B10 Week 2 Flashcards

1
Q

How does urine form and travel?

A

Urine forms in the kidneys and collects in the renal pelvis. It travels down the ureters to be stored in the bladder and excreted via the urethra

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2
Q

How does urine travel in the ureter?

A

Entry of urine into renal pelvis causes it to dilate. Induces pacemakers to produce action potential in ureter for peristaltic contractions to propel urine.

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3
Q

What are the divisions of the ureter?

A

Renal pelvis
Abdominal
Pelvic
Intramural

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4
Q

What are the natural ureteric constrictions?

A

Pelvi-ureteric junction
Bifurcation of common iliac artery
Vesico-ureteric junction

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5
Q

What is the pelvic-ureteric junction?

A

Area where the renal pelvis joins to the ureter.

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6
Q

What is the vesico-ureteric junction?

A

Area where ureter enters the bladder. Obstruction can occur here if the ureter is too short via Paquin’s law.

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7
Q

What is the blood supply to the ureter?

A

Segmental based on the ureter level.RGCI

Renal pelvis level: renal artery
Abdominal level: gonadal artery (testicular/ovarian)
Pelvic level: common iliac artery
Intramural level: internal iliac artery

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8
Q

What is the lymphatic drainage of the ureter?

A

Para-aortic lymph nodes

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9
Q

What is the innervation to the ureter?

A

Ureteric plexus in T11-L2, derived from renal, aorticorenal and superior and inferior hypogastric plexus.
T11-L2 is the sympathetic innervation.
S2-S4 for parasympathetic innnervation.

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10
Q

What is the sympathetic innervation of the ureter?

A

T11-L2

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11
Q

What is the parasympathetic innervation to the ureter?

A

S2-S4

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12
Q

How does urine enter bladder?

A

Enters the base of the bladder, partially covered by peritoneum.

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13
Q

What are the features of the bladder?

A

Contains rugae in bladder wall in order to expand and avoid changes in internal pressure.

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14
Q

What is the bladder trigone?

A

Triangular shaped region at the bladder base. It is formed by the openings of the ureter posteriorly in the bladder and the opening of the urethra.

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15
Q

What are the features of the trigone?

A

It has a smooth surface due to its mesodermal origin, as well as being less mobile and more sensitive to pain. The rest of the bladder is endodermal origin.

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16
Q

What is the lymphatic drainage of the bladder?

A

Para-aortic nodes and internal iliac nodes

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17
Q

What affects sensation in the bladder?

A

Suppression of nerve impulses due to bladder being empty. Reduced pain sensation upon empty bladder.

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18
Q

Parasympathetic innervation to the bladder

A

S2-S4
Stimulates the contraction of the detrusor muscle for bladder contraction. Inhibits the external urethral sphincter for micrutition.

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19
Q

Sympathetic innervation to the bladder

A

T10-L2.
Inhibits impulses to detrusor muscle to allow relaxation and storage of urine in bladder. Stimulates the external sphincter to prevent micrutition.

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20
Q

What is the innervation to the urethra?

A

Branches of the Inferior hypogastric plexus. This plexus is posterior to the urinary bladder:
Pudendal in females
Prostatic plexus in males

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21
Q

Innervation to male urethra?

A

Sympathetic, parasympathetic and visceral is delivered by the prostate plexus, a branch of the inferior hypogastric plexus which also controls the urethral sphincters.

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22
Q

What are the components of the male urethra?

A

Prostatic urethra: prostatic tissue surrounded by transitional epithelia

Membranous urethra: pseudostratified columnar epithelia and passes through the external urethral sphincter

Spongy urethra: surrounded by corpus spongiosum and transitions from pseudostratified columnar -> stratified squamous in glans penis

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23
Q

What is the lymphatic drainage of male urethra?

A

Internal iliac and deep inguinal nodes

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24
Q

What is the female urethra?

A

Much shorter than the male urethra and opens into a vestibule anterior to the vaginal opening.

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25
Q

What is the composition of the female urethra?

A

3 coats
Muscular coat: continuous with the detrusor muscle
Erectile coat: Surrounded by corpus spongiosus
Mucosal coat: Formed of stratified squamous epithelia which can produce mucus

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26
Q

What is the histology of the female urethra

A

Begins as transitional epithelia
-> Pseudostratified columnar
-> Stratified columnar
->Stratified squamous at external urethral orificie

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27
Q

What is the innervation of the female urethra?

A

Branch of the inferior hypogastric plexus -> pudendal nerve. This also controls the external urethral sphincter.

28
Q

What is the lymphatic supply to the female urethra?

A

Internal and external iliac nodes.

29
Q

What are the cells of the prostate?

