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Phase 2a Revision > Genitourinary > Flashcards

Genitourinary Flashcards

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1
Q

Kidney function

A

→ Water / Hormone homeostasis

→ Removal of waste

→ RBC production

→ Activate vit. D

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2
Q

AKI & CKD & Risk Factors

A 
AKI = Sudden loss of kidney function.
CKD = Gradual loss of Kidney function.
Risks:
→ Age > 65
→ Diabetes
→ High BP
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3
Q

AKI Diagnostic Criteria

A
  • Rise in creatinine of >= 26umol /L in 48 hrs
  • > = 50% rise in creatinine over 7 days
  • Fall in urine output to less than 0.5ml/kg/hr for more than 6hrs in adults (8 in kids)
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4
Q

Aetiology & characteristic for Pre-renal

A
  • Hypovolaemia Secondary to diarrhoea & vomiting (Dehydration)
  • Sepsis
  • NSAIDs / Diuretics

→ Normal Na+, Raised urea & creatinine. Responds well to Fluid therapy.

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5
Q

Aetiology & Characteristic for Intrinsic / Intra-renal

A
  • Post - strep. infection
  • Acute Tubular Necrosis
  • Rhabdomyolysis

→ T2DM & HTN, low urine osmolality, High urine Na+, High blood k+.

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6
Q

Aetiology & Characteristic for Post - renal

A
  • kidney stone in ureter / bladder
  • Benign Prostatic Hyperplasia
  • bladder cancer

→ Loin → Groin acute colicky pain, Microscopic haematuria.

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7
Q

AKI Management

A
  • Fluid balance
  • Stop Nephrotoxic Drugs
  • Treat hyperkalaemia → risk of arrythmias
  • Renal Replacement Therapy
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8
Q

Nephrotoxic drugs

A
  • NSAIDs
  • ACE-I & ARBs
  • Aminoglyclides e.g. Gentamicin
  • Loop diuretics
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9
Q

CKD management

A

ACE-I / ARB
→ Ramipril / Candesartan

Reduce risk of CVD
→ Atorvastatin

Anaemia
→ Erythropoietin

Reduce swelling
→ Chlorothiazide

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10
Q

CKD complications

A
  • Mineral bone diseases - low vit. D
  • HTN
  • Proteinuria
  • Anaemia
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11
Q

Benign Prostatic Hyperplasia (BPH)

A

Hyperplasia of stromal & epithelial cells of the Prostate. Presents in men > 50 yrs

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12
Q

BPH symptoms

A

Mainly LUTs Symptoms

  • Hesitancy - weak urine flow
  • Urgency
  • Frequency
  • Intermittency
  • Straining
  • Nocturia
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13
Q

BPH Investigations

A
  • Digital Rectal Examination
  • Prostate - Specific antigen
  • Prostate examination (abnormal transitional zone)
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14
Q

BPH management

A
  • Alpha-blockers [ Tamsulosin ]
  • 5 - alpha reductase inhibitors [ Finasteride ]
  • Transurethral Resection of Prostate (TURP)
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15
Q

Lower Urinary Tract Infections (LUTS]

A

Infection (mainly E.coli) in the bladder causing cystitis.

They can spread to kidneys & cause pyelonephritis

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16
Q

LUTS Symptoms

A
  • fever & Dysuria
  • Discomfort & Suprapubic pain
  • Frequency
  • Urgency
  • Incontinence
  • Cloudy & Smelly urine
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17
Q

LUTS investigations

A
  • Urinanalysis

- Urine dipstick - Nitrites → Gram -ve bacteria break down nitrates into nitrites.

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18
Q

Most common cause of UTI

A
  • E. Coli
  • Klebsiella
  • Enterococcus
  • Candida
  • Staphylococcus
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19
Q

UTI Management

A
  • Nitrofurantoin
  • Cefalexin
  • Trimethoprim or Amoxicillin if sensitive
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20
Q

Hydrocele

A

Fluid in tunica vaginalis - secondary to trauma/ infection

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21
Q

Hydrocele examinations & cause

A
  • testicle is Palpable
  • Transilluminated

→ Idiopathic

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22
Q

Hydrocele management

A
  • Watch & wait
  • Surgery (if inguinal hernia is seen)
  • Aspiration
  • Sclerotherapy
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23
Q

Varicocele

A

Veins in the Pampiniform Plexus which drains into the testicular Vein become Swollen.

Due to increased resistance in the testicular vein.

