15. The Urinary System and the Male Genital Tract Flashcards Preview

Pathology Year 2 > 15. The Urinary System and the Male Genital Tract > Flashcards

Flashcards in 15. The Urinary System and the Male Genital Tract Deck (38)
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1

Overview

Urinary tract infections
Kidneys
Bladder
Prostate
Testis

2

Urinary Tract Infections (1)

Very common disorder of the urinary tract

Risk factors include:
Females>males
Sexual intercourse
Pregnancy
Diabetes
Urinary tract obstructions e.g. stones or catheters

3

Urinary Tract Infections (2)

Bacteruria: bacteria in the urine, may be asymptomatic or symptomatic.

Urinary Tract Infection (UTI): the presence of pure growth of >10^5 organisms in fresh urine.

E.coli is the most common causative organism (>70% of community UTIs).

Other organisms include: Staphylococcus, Proteus and Klebsiella

4

Cystitis

frequency, dysuria, urgency, haematuria, suprapubic pain

5

Pyelonephritis

high fever, rigors, vomiting, loin pain and tenderness

6

prostatitis

flu-like symptoms, few urinary symptoms, swollen tender prostate

7

Management

Drink plenty of fluids.

Urinate often (double voiding).

Antibiotics (trimethoprim usually first line treatment in uncomplicated UTIs).

Imaging – US in non-resolving UTIs, children, men and pyelonephritis.

Severe cases may require hospital admission specially pyelonephritis and in the elderly

8

Kidney Function (1)

Maintinance of water, electrolyte and acid-base homeostasis.

Excretion of many toxic metabolic waste products (urea and creatinine).

Hormonal function
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.

9

Kidney Function (2)

The functional unit is the nephron (consisting of a glomerulus and a renal tubule).

Filtration of most small molecules from the blood in the glomerulus.

Selective reabsorption in the renal tubule of most of the water and some molecules.

Maintenance of the acid-base balance.

10

Acute Renal Failure

over hours or days

There is a low urine volume (

11

Causes

Pre-renal
Hypoperfusion, sepsis
Renal
ATN damage to tubules due to ischaemia or nephrotoxins
Post-renal
Renal tract obstruction (eg stones, tumours)

12

Management


Treat exacerbating factors ( hypovolaemia, sepsis.. etc).

Stop nephrotoxic drugs ( NSAIDs, ACE-I, gentamycin and Vancomycin)

May need renal replacement therapy (haemofiltration/dialysis)

13

Chronic Renal Failure

depending on the glomerular filtration rate (GFR)

GFR is the volume of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time

Symptoms usually occur by stage 4

14

Chronic Renal Failure stage

1 = >90
2 = 60-89
3 = 30-59
4 = 15-29
5 =

15

Chronic Renal Failure Common Causes

Glomerulonephritis
Diabetes
Renovascular disease
Hypertension
Polycystic disease

Managed under nephrology team. Treat reversible causes. Avoid exacerbating factors, avoid nephrotoxic drugs.

May progress to renal replacement therapy

16

Glomerulonephritis

A group of disorders where there is damage to the glomerular filtration apparatus. This may cause a leak of protein or blood into the urine.

Usually there is a deposition of immune complexes in one part of the nephron

17

Stones

Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.

Life time incidence 15%

Peak age 20-40 years.

Male: female = 3:1

18

Risk Factors (1)

Dehydration
Dietary factors ( increase chocolates, tea and rhubarb)
Drugs ( loop diuretics, antacids, corticosteroids, theophylline and aspirin)
Renal tract abnormalities
Recurrent UTIs
Metabolic abnormalities (hyperparathyroidism, hyperthyroidism and cancer)

19

Risk Factors (2)

Patient may be asymptomatic (found accidently on x-ray or blood on dipstick ).

Pain. Kidney stones causes loin pain. Ureteric stones case renal colic (from loin to groin). Bladder and urethral stones cause pain on micturition with interrupted flow. Patients often can’t lie still from the pain.

20

Management

Imaging options: KUB-xray (80% of stones are visible). CT scan (99% of stones visible).

Prompt pain relief

Stones 5mm or causing obstruction may need intervention

21

Renal Cancer

Renal cell carcinoma

85% of all renal cancers.

Usually presents between the ages of 50 and 70 years.

2:1 male predominance .

Smoking an important risk factor along with obesity, hypertension, exposure to asbestos and certain hereditary conditions.

22

Presentation

50% incidental findings on abdominal imaging.

Haematuria.

Loin pain.

Abdominal mass.

Para neoplastic syndromes: e.g. polycythaemia, hypercalcaemia and hypertension.

23

Treatment

Radical nephrectomy +/- chemotherapy

24

Bladder

Cystitis is the commonest benign condition

Transitional cell carcinomas are the most common malignant condition in the bladder

25

Transitional Cell Carcinoma

Presentation:
Classically – painless haematuria
Frequency, urgency and dysuria can occur.

Tests:
Urine for cytology
Cystoscopy and biopsy

26

Treatment

Depends on stage of disease and spread

Small lesions at early stage can be managed with diathermy on cystoscopy.

Later stages – radical cystectomy or palliative chemo/radiotherapy

27

Prostate

Prostate is a gland that is located at the base of the bladder and around the first part of the urethra.

In normal adults weighs around 20gm.

Helps in the secretion and maintenance of semen and spermatozoa.

28

Benign Prostatic Hyperplasia

Common

Hyperplasia: increase in the number of cells.

BPH: increase in number of cell resulting in the formation of nodules. Prostate weighs 60-100gm

40s = 20%
60s = 70%
80s = 90%

29

Signs and symptoms (1)

Usually those of lower urinary tract obstruction: increased frequency, hesitancy, nocturia, terminal dribbling.

Can lead to an increased risk of infection.

Enlarged prostate on PR.

30

Signs and symptoms (2)

If small and not symptomatic then conservative, reduce fluid intake (specially at night), reduce alcohol and caffeine, scheduled voiding.
Medical treatment: Alpha-blockers, reduces the smooth muscle tone in the prostate.
TURP (Transurethral Resection of the Prostate