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Medicine Phase 2a GU > Everything from Mind-maps > Flashcards

Everything from Mind-maps Flashcards

1
Q

Examples of renal cancer

A

Renal cell carcinoma (RCC)

Transitional cell carcinoma (TCC)

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2
Q

What is renal cell carcinoma

A

This is an adenocarcinoma originating from the cells that line the proximal convoluted tubule

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3
Q

RCC risk factors

A 
Male
Age 50-70 years
Smoking
Obesity
Mutation of the Von Hippel-Lindau tumour suppressor gene on chromosome 3
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4
Q

RCC signs and symptoms

A 
Unintentional weight loss
Loin pain
Haematuria
Palpable mass
Fever
Hypertension
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5
Q

What paraneoplastic syndromes are involved in RCC

A

Secretion of adrenocorticotrophic hormone (ACTH) - may produce symptoms of hypercalcaemia
Secretion of erythropoietin (EPO) - may produce symptoms of polycythaemia

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6
Q

Investigations of RCC

A

Radiology: ultrasound scan, CT scan, MRI scan

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7
Q

Conservative treatment of RCC

A

Patient education
Supportive, counselling and monitoring of psychological wellbeing (depression)
Refer patients to Macmillan nurses

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8
Q

Medical treatment of RCC

A

Interferon alpha
Sunitinib
Sorafenib
Bevacizumab

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9
Q

Surgical treatment of RCC

A

Partial or total nephrectomy is the treatment of choice

Radio-frequency ablation may be considered

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10
Q

Complications of RCC

A

Metastasis
Hypercalcaemia
Hypertension
Polycythaemia

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11
Q

Sites of RCC metastases

A

Brain, bone, lung, liver, adrenal glands and lymph nodes

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12
Q

What is a Transitional cell carcinoma

A

Cancer that arises from transitional urothelium

More common in MEN

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13
Q

Risk factors of TCC

A 
CAPS:
Cyclophosphamide
Aniline dyes
Phenacetin
Smoking
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14
Q

TCC signs and symptoms

A

Depends on the location of the cancer but is usually associated with painless haematuria and lower urinary tract symptoms e.g. frequency and urgency

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15
Q

TCC investigations

A

Cystoscopy and ureteroscopy with biopsy
Retrograde pyelography
CT scan
MRI scan

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16
Q

TCC conservative treatment

A

Supportive counselling and monitoring of psychological wellbeing (depression)
Refer patients to Macmillan nurses

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17
Q

TCC medical treatment

A 
Mitomycin
GC regimen (gemcitabine and cisplatin)
MVAC regimen (methotrexate, vinblastine, adriamycin and cisplatin)
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18
Q

TCC surgical treatment

A

Nephroureterectomy, cystectomy

Radio-frequency ablation may be considered

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19
Q

Complications of TCC

A

Metastasis (usually to bone)

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20
Q

Difference between nephrotic and nephritic syndromes

A

Nephrotic syndrome involves the loss of a lot of protein
Nephritic syndrome involves the loss of a lot of blood
Different groups of signs of varying diseases

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21
Q

Signs of Nephritic syndrome

A 
PHARAOH: (I the Pharaoh lost alot of blood)
Proteinuria
Haematuria
Azotaemia
Red blood cell casts
Antistreptolysin O titres
Oliguria
Hypertension
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22
Q

Signs of NephrOtic syndrome

A 
PHHO:
Proteinuria
Hypoalbuminaemia
Hyperlipidaemia
Oedema
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23
Q

Why does hyperlipidaemia occur in nephrotic syndrome

A

Hypoproteinaemia stimulates the production of more proteins form the liver, which results in the synthesis of more lipoproteins
Decreased levels of lipoprotein lipase means that lipid catabolism decreases

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24
Q

Focal proliferative causes of nephritic syndrome

A

IgA nephropathy
Systemic lupus erythematosus (SLE)
Henoch-Schonlein purpura
Alport’s syndrome

