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Block 34 metabolic -Ellen > Benign urological disease > Flashcards

Benign urological disease Flashcards

(75 cards)

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1
Q

typicaly presentation of renal stones

A

-acute renal colic

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2
Q

signs and symptoms of renal stones (6)

A
  • acute, severe flank pain
  • colicky pain radiating to groin
  • N&V
  • urinary frequency and urgency
  • haematuria
  • testicular pain
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3
Q

chance of recurrance of renal stones

A

50%

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4
Q

what size stone can pass through ureter and urethra without symptoms

A

<5mm

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5
Q

what size stone can cause symptoms

A

> 5mm

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6
Q

nephrolithiasis=

A

formation of crystallised minerals in kidneys

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7
Q

why is urine concentrated (2)

A
  • due to an increase mineral solutes

- decreased volume from dehydration

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8
Q

what happens to concentrated urine

A

becomes supersaturated

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9
Q

supersaturation=

A

urine solvent containing more solutes than it can hold in the solution

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10
Q

what does supersaturation cause

A

mineral crystals (nidus) to form which encourage aggregation and form a stone

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11
Q

what is supersaturation dependant on

A

urine pH

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12
Q

pH of urine for supersaturation to occur

A

acidic

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13
Q

2 chelating agents that inhibit nucleation and formation of crystals

A

magnesium

citrate

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14
Q

which stones can dietary magnesium and citrate inhibit

A

calcium oxalate

calcium phosphate

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15
Q

> 90% of stones =

A

calcium oxalate

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16
Q

risk factors for calcium stones

A

hypercalciruia

hyperoxaluria

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17
Q

2 conditions causing hypercalciruia

A

sarcoidosis and hyperparathyroidism

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18
Q

when is oxalate more readily absorbed from the gut

A

when dietary calcium is low

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19
Q

calcium oxalate stones on X-ray=

A

radiopaque

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20
Q

colour of calcium oxalate stones

A

dark brown

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21
Q

what type of stone does alkaline urine with hypercaclyiuria form

A

calcium phosphate

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22
Q

what does hypophosphatemia stimulate

A

calcitriol synthesis

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23
Q

what does excess calcitriol synthesis lead to

A

hypercalciuria

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24
Q

calcium phosphate stones colour

A

dirty white stones

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25
calcium phosphate stones on X-ray
radiopaque
26
what stones does excess purine ingestion cause
uric acid stones
27
risk factors for uric acid stones (3)
- low urine pH - low urine volume - hyperuricosuria
28
colour of uric acid stones
red-brown
29
uric acid stones on X-ray
transulcent
30
struvite stones are made up of (3)
magnesium ammonium phosphate
31
why are struvite stones refered to as infectious stones
urinary tract infection precipitates their formation
32
what causes struvite stones
urea splitting microorganisms | -proteus, staphylococcus, Klebsiella
33
what do urea splitting microorganisms do to urea
hydrolyse it to produce ammonia and OH- forming alkaline urine
34
struvite stones appearance
stag-horn dirty white
35
struvite stones on X-ray
radiopaque
36
least common stones=
cysteine stones
37
what can cause cystinuria
iheritible autosomal recessive condition
38
risk factors for renal stones (6)
``` high protein high salt intake white ancestry male dehydration obesity ```
39
urinalysis for renal stones
microhematuria nitrates leukocytes
40
conservative management of renal stones
hydration pain control anti-emetics
41
antibiotic therapy for stones
trimethoprim | nitrofurantoin
42
3 treatments for renal stones
- surgical decompression - medical expulsive therapy - extracorporeal shock wave lithotripsy
43
medical expulsive therapy=
tamsulosin alpha blocker
44
surgical decompression for stones (2) =
- ureteric stent for renal drainage | - nephrostomy
45
what coordinates micturition
pontine micturition centre
46
at what level of bladder fullness is the pontine micturition centre activated
200-400ml (half-full)
47
3 bladder nerves
splanchnic nerve hypogastric nerve pudendal nerve
48
splanchnic nerve=
parasympathetics - M3 receptors
49
hypogastric nerve =
sympathetic nerve
50
pudendal nerve=
somatic nerve
51
in bladder contraction which nerves are active
the splanchnic nerve (PS)
52
in bladder contraction which nerves are inactive
hypogastric | Pudendal
53
pudendal nerve innervates
external sphincter
54
hypogastric nerve innervates
internal sphincter | destrusor bladder muscle
55
splanchnic nerve innervates
M3 receptor of bladder wall contraction
56
4 types of incontinence
urge stress overflow neurogenic bladder
57
urge incontinence =
sudden urgency and need to urinate - overactive bladder
58
stress incontinence=
involuntary loss of urine during coughing, sneezing, laughing or exercise
59
common causes of stress incontinence (2)
- following pregnancy and birth -weakened internal sphincter and pelvic floor muscles - post-menopause
60
overflow incontinence=
involuntary loss of urine without urgency
61
when can overflow incontinence occur (4)
- BPH - prostate cancer - urethral narrowing - ineffective detrusor muscle
62
neurogenic bladder =
bladder dysfunction caused by neurological damage
63
symptoms of neurogenic bladder
- overflow - frequency - urgency - urge - retention
64
2 types of neurogenic bladder
flaccid | spastic
65
volume of urine in a flaccid bladder
large (750ml)
66
volume of urine in spastic bladder
low
67
main causes of flaccid neurogenic bladder (2)
- peripheral nerve damage | - cord damage at S2,3
68
main cause of spastic neurogenic bladder
brain damage or spinal cord damage above T12
69
prostatic carcinoma symptoms 6
- urinary frequency, hesitancy and dysuria - nocturia - weight loss - lethargy - bone pain - palpable lymph nodes
70
BPH is
hyperplasia of epithelial and stromal prostatic components
71
in BPH anatomically which lobes are most enlarged
medial and lateral lobes due to higher glandular tissue
72
why is the prostate enlarged in BPH
increased activity of aromatase and 5-alpha reductase enzymes
73
risk factors for BPH (5)
- over 50 years old - family history - obesity - type 2 diabetes - erectile dysfunction
74
treatment of BPH
- alpha blocker (doxazosin) - Slidenafil inhibitor - NSAIDs - Finasteride
75
Finasteride =
5-alpha reductase inhibitor

Block 34 metabolic -Ellen (8 decks)

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