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Med Year 3 > urological diseases > Flashcards

urological diseases Flashcards

1
Q

differential diagnoses for haematuria

A 
renal stones
UTI
renal or bladder tumours
trauma, eg biopsy 
PCKD
IgA nephropathy

warfarin can make haematuria worse

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2
Q

what investigations would you do for haematuria

A 
MSU
U&E for renal causes 
flexible cystoscopy for bladder cancer 
USS
CT urogram 
X-ray KUB for calcification

IVP

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3
Q

how do urological stones present?

A
  • pain

- haematuria

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4
Q

what are the causes of urological stones?

A

metabolic (50%)= renal tubular acidosis, hyperparathyroidism, cystinuria

urological = lesions causing stasis

infection 15%

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5
Q

what can urological stones be made of?

A

calcium oxalate = predisposition is IBD, bowel resection

calcium phosphate: HPT

struvite = staghorn stones, associated with UTI’s, catheters etc

uric acid: predisposition is obesity, DM (treated with urinary alkalinisation

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6
Q

how do you manage urological stones?

A

increase fluid intake, reduce animal protein and sodium

treat infection

medical therapies include bendroflumethiazide, allopurinol, penicillamine

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7
Q

what is the surgical management if a stone is >5mm?

A
  • ESWL
  • laser removal of stone via ureter
  • if blockage causing hydronephrosis = nephrostomy or stent, then removal of stone 6 weeks later
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8
Q

what are the types of kidney cancer?

A

renal cell carcinoma

transitional cell carcinoma

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9
Q

what is RCC

A

presents in 40-60s
haematuria, pain, palpable mass = clinical triad

management is resection or medical immunotherapy

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10
Q

what is TCC

A

> 45 years
haematuria, pain, LUTS
risk factors: smoking, DYES !! , bilharzia

management is surgical resection or intravesical chemotherapy

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11
Q

what is papillary necrosis

A

necrosis and shedding of medullary papillae

RF: analgesia, NSAIDs, diabetes

may cause obstruction and pyelonephritis

drainage and AB treatment

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12
Q

what is renal colic

A

severe, acute pain due to stone obstructing the ureter

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13
Q

how does a renal stone present

A 
loin to groin pain
nausea, vomiting
occasional LUTs
micro haematuria 
tachycardia and dehydration
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14
Q

what are common differentials for renal colic

A 
pyelonephritis 
ectopic pregnancy 
appendicitis 
pancreatitis 
ruptured AAA
MSK
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15
Q

what diagnostic tests should you do for renal colic

A

blood, FBCs, u&es, CRP
CALCIUM levels

non contrast CT abdo and pelvis

KUB x ray

USS = hydronephrosis

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16
Q

how do you manage renal colic

A

opiates or NSAIDs
hydration
<5mm pass alone
>5mm shockwave or uteroscopy

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17
Q

when should you never leave a renal stone?

A

patient is pyrexial
bilateral stone or reduced renal function

untreatable pain

stent or nephrostomy necessary

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18
Q

what is pyelonephritis?

A

Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)

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19
Q

what are RF for pyelonephritis?

A

Female, structural urological abnormalities and diabetes

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20
Q

what causes pyelonephritis (organisms that also cause UTIs)

A

Escherichia coli is the most common cause
Klebsiella
Enterococcus
Pseudomonas

21
Q

how does pyelonephritis present

A

High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of the renal angle (over kidney)

22
Q

what do you see on a urine dip for PN

A

Blood
Protein
Leukocyte esterase (produced by neutrophils)
Nitrite (gram negative organisms metabolise nitrates in the urine, which is normal to nitrites, which are not normally present)

23
Q

how do you test for PN

A

USS
CT
Dimercaptosuccinic acid (DMSA) scans involves injecting radiolabelled DMSA, which builds up in the kidneys and when imaged using gamma cameras gives an indication of renal scarring. This is used in recurrent pyelonephritis to assess the damage.

