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Flashcards in Benign Conditions of GI Tract Deck (58)
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1
Q

Urolithiasis

A

A state marked by or tending to the formation of urinary claculi

2
Q

Nephrolithiasis

A

kidney stone

3
Q

Ureterolithiasis

A

stone in ureter

4
Q

Most common kidney stone crystals

A

Calcium oxalate- (indicate acidic urine environment)

5
Q

Marathon runners may have this condition-

A

crystalluria

6
Q

Patient that has recurrence of calcium oxalate kidney stones. What 4 things do you tell them it might have been caused by and tx?

A
  1. Low fluid intake. Stay hydrated! 2. Hypercalciuria. Too much calcium being excreted- increase calcium intake and use thiazide diuretics. 3. Hyperoxaluria- Increase calcium intake and avoid foods high in oxalate. 4. Hypocitraturia- Get potassium citrate supplementation, and increase intake of high citrate foods (lemon juice)
7
Q

Foods high in oxalate

A

rhubarb, spinach, beets, chocolate

8
Q

Risk factors for uric acid stones

A

Hyperuricosuria from Gout or Tumor lysis sundrome

9
Q

Tx of uric acid stones

A

Make urine alkaline, increase intake of high citrate foods, increased fluid intake, dec meat, cranberries, and animal protein intake, allopurinol

10
Q

Why is allopurinol given as tx in some cases of nephrolithiasis?

A

decreases amount of uric acid in blood- helpful in tx of uric acid stones

11
Q

struvite stones aka

A

magnesium ammonium phosphate stones

12
Q

risk factors for struvite stones

A

STAGHORN calculi, recurrent UTI’s with urease-splitting Klebsiella and Proteus species

13
Q

Risk factors for cystine stones

A

LARGE, BRANCHED calculi in childhood or adolescense

14
Q

What foods to avoid if have very alkaline urine causing kidney stones?

A

high citrus foods. avoid lemon juice, oranges, etc.

15
Q

What foods to avoid if you have very acidic urine causing kidney stones?

A

decrease meat, cranberries

16
Q

tx of struvite stones

A

chronic abx therapy and stone removal

17
Q

tx of cystine stones

A

make urine alkaline, penicillamine, captopril

18
Q

shapes of calcium oxalate crystals

A

dumbbell shaped or needle-shaped- monohydrate. envelope shaped- dihydrate.

19
Q

Shape and color of uric acid crystals

A

rhombic plates or rosettes, yellow or reddish brown

20
Q

Magnesium ammonium phosphate, or struvite cystals shape

A

“coffin lid”

21
Q

Shape of cystine crystals

A

hexagonal

22
Q

Cystine crystals are pathognomonic for..

A

cystinuria

23
Q

Patient complaint of sudden onset of unilateral flank pain, N/V, and urinary frequency and urgency. Hematuria sometimes as well. Dx?

A

Nephrolithiasis. If increased urinary frequency and urgency, may be uretolithiasis

24
Q

Nephrolithiasis Dx options

A
  1. Lab tests- serum creatinine, serum electrolytes, serum calcium, serum phosphate, serum uric acid. 2. UA– gross and microscopic hematuria, urine sediment. 3. Serum PTH levels. 4. Stone analysis (strain urine). 4. 3 24-hour urine collections
25
Q

Gold standard to determine stone composition

A

Stone analysis (strain urine)

26
Q

When are three 24-hour urine collections indicated?

A

If positive family hx of nephrolithiasis, recurrent nephrolithiasis, chronic medical conditions favoring stone formation. To determine urine volume, pH, creatinine, sodium, calcium, uric acid, oxalate, citrate.

27
Q

Stones in imaging studies are usually RADIOPAQUE, exception=

A

uric acid stones

28
Q

What imaging study is gold standard for diagnosis of kidney stones?

A

Non-contrast helical abdominal CT

29
Q

Best prevention of nephrolithiasis

A

intake of more than 2 L of fluid/day, decrease dietary sodium and protein intake, increase calcium 800-1200 mg/day

30
Q

May be causal association between nephrolithiasis and…

A

progression to CKD/ESRD

31
Q

4 types of urinary incontinence associated with lower UT dysfunction

A

stress, urge, mixed, overflow

32
Q

Overactive bladder syndrome

A

type of urge urinary incontinence with urgency, frequency, and nocturia without incontinence

33
Q

UI most common in men and women

A

stress in women, urge in men

34
Q

When emptying bladder, what contracts and what relaxes?

A

contraction of detrusor smooth muscle, relaxation of smooth internal and striated external sphincter muscles

35
Q

Causes of UI in person

A

Trauma, UTI, meds (diuretics), DM, neurogenic, surgical, prostate disease (men), BPH, prostate cancer

36
Q

What UI has increased post-void residual volume?

A

Overflow urinary incontinence

37
Q

PE of UI patient

A

cardio, abdominal, GU, neurologic

38
Q

Lab tests in UI

A

UA, renal function, prostate specific antigen

39
Q

What are components of dx in UI?

A

history, and PE, lab tests (UA, renal function, PSA), PVR, urodynamic tests

40
Q

PVR =

A

more than 200-300 ml in ultrasound or cath

41
Q

normal male sexual function depends on interactions between these systems

A

hormonal, psychological, neurogenic, and vascular

42
Q

Causes of erectile dysfunction

A

Endocrine abnormality, psychogenic, meds, vascular disease, neurogenic, decreased libido

43
Q

Meds that may cause ED

A

antihypertensives, antidepressants (SSRI’s), antiandrogens, and narcotics/NSAIDS

44
Q

ED Diagnosis (PE)

A

usually not very helpful. can do cardio exam to check for risk factors, GU- secondary sexual characteristics like hypogonadism, neuropathy

45
Q

ED diagnosis- labs to get

A

FBG, BUN, creatinine, fasting lipid profile, serum total testosterone, serum PRL, thyroid, FSH, LH

46
Q

ED tx

A

treat underlying cause. Testosterone replacement if hypogonadism. PDE-5 inhibitors, PGE E1 (alprostadil) therapies, vacuum erection devices, penile implants

47
Q

when are prostaglandin E1 therapies contraindicated?

A

intraurethral alprostadil contraindicated in men with hx of priapism. Intrapenile alprostadil contraindicated in men with hx of priapism or severe coagulopathy

48
Q

PDE-5 inhibitors contraindicated in men on…

A

nitrate therpay or with hx of ischemic optic neuropathy

49
Q

balanitis

A

inflammation of the glans penis or glans clitoridis

50
Q

balanoposthitis

A

inflammation of the glans penis and overlying prepuce

51
Q

Hydrocele

A

collection of fluid between the parietal and visceral layers of the tunica vaginalis

52
Q

varicocele

A

a collection of dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum

53
Q

Fluid around testis in communicating hydrocele

A

peritoneal fluid

54
Q

fluid in non-communicating hydrocele

A

from the mesothelial lining of the tunica vaginalis

55
Q

What occurs d/t failure of processus vaginalis to close during development?

A

communicating hydrocele

56
Q

what type of hydrocele is not reducible and does not increase in size with crying or straining?

A

Non-communicating hydrocele

57
Q

spermatic cord resembling “bag of worms”

A

varicocele

58
Q

varicocele occurs more commonly on what side?

A

L