Gastrinourinary Flashcards

Question

Future trends of the imaging and management of prostate carcinoma?

Answer 1

New imaging techniques to improve diagnosis of recurrent prostate cancer – using PSMA and PET scanning (46). Enhance the use of biopsies for prostate cancer Using MRI and ultrasound Testing the use of artificial intelligence (AI)

Answer 2

Renal carcinoma is also known as kidney cancer. It is a disease in which malignant cells are found in the lining of the tubules in the kidneys.

Answer 3

GP: Tests and initial consultation Symptomatic Patients include: flank mass, flank pain, haematuria systemic symptoms suggestive of advanced disease, such as weight loss or fever Non-symptomatic – incidental findings A/E: Pathological fracture from mets Referred to ?? specialist

Answer 4

Ultrasound: Abdominal CT: Gold standard imaging technique provide precise information about the size, shape and location of the tumour. It can check has the cancer spread to surrounding tissues/lymph nodes or organs of the kidneys Ultrasound young patients no radiation cost-effective non-ionising technique for assessing the kidneys and bladder Ultrasound helps to tell if a structure is soft tissue or fluid filled. Patterns on ultrasound can also help tell the difference if they are benign or malignant tumours although further imaging would be required MRI - higher soft tissue contrast than CT and no radiation burden - prone to motion artefacts (long scan time) - limited by MR contraindications and scanner availability - It will be used in the case of pregnancy or when patients have an iodinated contrast allergy or renal failure - MRI scans are typically used to visualise venous involvement with the tumour and extent of infiltration - MRI is also used when the patient has an allergy to contrast die as different weighted techniques help visualise the mass . Metastases If the primary tumour is large or locally aggressive chest CT should be performed in the instance of mets Chest x-ray should be reserved for patients at low risk of metastatic disease or those under long-term surveillance Brain MRI and nuclear medicine bone scanning: - generally justified only if there are symptoms and signs to suggest disease at these sites - or if the tumour is large and locally aggressive

Answer 5

primary treatment option for early stage disease: - Radical Nephrectomy - partial nephrectomy allows for renal function to be preserved with a high success rate At diagnosis 30% of patients will be diagnosed with Metastatic renal cell carcinoma: Treatment for mRCC is palliative - aims at prolonging the patient's lifespan, - primarily the use of therapeutic drugs and undergoing chemotherapy treatments (33). Cryotherapy: Cryoablation under imaging guidance (CT) Needles are inserted into the tumour/lesion temperature is cold Freezes the lesion/tumour cells

Answer 6

Previously the treatment of mRCC was to use cytokine which delivered a non- specific immune approach Future trends are developing rapidly with a large emphasis currently placed on creating immuno- specific drugs and antibodies which target the areas affected by disease without affecting the surrounding structures in a hope the patient's symptoms will be less severe

Answer 7

kidney stones can be composed of: calcium uric acid struvite and can come in varying: shapes sizes volumes and found in varying locations: ureters renal pelvis

Answer 8

GP Patient symptoms clinical indications blood test - general kidney function - egfr blood sugar iron level referred to urologist: referred for imaging:

Answer 9

Ultrasound: younger patients as it doesn’t expose them to ionizing radiation. It does have a lower sensitivity and specificity than CT provides however It still provides accurate diagnosis. CT: Urgent patients: Rapid and good differentiation between different calculi visualise any secondary signs or signs of complication for example hydronephrosis, dilated ureters or other damage to surrounding structures X-ray Helpful in evaluating individual stone growth in patient with known stone disease Less useful for acute stones Used to monitor

Answer 10

Treatments to help small kidney stones pass: Drink water Add lemon juice to your water Avoid fizzy drinks and eating surplus amounts of salt. Treatments for larger kidney stones are primarily surgical: Shockwave lithotripsy (SWL): uses shockwaves that are produced using a machine and are focused on to the renal calculi using x-ray or ultrasound guidance shockwaves pass through the skin and break apart the kidney stone into smaller fragments so that they can be passed naturally. It is non invasive and generally tolerable by patients. Ureteroscopy: done in theatre and involves the patient being done under general anaesthesia. During the procedure ureteroscope is passed up through the bladder and into the affected ureter under x-ray guidance. Using a probe or laser the kidney stones are broken down and taken out. Percutaneous nephrolithotomy: cystoscope is inserted into the bladder along with a tube that passes contrast media into the kidney. Under x-ray guidance a needle punctures the skin and the tract of the needle is dilated to allow a scope and other tools to be passed into the kidney such as a laser or an ultrasonic probe. These tools are used to break down stone and remove it from the kidney A nephrostomy tube is left in the patient after the procedure to ensure good urinary drainage.

Answer 11

Future Trends Thulium fibre lasers: new form of laser technology that only started being used in 2020. This laser technology allows the laser to reach higher peak energies which in turn allows for a more complete break down of the kidney stones. Robotic Ureteroscopy: Robots controlled by specialists can have better instrument stability and reproducibility. They also can work in conjunction with AI to plan where to go during the procedure meaning minimal x-ray guidance is required during the procedure. Radiation Free protocols are also being investigated to help reduce patient doses to ionizing radiation. Although x-ray helps patients involve intrusive open surgery, different procedures using AR technology and AI for planning has helped reduce the screening time used or these procedures.

