndrome?

A

IgA nephropathy/ Berger’s
Post strep glomerulonephritis
SLE
Goodpastures
Haemolytic uremic syndrome

156
Q

What are the complications of nephrotic syndrome?

A

Hyperlipidaemia
Thrombolytic events
Susceptibility to infection

157
Q

What is the only non-type 3 hypersensitivity reaction cause of nephritic syndrome?

A

Goodpastures - T2

158
Q

What are the symptoms of IgA nephropathy?

A

Visible haematuria 1-2 days after viral infection (tonsillitis or gastroenteritis) due to IgA deposition in the meseangium of the kidney

159
Q

How is IgA nephropathy diagnosed?

A

Immunofluorescence microscopy shows IgA complex deposition

160
Q

How is IgA nephropathy treated?

A

Non-curative (30% = ESRF)
BP control
Fish oil and steroids if present >3 months

161
Q

What are the symptoms of post strep glomerulonephritis?

A

Visible hamematuria 2 weeks after pharyngitis from group A beta haemolytic strep (pyrogenes)

162
Q

How is post strep glomerulonephritis diagnosed?

A

Evidence of strep infection
Immunofluoresence shows starry sky appearance due to antigen deposited in glomerulus

163
Q

How is post strep glomerulonephritis treated?

A

Usually self limiting
Antibiotics

164
Q

How is SLE nephritic syndrome diagnosed?

A

ANA posited
Anti dsDNA positive

165
Q

How is SLE nephritis treated?

A

Steroids
Hydroxychloroquine
Immunosuppressant

166
Q

What is Goodpastures?

A

Pulmonary and alveolar haemmorage with glomerulonephritis due to autoantibodies

167
Q

How is Goodpastures diagnosed?

A

Anti-GBM present

168
Q

How is Goodpastures treated?

A

Steroids
Plasma exchange
Immunosuppressants (cyclophosphamide)

169
Q

What are the symptoms of Goodpastures?

A

SOB
Ogliouria

170
Q

When does haemolytic uremic syndrome occur?

A

Around 5 days post infection of shiga toxin (e. Coli or shigella)

171
Q

What are 3 functions of the prostate?

A

Produces 80% of seminal fluid
Testosterone and DTH production
Regulates urine flow

172
Q

Define benign prostate hyperplasia (BPH)

A

Increase in the size of prostate without presence of malignancy

173
Q

What are the risk factors of BPH?

A

40% of men >60
Afro carribeans
Obesity
Heart disease
FHx

174
Q

Outline the pathophysiology of BPH

A

Benign modular or diffuse proliferation -> grows bigger -> can squeeze or partially block urethra -> problems with urinating

175
Q

What are the symptoms of BPH?

A

FUNI- need to wee
Frequency, Urgency, Nocturia ,Incontenence

SHID- hard to wee
Poor Stream ,Hesitant, Incomplete emptying ,Dribbling

176
Q

How is BPH diagnosed?

A

DRE (digital rectal exam) shows enlarged but smooth prostate
PSA may be high
Urine test to exclude infection

177
Q

How is BPH treated?

A

Lifestyle factors: avoid caffeine and alcohol
1. Alpha 1 antagonist (tamulosin)
2. 5-alpha reductase inhibitor (finasteride)

Not responding or massive = TURP/ TUIP (transurethral resection/incision of prostate)

178
Q

How does tamulosin/alpha 1 antagonists work?

A

Relax smooth muscle in bladder neck and prostate producing increase in urine flow rate

179
Q

What are the side effects of tamulosin?

A

Drowsiness
Dizziness
Ejactulatory failure
Weight gain

180
Q

When is tamulosin contraindicated?

A

Postural HTN

181
Q

How does finasteride work?

A

Blocks conversion of testosterone to its active form (dihydrotestosterone) which causes prostatic growth

182
Q

What are the side effects of finasteride?

A

Impotence
Decreased libido

183
Q

What are the complications of untreated BPH?

A

Bladder calculi
UTI
Haemaruria
Acute retention

184
Q

What is the MC male malignancy?

A

Prostate cancer

185
Q

Where do prostate cancers usually occur?

A

Peripheral zone of prostate gland

186
Q

What is the MC type of prostate cancer?

A

Adenocarcinoma

187
Q

Where does prostate cancer most commonly metastasise?

A

Lymph and bone through prostate capsule

188
Q

What are the risk factors of prostate cancer?