24
Q

how do you treat PN

A

Blood and urinary cultures
Broad spectrum antibiotics (e.g. co-amoxiclav) until culture and sensitivities are avaliable
Admission if systemically unwell or complicated
IV rehydration
Analgesia
Antipyretics

25
Q

what is Chronic pyelonephritis

A

Recurrent kidney infections
Leads to scarring of the renal parenchyma
Can result in chronic kidney disease
Can result in abscess and/or pus in or around the kidney

prophylactic antibiotics

26
Q

what is a UTI

A

infection of the urinary tract, can lead to cystitis (infection and inflammation in bladder), or spread up to kidneys

27
Q

what are risk factors for UTIs

A

women bc short urethra
unhygienic bc faecal matter spreads –> E coli
after sexual activity
urinary catheters

28
Q

what are LUTs

A

o Dysuria = pain or burning when passing urine
o Suprapubic pain
o Frequency
o Urgency
o Incontinence
o Confusion is commonly the only symptom in order or more frail patients

29
Q

what is an uncomplicated UTI

A

infection in a healthy, non-pregnant, pre-menopausal FEMALE

30
Q

what is a complicated UTI

A

male, or recurring (>3 in a year)

31
Q

how do you manage UTI

A

3 days of AB for simple UTI in women
5-10 days if immunosuppressed woman, abnormal anatomy or impaired kidney function

7 days for men, pregnant women or catheter UTIs

32
Q

what are the choices of AB?

A

trimethoprim or nitrofurantoin for women

for men: 7 day course of cephalaxin, cipro or trimethoprim

33
Q

what is a CI for trimethoprim?

A

pregnant women

34
Q

what are recurrent UTIs

A

> 3/ year

if not responding to AB = cystoscopy and USS

35
Q

what do men need once diagnosed with a UTI and why?

A

USS of bladder to exclude chronic retention of urine

36
Q

what are the main RF for bladder cancer?

A

o Increasing age
o Being male (3x)
o Smoking
o Exposure to industrial chemicals such as dye industries

37
Q

how does bladder cancer present

A

o Visible haematuria or LUTIs that do not resolve with AB treatment

38
Q

what are the types of bladder cancer

A

TCC

squamous cell carcinoma

39
Q

how do you stage bladder tumours

A

o Stage pTa: tumour cells confined to the epithelium
o Stage cis: aggressive cells confined to the epithelium, usually a flat tumour
o Stage t1: tumour cells in sub-epithelial connective tissue
o Stage 2/3: tumour cells in bladder wall muscle
o Stage t4: tumour cells in adjacent organs such as the prostate

40
Q

how do you manage bladder cancer

A

TURBT
t1 or above: BCG therapy into bladder or total cystectomy

if metastatic: systemic chemo

41
Q

risk factors for prostate cancer?

A

FH, black, male, age, anabolic steroids

42
Q

how does prostate cancer present?

A

BPH symptoms as well as ED, haematuria and weight loss, fatigue and bone pain

slow growing

43
Q

what investigations should you do?

A

DRE
PSA
biopsy: multiple needle transrectal or transperineal

44
Q

how do you grade prostate cancer?

A

gleason grading
o Histology used to decide on the grade

1: well differentiated

2-4: moderate to poor differentiated

5: anaplastic

45
Q

how do you manage prostate cancer?

A

watch and wait
radiotherapy
brachytherapy (radioactive seeds)
hormonal treatment = stop prostate growing by blocking androgens or bilateral orchidectomy

prostatectomy but = ED, urinary incontinance etc

46
Q

what is BPH

A

benign prostatic hyperplasia caused by hyperplasia of stromal and epithelial cells of the prostate

47
Q

how does BPH present?

A 
o	Hesitancy 
o	Urgency 
o	Frequency 
o	Intermittency 
o	Straining to avoid 
o	Terminal dribbling 
o	Incomplete emptying
48
Q

how do you assess for BPH

A

urine dip to rule out UTI
PSA
rectal exam

49
Q

management for BPH?

A

tamsulosin 400mcg OD = relaxes smooth muscle to allow urine to flow through, is an alpha blocker

finasteride: 5-alpha reductase inhibitors; blocks testosterone and reduces size of prostate

TURP = shave off prostate tissue from inside

Med Year 3 (25 decks)

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