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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
Q

Diffuse proliferative causes of nephritic syndrome

A

Rapidly progressive glomerulonephritis e.g. Goodpastures syndrome
Systemic lupus erythematosus (SLE)
Membranoproliferative glomerulonephritis
Cryoglobinaemia

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26
Q

Investigations of nephritic or nephrotic syndrome

A 
Bloods
Urinalysis
Nephritic screen (done in nephrotic investigations also)
Renal biopsy
Radiology - ultrasound scan
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27
Q

What blood investigations are done in nephritic or nephrotic syndrome

A 
FBC
WCC and platelets
U and Es
LFTs
Creatinine
Urea
CRP
ESR
Glucose
Lipid profile
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28
Q

What is analysed in a urinalysis investigation

A 
Blood
Protein
Glucose
Leucocytes
Nitrites
Bence Jones protein
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29
Q

What is looked for in nephritic screen

A 
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
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30
Q

Conservative treatment of nephritic or nephrotic syndrome

A

Lifestyle advice

Low salt diet

31
Q

Medical treatment of nephritic or nephrotic syndrome

A 
Depends on the cause:
Treat hypertension
Treat proteinuria
Treat hypercholestrolaemia
Give prophylactic anticoagulation therapy
Immunotherapy regimen
Dialysis if sever
32
Q

Complications of nephritic syndrome (I the pharaoh lost alot of blood)

A

Nephrotic syndrome
Chronic glomerulonephritis
Heart failure

33
Q

Causes of nephrotic syndrome

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
Diabetes nephropathy
Amyloidosis
Mesangial proliferative glomerlonephritis
SLE
34
Q

Complications of nephrotic syndrome

A

Hypertension
Acute Kidney Injury
Chronic Kidney Injury
Infection

35
Q

Congenital kidney abnormalities examples

A 
HERD:
Horseshoe kidney
Ecotopic kidney
Renal agenesis
Duplex ureters
36
Q

What is horseshoe kidney

A

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
Q

Signs and symptoms of horseshoe shaped kidney

A

Asymptomatic
Recurrent urinary tract infection (UTI)
Renal calculi
Obstructive uropathy

38
Q

Causes of horseshoe shaped kidney

A

Congenital abnormality

39
Q

Investigations of horseshoe shaped kidney

A

Ultrasound scan is diagnostic

40
Q

Treatment of horseshoe shaped kidney

A

Treat complications

41
Q

Complications of horseshoe shaped kidney

A

Susceptible to trauma
Renal calculi formation
Increased risk of transitional cell carcinoma of the renal pelvis

42
Q

What is ectopic kidney

A

Congenital abnormality in which the kidney lies above the pelvic brim or within the pelvis

43
Q

Signs and symptoms of ectopic kidney

A

Usually asymptomatic

44
Q

Causes of ectopic kidney

A

Genetic abnormalities
Poor development of the metanephrogenic diverticulum
Teratogen exposure

45
Q

Investigations of ectopic kidney

A

Ultrasound is diagnostic

46
Q

Treatment of ectopic kidney

A

None

Treat complications should they develop

47
Q

Complications of ectopic kidney

A

UTI

Renal calculi

48
Q

What is renal agenesis

A

Bilateral or unilateral absence of the kidney

49
Q

Types of renal agenesis

A 
Bilateral absence (Potters syndrome)
Unilateral absence
50
Q

Signs and symptoms of Bilateral renal agenesis

A

Low set ears
Limb defects
Receding chin
Flat, broad nose

51
Q

Signs and symptoms of unilateral renal agenesis

A

Hypertension
Increased risk of respiratory infections
Proteinuria
Haematuria

52
Q

Causes of renal agenesis

A

Failure of ureteric bud development

53
Q

Investigations of renal agenesis

A

Antenatal screening

54
Q

Treatment of bilateral renal agenesis

A

Neonates usually die afew days after birth

If the baby survives they require chronic peritoneal dialysis

55
Q

Treatment of unilateral renal agenesis

A

Treatment of hypertension

56
Q

Complications of renal agenesis

A

Susceptible to trauma (unilateral)

Death

57
Q

What are duplex ureters

A

Occurs when the ureteric bud splits during embryonic development and results in the development of 2 ureters, which drain 1 kidney

58
Q

Signs and symptoms of duplex ureters

A

Asymptomatic

Recurrent UTI

59
Q

Causes of duplex ureters

A

Splitting of the ureteric bud

60
Q

Investigations of duplex ureters

A

Ultrasound scan and excretory urography is diagnostic

61
Q

Treatment if duplex ureters

A

Treat complications

62
Q

Complications of duplex ureters

A

Vesicoureteral reflux
Ureterocele
UTI

63
Q

What are renal calculi

A

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
Q

What can renal calculi be made of

A

calcium (radiopaque)
struvite (staghorn calculus)
uric acid crystals (radiolucent)

65
Q

Signs and symptoms of renal calculi

A 
Asymptomatic
Pain (suprapubic and loin pain that may radiate to the genital region)
Dysuria
Urinary tract infection (UTI)
Haematuria
66
Q

Causes of renal calculi

A 
Idiopathic 
Hypercalcaemia
Hyperuricaemia
Hyperoxaluria
Recurrent UTI
Drugs e.g. lopp diuretics
Hereditary conditions increase risk e.g. polycystic kidney disease
67
Q

Investigations of renal calculi

A

24-h urine analysis
CT kidney, ureter, bladder for radioplaque stones
Ultrasound and IVU can be used
Chemical analysis of stone compsition

68
Q

Investigations of renal calculi: what is assessed in 24-h urine analysis

A

Levels of calcium, uric acid, oxalate and citrate

69
Q

Complications of renal calculi

A

Recurrent UTI
Recurrent calculi
Obstruction
Trauma to ureter/ureteric stricture

70
Q

Conservative treatment of renal calculi

A

Prevent cause e.g. low calcium diet

Education about risk factors

71
Q

Medical treatment of renal calculi

A 
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
Q

Radiological treatment of renal calculi

A

Nephrostomy insertion

Antegrade ureteric stent insertion

73
Q

Surgical treatment of renal calculi

A

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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