A

FHx
Genetics
Black
Increased age

189
Q

What are 2 genes that increase the risk of prostate cancer?

A

HOXB13
BRCA2

190
Q

What are the symptoms of prostate cancer?

A

LUTS: nocturia, hesitancy, poor stream, terminal dribbling
Erectile dysfunction
Weight loss

191
Q

How is prostate cancer diagnosed?

A

DRE: hard, irregular prostate
Raised PSA
GS: TRUS and biopsy

192
Q

How is prostate cancer treated?

A

Radical prostatectomy (<70)
Radiotherapy and hormone therapy
LHRH agonists
Androgen receptor blocker

193
Q

What are 2 LHRH agonists?

A

Leuprorelin
Goserelin

194
Q

What is an androgen receptor blocker?

A

Bicalutamide
Flutamide

195
Q

How is prostate cancer graded?

A

Gleason score- higher = worse prognosis

196
Q

Who is commonly affected by testicular cancer?

A

20-40 year old men

197
Q

Where do most testicular cancers arise from?

A

Germ cells (seminomas)

198
Q

What are the risk factors of testicular cancer?

A

Undescended testes (Cryptorchidism)
Infertility
FHx
HIV
Kleinfelters

199
Q

What are the symptoms of prostate cancer?

A

Painless lump in testicles
Testicular and abdo pain
Hydrocele (scrotum swelling)
Gynaecomastia (man boobs)

200
Q

What are 2 differential diagnoses of testicular cancer?

A

Testicular torsion
Lymphoma
Hydrocele

201
Q

How is testicular cancer diagnosed?

A

Doppler ultrasound (GS)
raised AFP and B-hCG
CT staging

202
Q

How is testicular cancer treated?

A

Radical inguinal orchidectomy (ball removal)
Chemotherapy
Store sperm!

203
Q

What is bladder cancer an example of?

A

Transitional cell carcinoma (TCC)

204
Q

Who is most commonly affected by bladder cancer?

A

Men
>55

205
Q

What are 3 risk factors of bladder cancer?

A

Smoking
Occupational exposure: dyes (hairdresser) paint, other carcinogens
Chronic inflammation of UT
FHx

206
Q

What are the symptoms of bladder cancer?

A

Painless haematuria
Back pain
Voiding inability

207
Q

What are 2 differential diagnoses of bladder cancer?

A

UTI
Urethral trauma
Haemmoragic cystitis
Renal cancer

208
Q

How is bladder cancer diagnosed?

A

Flexible cystoscopy with biopsy
CT urogram (also staging)
Urinalysis

209
Q

How is bladder cancer treated surgically?

A

TURBT (transurethral removal of bladder tumour)
Radical cystectomy
- extenteration in women: bladder, womb
- cystoprostatectomy in men: bladder, prostate

210
Q

What are 2 types of kidney cancer?

A

Renal cell carcinoma (RCC)
Wilms tumour/nephroblastoma

211
Q

Where does RCC arise from?

A

Proximal convoluted tubule epithelium

212
Q

Who is most commonly affected by RCC?

A

Males>females
Usually around 55
Czech Republic

213
Q

What are the risk factors of RCC?

A

Smoking
Obesity
HTN
Haemodialysis
VHL syndrome

214
Q

What gene increases the risk of RCC?

A

Von Hippel Linadu syndrome (VHL)
- Autodom mutation on chromosome 3

215
Q

What are the symptoms of RCC?

A

Often asymptomatic
Haematuria
Loin pain
Abdo mass
Variocele if left(rare)
Polycythaemia

216
Q

How is RCC diagnosed?

A
  1. USS abdo
    GS: CT chest and abdomen with contrast
217
Q

What is the name of the staging used in RCC?

A

Robson staging

218
Q

How is RCC treated?

A

Localised = nephrectomy (full/partial)
Untolerable for surgery: cryoalbation
Can need adrenalectomy

219
Q

Define Wilms tumour

A

Childhood tumour of primitive renal tubules and mesenchymal cells (<3)

220
Q

How many people >50 have renal cysts?

A

50%

221
Q

Define Polycystic kidney disease

A

Cyst formation in renal parenchymal causing bilateral enlargement and damage

222
Q

What is the MC inherited kidney disease?

A

Autodom Polycystic disease

223
Q

What are the 2 types of Polycystic kidney disease?

A

Autodom (MC)
Autorec

224
Q

What genes are mutated in Autodom PKD?

