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Urinary > 9- Dev of Urinary Tract, Obstruction and Prostate > Flashcards

9- Dev of Urinary Tract, Obstruction and Prostate Flashcards

1
Q

What is the order of the fetal kidney systems

A

Pronephros (week 4), Mesonephros (form trigone), Metanephros

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2
Q

What mesodermal layer does the kidney develop from

A

Intermediate

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3
Q

Where does the first kidney structure appear

A

Cervical region

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4
Q

What does the pronephros do

A

Makes duct from cervical region to cloaca and drives development of next developmental stage

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5
Q

What is the urogenital ridge

A

Intermediate mesoderm that gives rise to embryonic kidney and gonad.

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6
Q

Where does mesonephric tubule develop

A

Caudal to pronephric region

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7
Q

What is the embryonic kidney made of

A

Mesonephric tubules and mesonephric duct

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8
Q

Can this stage conserve water

A

No

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9
Q

Importance of mesonephros

A

Reproductive system in males. Also sprouts ureteric bud which induces development of definitive kidney.

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10
Q

What does the ureteric bud do

A

Induces development (by releasing growth factors) of undifferentiated intermediate mesoderm (metanephric blastema) to form mesonephros.

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11
Q

Collecting system is derived from

A

Ureteric bud

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12
Q

Excretory component is derived from

A

Intermediate mesoderm under influence of ureteric bud

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13
Q

Ascent of kidney

A

Caudal to cranial. Cross arterial fork of vessels from fetus to placenta. This occurs due to elogation of trunk and expansion of pelvic volume.

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14
Q

Vascularisation of ascending kidney

A

Vascularised from aorta at higher level. Sometimes accessory renal arteries are kept.

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15
Q

What can go wrong

A 
Renal agenesis- bud doesn't interact effectively
Migration awry
Duplication defects
Ectopic ureter- incontinence
Cystic disease
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16
Q

Name 2 anomalies related to migration

A

Pelvic kidney

Horseshoe kidney

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17
Q

Why does duplication defects and ectopic urethral orifices occur

A

Splitting of bud

Ability to drive differentiation = more lobes or distal part of bud opens ectopically.

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18
Q

What 3 systems start by sharing common caudal opening

A

Repro, Urinary, GI

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19
Q

Is the cloaca open to outside

A

No there is cloacal membrane

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20
Q

What is the function of urorectal septum

A

Divide the GI from urinary and repro. Creates urogenital sinus. The cloacal membrane ruptures giving access to outside

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21
Q

Urogenital sinus becomes…

A

Superior part connects to umbilicus. Majority becomes bladder, inferior part develops into urethra.

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22
Q

Development with NO Y chromosome present

A

Mesonephric duct reaches urogenital sinus and ureteric bud sprouts from mesonephric duct. The sinus expands and duct regress. Bud connected directly to bladder = development of ureter and bladder from sinus.

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23
Q

Development with Y chromosome present

A

Duct reaches sinus. Bud sprouts from duct. Sinus expands. Bud and duct make independent opening in sinus. Duct becomes vas deferens and connects epididymis to urethra. Interaction between trigone of bladder and ducts = prostate develops.

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24
Q

Parts of male urethra

A

Pre-prostatic, prostatic, membranous, spongy.