Answer 12

Multiple cysts grow within the kidneys Increases the size/mass of the kidneys Replace kidney tissue reduce renal function leading to renal failure Normal to have cysts (normal amount depends on age)

Answer 13

GP with pain, haematuria Offshore medical – High BP (incidental)

Answer 14

No treatment - incidental and no symptoms Manage symptoms such as headaches, hypertension, UTIs Tolvaptan - the first-ever disease-modifying drug for ADPKD. Tolvaptan slows the growth of kidney cysts and prolongs kidney function. Dialysis or renal transplant - if PCKD causes renal failure

Answer 15

US Grape sign multiple rounded anechoic cyst-like structures

Answer 16

Growth of abnormal/cancerous cells within the urinary bladder

Answer 17

GP - Haematuria – macro or microscopic Urge frequency/frequent urination Nocturia Dysuria Blood tests/physical/history Referred to Urology

Answer 18

DAC – haematuria Ultrasound Cystoscopy CT for staging/ CT KUB

Answer 19

Radiotherapy Chemotherapy Immunotherapy/targeted therapy Transurethral resection (TUR) with fulguration (radiofrequency ablation): Cystoscope into the bladder via urethra. Tumour is then burned away with wire loop – uses high-energy electricity. FULGARATION Surgery: Preoperative/neoadjuvant therapy: shrink tumour so minimum amount of tissue needs to be removed. Postoperative or adjuvant therapy: kill any cancer cells left Partial cystectomy: Part of the bladder is removed: - for low grade tumours that have only invaded one area of the bladder wall. Radical cystectomy with urinary diversion: The bladder and any adjacent organs with cancer are removed - when a large section of bladder is involved or muscle layers are invaded. - resulting in the need of stoma - ileal conduit or cutaneous ureterostomy

Answer 20

Hydronephrosis is the build up of urine within the kidney causing it to swell. This is usually as a result of a blockage which prevents urine draining to the bladder. Dependant on where the blockage is, the ureter may also fill with urine (hydroureter).

Answer 21

GP Urologist

Answer 22

Ultrasound

Answer 23

- Stent - allows urine to flow from the kidney into the bladder - Nephrostomy - allows the blocked urine to drain out of the body into a drainage bag - Antibiotics for infections - Surgery to correct the blockage or reflux - Removal of any stone that is causing obstructive uropathy Without treatment, can lead to renal failure

Answer 24

Renal artery stenosis is the narrowing of the one or both of renal arteries Most commonly due to atherosclerosis – accounts for 90%

Answer 25

GP or offshore medical: - Sudden onset hypertension – up to 5% - Refractory (difficult to control) hypertension - Unexplained renal failure or worsening renal function Urologist

Answer 26

Ultrasound – assess renal size (15mm discrepancy) - doppler CT angio/MR angio - patency

Answer 27

Renal angioplasty - stent used to open and restore blood flow Endarterectomy - removal of plaque Bypass procedure

Answer 28

GP Urology referral/Expedited GP report Blood Tests – HCG, AFP Acute admission to hospital

Answer 29

Ultrasound is the first line CT - staging NM - bone or PET

Answer 30

Only cure is removal of the testicle – orchidectomy Prosthesis can be inserted at time of operation

Answer 31

Acute onset – NHS 24 – acute admission Urological opinion – clinical examination

Answer 32

Ultrasound

Answer 33

Surgery - orchiopexy

Answer 34

GP (intermittent cramps) A/E or NHS 24 for acute pain – admission Surgical ward Pelvic examination

Answer 35

Ultrasound Laparoscopy/Laparotomy Cystectomy/salpingo-oophorectomy/oophorectomy

Answer 36

Endometriosis is a condition that causes cells similar to those that line the inside of the uterus to grow outside the uterus. Some of the tissue can attach to the ovary and form a cyst - cyst-endometrioma

Answer 37

GP Pelvic Examination

Answer 38

Ultrasound – first line MRI Gynaecology Laparoscopy – gold standard

Answer 39

Known as chocolate cyst Cysts are filled with old menstrual blood

Answer 40

Ultrasound ovary crunched and displaced A negative sliding sign (no separate movement of the uterus) indicates a high chance of endometriosis

Answer 41

Hormone treatment to stop menstruation – OCP Excise and cauterise at laparoscopy

Answer 42

GP Cervical Smear Gynaecology

Answer 43

Endometrial cancer begins in the endometrium. Endometrial cancer is often found at an early stage because it causes symptoms.

Answer 44

Ultrasound – first line CT MRI Biopsy NM/PET

Answer 45

If the cervix is involved – Standard hysterectomy with bilateral salpingo-oophorectomy, followed by adjuvant radiotherapy Radical hysterectomy Pelvic and para-aortic lymph node dissection. Post – op vaginal brachytherapy Radiation therapy alone – those with contraindications to surgery.

Gastrinourinary Flashcards

(70 cards)