A

PKD1 on chromosome 16
Or
PKD2 on chromosome 4

225
Q

When is ESRF reached if PKD1 is mutated?

A

50s

226
Q

When is ESRF reached if PKD2 is mutated?

A

70s

227
Q

Outline the pathophysiology of Autodom PKD

A

PKD1 + 2 code for polycystin (calcium channel) -> normally Ca2+ influx inhibits growth of cilia so lack of = excessive cilia growth -> cysts

228
Q

What are the symptoms of Autodom PKD?

A

Usually occurs >20
Loin pain
Haematuria
HTN
Polycystic liver
Berry aneurysms

229
Q

What thrombotic event is associated with PKD?

A

Berry aneurysm rupture -> subarachnoid haemorrhage

230
Q

How is PKD diagnosed?

A

Ultrasound of kidney shows echogenic spaces
FHx
BP raised

231
Q

How is Autodom PKD treated?

A
  1. Transplant
    Non curative
    BP control
    RRT
    Tolvaptan
232
Q

What gene is mutated in autorec PKD?

A

PKHD1 mutation on chromosome 6

233
Q

Who does autorec PKD commonly occur in?

A

Infants- increased fetal mortality

234
Q

What are the symptoms of autorec PKD?

A

Abdo mass and renal failure in childhood

235
Q

How is autorec PKD diagnosed?

A

Prenatal USS
Kidney biopsy

236
Q

What is the MC STI?

A

Chlamydia

237
Q

What is the proper name for gonorrhoea?

A

Neisseria gonorrhoea

238
Q

What is the real name for chlamydia?

A

Chlamydia trachomatis

239
Q

What is the incubation period of chlamydia?

A

7-21 days

240
Q

What is the incubation period of gonorrhoea?

A

2-5 days

241
Q

What is the primary site of STI infection in males?

A

Urethra

242
Q

What is the primary site of STI infection in females?

A

Cervix

243
Q

What are 3 complications of STIs?

A

Pelvic inflammatory disease
Neonatal transmission
Ectopic pregnancy
Fitz Hugh Curtis syndome

244
Q

What are the symptoms of chlamydia in men?

A

50% asymptomatic
Voiding symptoms
Dysuria

245
Q

What are the symptoms of chlamydia in women?

A

70% asymptomatic
Vaginal discharge
Dysuria

246
Q

What are the symptoms of gonorrhoea in males?

A

Dysuria
Increased frequency
Discharge

247
Q

What are the symptoms of gonorrhoea in women?

A

Vaginal discharge
Dysuria
Pelvic pain

248
Q

Define epididymal cyst

A

Smooth extratesticular spherical cyst in the head of the epididymis

249
Q

What does an epididymal cyst contain?

A

Spermatocele fluid (clear and milky)

250
Q

What are the presentations of epididymal cysts?

A

Lump above and behind testes
Transilluminate as fluid filled
Testes palpable separately from the cyst (unlike hydrocele)

251
Q

How is an epididymal cyst diagnosed?

A

Scrotal ultrasound

252
Q

How are epididymal cysts treated?

A

Usually fine
If painful can be removed surgically

253
Q

Define hydrocele

A

Abnormal collection of fluid in the tunica vaginalis

254
Q

Who is hydrocele common in?

A

Usually in younger men

255
Q

What are the 2 types of hydrocele?

A

Simple hydrocele
Communicating hydrocele

256
Q

Define simple hydrocele

A

Overproduction of fluid in tunica vaginalis

257
Q

Define communicating hydrocele

A

Processus vaginalis fails to close allowing peritoneal fluid to communicate freely with the scrotal portion

258
Q

What are the symptoms of hydrocele?

A

Scrotal enlargement with non-tender, smooth swelling
Not usually painful unless infected
Testes can be hard to palpate
Anterior and below to testes
Transilluminate

259
Q

What is the difference in position between hydrocele and epididymal cyst?

A

Hydrocele: anterior and below
Cyst: inferior and behind

260
Q

How is hydrocele diagnosed?

A

Scrotal ultrasound

261
Q

How is hydrocele treated?

A

Usually fine
Infants fine within 2 years
If bad, aspiration or surgical removal

262
Q

Define varicocele

A

Abnormal dilation of testicular veins in the venous plexus, caused by venous reflux

263
Q

What side is more likely to be affected by varicocele?

A

Left

264
Q

What are the symptoms of varicocele?