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25
Male urethra development
Genital tubercle elongates and genital folds fuse = spongy urethra.
26
What is required for genital folds to fuse
Androgens and responsive tissue.
27
What is hypospadias
Defect in fusion of urethral folds. Urethra opens onto ventral surface not the end of glans.
28
Growth factors and metanephric blastema
Release growth factors which cause uteric bud to form . This then release GF = reciprocal induction
29
What are main pathogens for acute prostatitis
Escherichia Coli. Staphylococcus. Chlamydia Trachomatis. Neisseria Gonorrhoeae.
30
Symptoms of acute prostatitis
Malaise, rigors, fever, passing urine difficulty, dysuria, perineal tenderness
31
Cause of chronic prostatitis
Chlamydia trachomatis.
32
Histological findings of chronic prostatitis
Fibrosis as a result of chronic inflammation
33
What is BPH and who is it common in
Common over 60 | Non-neoplastic enlargement - can lead to obstruction
34
Cause of BPH
Unknow, maybe levels of testosterone
35
Symptoms of BPH
Enlarged prostate Compresses prostatic urethra Obstructive lower urinary tract symptoms- poor stream, dribble, frequency, nocturia
36
Findings of a rectal exam for BPH
Firm, smooth, rubbery
37
Risk of untreated BPH
Retention, overflow incontinence, bilateral upper tract obstruction, renal impairment - CKD
38
Treatment of BPH- drugs
Smooth muscle relaxers- alpha blockers (bladder neck and prostate) Finasteride- prevents conversion of testosterone into more potent dihydrotestosterone.
39
Risk of obstruction
UTI- stasis Reflux up ureter Stone formation
40
Causes of renal retension
Calculi, pregnancy, tumours, drugs, surgery, strictures, BPH, neurogenic disorders (trauma- interferes with micturition pathway)
41
Symptoms of acute retention
Painful to void | Residual volume- 300-1500ml
42
Symptoms of chronic retention
Painless Still void Residual volume - 300-4000ml
43
Management of acute retension
``` Catheter History Exam Urine U&Es Treat causes- constipation ```
44
Management of chronic retension
``` Catheterise and measure residual History Exam Dip and U&Es Long term catheter plan ```
45
Low pressure vs high pressure
Normal renal function No hydronephrosis Bladder compliant but not emptying ? neuro problem VS Abnormal U&Es, hydronephrosis, renal scarring and risk of CKD development.
46
Post obstructive diuresis
``` Following resolution of retention Over diurese Worsening AKI as electrolytes and fluid excreted. Therefore loss of countercurrent in loop of henle because of back up = more water lost Monitor for 24 hrs post catheter. Treat with IV fluid and ```
47
Hydronephrosis When bilateral when unilateral
Dilation of renal pelvis and calyces due to obstruction. Leads to increased pressure and blockage. Bilateral- if lower urinary tract obstruction Unilateral- if upper urinary tract obstruction
48
Problems with hydronephrosis
Progressive atrophy of kidney= increased hydrostatic pressure in Bowman's capsule = GFR decreases = renal failure if bilateral.
49
Hydronephrosis VS hydroureter
Obstruction at pelviureteric junction vs ureter. Hydroureter develops into hydronephrosis.
50
How does hydroureter develop
Hydroureter develops from obstruction of bladder neck/urethra --> bladder distension with hypertrophy
51
Acute ureteric obstruction causes what pain
Renal colic- pain loin to groin radiating
52
Cause of acute ureteric obstruction
Calculus, clots, slough papilla | Can lead to pyelonephritis
53
What is Pyelonephritis
Infected, obstructed kidney.
54
Failure to treat pyonephrosis can lead to..
need to decompress as it may lead to death from sepsis and permanent loss of renal function.
55
Diagnosis of upper urinary tract obstruction
CT USS Diuretic renography: furosomide and then expect to see tract decline.
56
Drainage of upper urinary tract
nephrostomy (direct from kidney to outside) | JJ stend - helps bladder drain.
57
Urinary calculi affects mostly...
White, men
58
What causes increases in occurance
Dehydration
59
Where can stones/obstruction form
Pelviureteric junction, pelvic brim, vesicoureteric junction Narrowest point
60
Gold standard for stone diagnosis
CT
61
Composition of calculi
Calcium oxalate (hypercalcemia, primary hyperparathyroidism) Calcium phosphate- alkaline urine Magnesium ammonium phosphate- urea splitting bacteria Uric acid stone- gout and myeloproliferative disorders Cystine stones- inherited cystinuria
62
Presentation of stones
Dull ache in loins Radiates if ureteric stones due to peristalsis Pale, sweaty, restless, nausea, vomiting Strangury (urge to pass something that won't) Recurrent UTIs untreatable, haematuria, renal failure Asymptomatic
63
Treatment of stone
Less than 5mm- wait Larger than 5mm- extracorporeal shock waves, ureteroscopic destruction and removal, percutaneous nephrolithotomy, open surgical removal.
64
Prevention of stones
Hydration | Correct metabolic abnormalities- Ca and PTH

Urinary (11 decks)

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