A

Fibroblasts for supportive structure
Glands for semen production
Muscle cells for control of flow of ejaculation/urine

30
Q

What is the largest zone of the prostate?

A

Peripheral zone where carcinomas are most likely to occur

31
Q

What is the arterial supply to the prostate?

A

Inferior vesical artery

32
Q

What is the venous drainage of the prostate?

A

Prostatic venous plexus into internal iliac vein

33
Q

When does adenomatous prostatic growth occur?

A

Type of BPH where adenoma forms in the stromal/epithelial cells around age 30.

34
Q

What drives Benign prostatic hyperplasia?

A

Aging increases levels of 5-alpha reductase for depletion of testosterone levels via catalysing:
testosterone -> dihydrotestosterone
or
Testosterone -> Oestrogen

35
Q

What drives prostatic cell growth?

A

Most potent is dihydrotestosterone. Oestrogen has a lesser effect.

36
Q

Consequences of BPH issues?

A

Filling issues and Voiding issues

37
Q

What are the filling issues?

A

Increased frequency and urgency of urination, dysuria and nocturia

38
Q

Why does terminal dribbling occur?

A

Weakness of pelvic muscles surrounding urethra.
-> occurs due to continuous straining of bowels, overweight, constant cough, prostate surgery.

39
Q

Why does incomplete voiding occur?

A

Damage to the cauda equina that can also cause incontinence
Pelvic splanchic nerve damage

40
Q

What causes poor stream?

A

Overactive bladder which increases urge
Enlarged prostate with compression of urine outflow

41
Q

Why does decreased urination frequency occur?

A

Dehydration
Shock
Enlarged prostate- preventing urinary flow
Expanding haematoma- prevents flow
Tumour compression

42
Q

Why does hesitancy of urination occur?

A

Enlarged prostate/prostate infection

43
Q

What causes elevated PSA?

A

UTI
Prostatitis
Benign prostatic hyperplasia
Prostate cancer

44
Q

What is sensitivity?

A

Proportion of true positives that are identified.
True positives/ True positives + false negatives

45
Q

What is specificity?

A

Proportion of true negatives that are identified

True negatives/ True negatives+ false positives

46
Q

What is the ROC curve?

A

Plot of the true positive against the rate of false positives

47
Q

Why is sensitivity important?

A

Important in patient diagnosis to avoid unneeded interventions or treatment that may cause harm

48
Q

Symptoms of cystitis

A

Dysuria, polyuria and urge to urinate

49
Q

Symptoms of pyelonephritis

A

Accompanies symptoms of cystitis with fever, flank pain, nausea and vomiting

50
Q

Symptoms of cystitis in children

A

Fever, onset of urinary incontinence
Infants will feed poorly, vomit, sleep more and show jaundice signs.

51
Q

Symptoms of cystitis in elderly

A

Change in mental status such as confusion, fatigue and there may be incontinence.

52
Q

Features of E.Coli

A

Baccili gram negative anaerobic bacteria commonly found as part of gut microbiome

53
Q

How is E.Coli introduced into the urinary tract?

A

Wiping back to front after defaecation
Anal intercourse
Switching from anal to vaginal intercourse

54
Q

Bacterial cause of UTI

A

E.Coli, Staphylcoccus saprophyticus, Proteus

55
Q

Staphylcoccus saprophyticus

A

Gram positive bacteria found in the female genital tract. Increased risk of UTI with sexual activity when this is displaced into the urethra.

56
Q

Proteus

A

Gram negative baccili bacterium found in soil and water. Once establishing UTI, commonly ascends up urinary tract to kidney

57
Q

What is the diagnostic criteria for UTI?

A

Urinalysis for RBC, WBC, nitrites or leukocyte esterase
Urine culture for bacterial cause

58
Q

Treatment of UTI?

A

Antibiotics such as trimethoprim + sulfamethaxodaole

59
Q

BPH risk factors

A

Increasing age, obesity, family history and inactivity.
Driven by levels of dihydrotestosterone and oestrogen.

60
Q

Consequences of BPH

A

Reduced urine flow which leads to:
Bladder stones and bladder failure
Urination issues with voiding and storage
Urinary retention

61
Q

Dietl’s crisis

A

Episodic pain in the flank due to pelvi-ureteric obstruction

62
Q

Testicular cancer pathology

A

Most commonly germ cell tumour. This is divided into seminomatous and non-seminomatous
Lymphoma and secondary metastases

63
Q

Prostate cancer pathology

A

Malignancy with glandular origin in the acinar or ductal epithelia which originates in the peripheral zone, lesser in the transitional zone and central zone.

64
Q

Renal abscess

A

Caused by haematogenous spread of UTI

65
Q

Orchitis

A

Inflammation of the testicles due to mumps virus