A

Distended scrotal veins “BAG OF WORMS”
Dull ache or heaviness
Hangs lower on site of varicocele

265
Q

How is varicocele diagnosed?

A

Venography
Colour doppler USS

266
Q

What is the complication of varicocele?

A

Infertility

267
Q

When is surgery needed in varicocele?

A

Pain
Infertility
Testicular atrophy

268
Q

Define testicular torsion

A

Twisting of the testes around spermatic cord causing occlusion of blood vessels, causing ischemia and infarction and POTENTIAL LOSS OF TESTES

269
Q

What time period should surgery be performed in testicular torsion?

A

<6 hours

270
Q

Who does testicular torsion commonly occur in?

A

Adolescent boys or young men
11-30

271
Q

What are the symptoms of testicular torsion?

A

Sudden onset of pain in one testes
Abdo pain, N+V
Negative phrens sign
Cremasteric reflex lost

272
Q

What is the cremasteric reflex?

A

stroking inner thigh → cremaster muscle contracts and pulls ipsilateral testicle towards inguinal canal

273
Q

What is a risk factor of testicular torsion?

A

Belt clapper deformity- testes not fully fixed to scrotum

274
Q

What are 2 differential diagnoses of testicular torsion?

A

Epididymo orchitis (test phrens sign- TT= negative)
Acute hydrocele
Idiopathic scrotal oedema

275
Q

How is testicular torsion diagnosed?

A

Doppler USS
Surgical exploration

276
Q

How is testicular torsion treated?

A

Surgery to untwist and expose testes
If too late…. Orcihdectomy (remove testes)
orchiplexy (fixation)

277
Q

What are 3 types of incontinence in females?

A

Stress (sphincter weakness)
Urge (detrusor overactivity)
Spastic paralysis

278
Q

How is incontinence treated?

A

Surgery
Anti muscarinic (oxybutynin)

279
Q

Define retention

A

Males
Inability to pass urine even when bladder is full

280
Q

What are 3 causes of retention in males?

A

Stones
BPH
Neurological flaccid paralysis

281
Q

What are 4 storage symptoms?

A

FUNI- need to wee

Frequency
Urgency
Nocturia
Incontenence

282
Q

What are 4 voiding symptoms?

A

SHID- hard to wee

Poor Stream
Hesitant
Incomplete emptying
Dribbling

283
Q

What is the function of the detrusor muscles?

A

Relaxes in storage
Contracts in voiding

284
Q

What nerves control detrusor muscles?

A

Parasympathetic cholinergic control
S3, S4, S5

285
Q

What is the function of distal sphincter?

A

Contracts in storage
Relaxes in voiding

286
Q

What are some factors that cause an increase in PSA?

A

prostate hyperplasia or cancer
prostatis
recent ejaculation
UTI
age

287
Q

What drugs should be stopped in AKI?

A

DAAMN

diuretics
Ace-I/ARB
Aminoglycosides
Metformin
NSAIDs

288
Q

What is minimal change disease associated with?

A

Upper respiratory tract infection

289
Q

What is a group a beta haemolytic strep?

A

Strep pyogenes

290
Q

What are the symptoms of haemolytic uremic glomerulonephritis?

A

Haemolytic anaemia
AKI
Thrombocytopenia

291
Q

What is the testicular appendage?

A

Small functionless piece of tissue above the testicle

292
Q

What are the symptoms of testicular appendage torsion?

A

Similar to TT

Small blue dot at top of testes

293
Q

How is testicular appendage torsion treated?

A

NOT A SURGICAL EMERGENCY

rest + analgesia

294
Q

How is erectile dysfunction treated?

A

Sildenafil (viagra)

295
Q

How does sildenafil work?

A

Phosphodiesterase inhibitor- causes smooth muscle relaxation and vasodilation

296
Q

What are the side effects of Sildenafil?

A

Hypotension
Inc risk of stroke

297
Q

Where do potassium soaring diuretics work?

A

Collecting duct

298
Q

What eGFR indicates stage 2 CKD?

A

89-60

299
Q

What eGFR indicates stage 3a CKD?

A

59-45

300
Q

What eGFR indicates stage 3b CKD?

A

44-30

301
Q

What eGFR indicates stage 4 CKD?

A

29-16

302
Q

When is trimethoprim contraindicated?

A

Pregnancy

303
Q

What is the triad of haemolytic uraemia syndrome?

A

Thrombocytopenia
Haemolytic anaemia
AKI

Phase 2a Annabel (12 decks)

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