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25
Diffuse proliferative causes of nephritic syndrome
Rapidly progressive glomerulonephritis e.g. Goodpastures syndrome Systemic lupus erythematosus (SLE) Membranoproliferative glomerulonephritis Cryoglobinaemia
26
Investigations of nephritic or nephrotic syndrome
``` Bloods Urinalysis Nephritic screen (done in nephrotic investigations also) Renal biopsy Radiology - ultrasound scan ```
27
What blood investigations are done in nephritic or nephrotic syndrome
``` FBC WCC and platelets U and Es LFTs Creatinine Urea CRP ESR Glucose Lipid profile ```
28
What is analysed in a urinalysis investigation
``` Blood Protein Glucose Leucocytes Nitrites Bence Jones protein ```
29
What is looked for in nephritic screen
``` Serum complement (C3 and C4) Antinuclear antibody (ANA) Double stranded DNA Anti-neutrophil cytoplasmic antibody (ANCA) Antiglomerular basement membrane (GBM) HIV serology HBV and HCV serology Blood cultures Venereal Disease Research Laboratory Test for Syphilis ```
30
Conservative treatment of nephritic or nephrotic syndrome
Lifestyle advice | Low salt diet
31
Medical treatment of nephritic or nephrotic syndrome
``` Depends on the cause: Treat hypertension Treat proteinuria Treat hypercholestrolaemia Give prophylactic anticoagulation therapy Immunotherapy regimen Dialysis if sever ```
32
Complications of nephritic syndrome (I the pharaoh lost alot of blood)
Nephrotic syndrome Chronic glomerulonephritis Heart failure
33
Causes of nephrotic syndrome
``` Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Diabetes nephropathy Amyloidosis Mesangial proliferative glomerlonephritis SLE ```
34
Complications of nephrotic syndrome
Hypertension Acute Kidney Injury Chronic Kidney Injury Infection
35
Congenital kidney abnormalities examples
``` HERD: Horseshoe kidney Ecotopic kidney Renal agenesis Duplex ureters ```
36
What is horseshoe kidney
Occurs during development when the lower poles of both kidneys fuse, resulting in the fomration of one horseshoe-shaped kidney This cannot ascend to the normal anatomical position due to the central fused portion catching the inferior mesenteric artery
37
Signs and symptoms of horseshoe shaped kidney
Asymptomatic Recurrent urinary tract infection (UTI) Renal calculi Obstructive uropathy
38
Causes of horseshoe shaped kidney
Congenital abnormality
39
Investigations of horseshoe shaped kidney
Ultrasound scan is diagnostic
40
Treatment of horseshoe shaped kidney
Treat complications
41
Complications of horseshoe shaped kidney
Susceptible to trauma Renal calculi formation Increased risk of transitional cell carcinoma of the renal pelvis
42
What is ectopic kidney
Congenital abnormality in which the kidney lies above the pelvic brim or within the pelvis
43
Signs and symptoms of ectopic kidney
Usually asymptomatic
44
Causes of ectopic kidney
Genetic abnormalities Poor development of the metanephrogenic diverticulum Teratogen exposure
45
Investigations of ectopic kidney
Ultrasound is diagnostic
46
Treatment of ectopic kidney
None | Treat complications should they develop
47
Complications of ectopic kidney
UTI | Renal calculi
48
What is renal agenesis
Bilateral or unilateral absence of the kidney
49
Types of renal agenesis
``` Bilateral absence (Potters syndrome) Unilateral absence ```
50
Signs and symptoms of Bilateral renal agenesis
Low set ears Limb defects Receding chin Flat, broad nose
51
Signs and symptoms of unilateral renal agenesis
Hypertension Increased risk of respiratory infections Proteinuria Haematuria
52
Causes of renal agenesis
Failure of ureteric bud development
53
Investigations of renal agenesis
Antenatal screening
54
Treatment of bilateral renal agenesis
Neonates usually die afew days after birth | If the baby survives they require chronic peritoneal dialysis
55
Treatment of unilateral renal agenesis
Treatment of hypertension
56
Complications of renal agenesis
Susceptible to trauma (unilateral) | Death
57
What are duplex ureters
Occurs when the ureteric bud splits during embryonic development and results in the development of 2 ureters, which drain 1 kidney
58
Signs and symptoms of duplex ureters
Asymptomatic | Recurrent UTI
59
Causes of duplex ureters
Splitting of the ureteric bud
60
Investigations of duplex ureters
Ultrasound scan and excretory urography is diagnostic
61
Treatment if duplex ureters
Treat complications
62
Complications of duplex ureters
Vesicoureteral reflux Ureterocele UTI
63
What are renal calculi
Stones that form within the renal tract Most stones are made from calcium (radiopaque), but others are made from struvite (staghorn calculus) and uric acid crystals (radiolucent)
64
What can renal calculi be made of
calcium (radiopaque) struvite (staghorn calculus) uric acid crystals (radiolucent)
65
Signs and symptoms of renal calculi
``` Asymptomatic Pain (suprapubic and loin pain that may radiate to the genital region) Dysuria Urinary tract infection (UTI) Haematuria ```
66
Causes of renal calculi
``` Idiopathic Hypercalcaemia Hyperuricaemia Hyperoxaluria Recurrent UTI Drugs e.g. lopp diuretics Hereditary conditions increase risk e.g. polycystic kidney disease ```
67
Investigations of renal calculi
24-h urine analysis CT kidney, ureter, bladder for radioplaque stones Ultrasound and IVU can be used Chemical analysis of stone compsition
68
Investigations of renal calculi: what is assessed in 24-h urine analysis
Levels of calcium, uric acid, oxalate and citrate
69
Complications of renal calculi
Recurrent UTI Recurrent calculi Obstruction Trauma to ureter/ureteric stricture
70
Conservative treatment of renal calculi
Prevent cause e.g. low calcium diet | Education about risk factors
71
Medical treatment of renal calculi
``` Pain - analgesia and tamsulosin Dehydration - IV and oral fluids Nausea/vomitting - antiemetics Hypercalcaemia - Low calcium diet and stop thiazide diuretics if possible High oxalate - low oxalate diet High uric acid - allopurinol ```
72
Radiological treatment of renal calculi
Nephrostomy insertion | Antegrade ureteric stent insertion
73
Surgical treatment of renal calculi
Antegrade or retrograde removal of large stones or staghorn calculus Extracorporeal shock wave lithotripsy (ESWL) for the treatment of larger stones (>0.5cm)

Medicine Phase 2a GU (18 decks)

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