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24
Q

Testicular vein drainage

A

Right Testicular vein = drains into infcrior vena cava

Left Testicular vein = drains into the left renal vein

Most varicocele occurs in Left due to increased resistance

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25
Varicocele Symptoms
- Throbbing / dull pain or discomfort, worse on Standing - dragging sensation - 'Bag of worms'
26
Varicocele investigations
- Ultrasound with Doppler imaging - Semen analysis - Hormonal test ( FSH & testosterone)
27
varicocele Management
- Surgery | - Endovascular embolisation - for testicular atrophy / infertility
28
Testicular torsion Sx: Ix: Mx:
= twisting of cord that supply testicle Sx: - severe pain, hot, red & swollen - Unilateral, Swollen, Tender, Retracted upwards Ix: Imaging - Prehn's sign -ve Mx: De - torsion
29
Epididymitis Sx: Ix: Mx;
- Inflammation in tube that's at back of testicle carrying sperm - Gradual unilateral pain - Prehn's sign + ve - start IM Ceftriaxone + Doxycycline
30
Epididymal Cyst Ix: Mx:
- Common cause of Scrotal swelling - painless lump found in Posterior aspect of testicle (epididymus) - Clear/ milky fluid - Transillumination & Ultrasound - Analgesia
31
Cystitis
Infection of the urinary bladder due to E. coli - common in young sexually active women
32
Cystitis Risks
- History of UTI - Diabetic - Frequent sex - Pregnancy
33
Cystitis Symptoms
- Dysuria - discomfort, pain, burning on urination - Frequency - Urgency - cloudy smelly urine - Suprapubic tenderness
34
Cystitis Investigations
- Urine dipstick - if + ve then UTI | Gold - Urine culture & sensitivity
35
Cystitis management
- Antibiotic = Trimethoprim / NitrofurantoinI avoid in 3rd trimester)
36
Prostate cancer Sx: Ix: Tx:
- Adenocarcinoma in peripheral zone - LUTS symptoms - Metastasis - haematuria, back pain - MRI - Give Goserelin (GnRH agonist), Radiotherapy
37
Nephritic Syndrome
Inflammation within the kidney.
38
Features that define Nephritic Syndrome
→ Haematuria - reflects inflammation of kidney → Dysuria - due to less GFR → Proteinuria - less than 3g/ 24 hrs → Hypertension - due to fluid overload
39
Systemic Causes of Nephritic Syndrome
- SLE - Post strep GN - Small vessel vasculitis - Goodpasture's /anti-GMB disease
40
Renal cause of Nephritic Syndrome
lgA nephropathy
41
Nephritic Syndrome investigations
- Kidney biopsy - Urinalysis - blood & Protein - Bloods - high ESR & CRP & eGFR
42
Nephritic Syndrome Management
- Blood pressure control - ACE-I / ARB | - Corticosteroids
43
IgA Nephropathy
Deposition of lgA into the Mesangium of the kidney. This results in inflammation & damage. It presents asymptomatically with microscopic haematuria.
44
IgA Nephropathy Investigations
Biopsy
45
lgA Nephropathy Management
- Corticosteroids - Rituximab - Give fish oil
46
Goodpasture's Disease
Caused by autoantibodies to Type lV collagen in glomerular & alveolar membrane.
47
Goodpasture 's Disease Symptoms
- Dyspnoea - Oliguria → due to resp & renal damage
48
Goodpasture' s disease Investigations
- Anti-GBM antibodies in bloods & biopsy
49
Goodpasture's Disease Management
- Plasma exchange - steroids - Cyclophosphamide (for immune suppression)
50
Nephrotic Syndrome
Issue with the filtration barrier, with podocytes being primarily implicated, which results in leaking of Protein into the urine.
51
Features of Nephrotic Syndrome
- Proteinuria - >3g/24 hr - Hypalbuminaemia - due to Ioss of albumin in urine - Oedema - loss of of oncotic pressure, this can be rapid & severe
52
Symptoms of Nephrotic Syndrome
- Oedema | - Frothy Urine - Shows Proteinuria
53
Nephrotic Syndrome Investigations
- Urinalysis - Urine protein: Creatinine ratio - Blood tests - renal function, elevated lipids - Renal biopsy
54
Nephrotic Syndrome Management
- Corticosteroids (prednisolone) - Low salt diet - Diuretics - Antibiotic Prophylaxis
55
Nephrotic Syndrome Complications
Hyperlipidaemia - loss of albumin increases cholesterol formation. - Manage with Statins VTE - due to increased clotting factors. - Give heparin
56
Causes of Nephritic Syndrome
→ lgA nephropathy → Goodpasture's disease → Post Streptococcal glomerulonephritis
57
Causes of Nephrotic Syndrome
→ Minimal change disease → Focal segmental glomerulosclerosis → Membranous Nephropathy
58
Minimal Change Disease Diagnosis Treatment
Normal appearance upon microscopy but there's abnormal Function. Most common in children - Biopsy = Presentation is nephrotic (Periorbital oedema, ankle oedema, frothy urine) - Treatment = High dose steroids → Prednisolone
59
Focal Segmental Glomerulosclerosis Diagnosis Treatment
Can be idiopathic or Secondary to HIV, Heroin & Lithium. - Diagnosed by presence of scarring of glomeruli i.e. Focal sclerosis - Give steroids idiopathic disease - Give ACE-I / ARB ) → Blood pressure control
60
Membranous Nephropathy Diagnosis Treatment
- Immunologically mediated - small vessels in glomeruli get inflammed. - Diagnosed by renal biopsy → Shows thickened glomerular basement membrane. - Anti Phospholipase A2 receptor antibody → Give ACE-I / ARB for all. → Prednisolone + Cyclophosphamide
61
Renal colic (Nephrolithiasis/ Urolithiasis)
- Renal stones that form in the renal pelvis, where urine collects before travelling to ureters. Sites: → Pelviureteric junction → Pelvic brim → Vesicoureteric junction
62
Renal colic Complications
→ Obstruction = leading to A.K.I → Infection = with Obstructive Pyelonephritis
63
Types of renal colic
- Calcium - based stones: → Calcium Oxalate → Calcium Phosphate - Having a raised Serum calcium (hypercalcium) and a low urine output. Other types: - Uric acid - Struvite - Cystine
64
Renal Colic Symptoms
- Unilateral loin to groin pain - Colicky - Haematuria - Nausea & vomiting - Reduced urine output
65
Renal colic Investigations
- Kidney, Ureter, Bladder (KUB) X-Ray =1st line - NCCT - KUB = Gold Standard - Ultrasound
66
Cause of renal Stones/ colic
- Hypercalcaemia
67
Renal colic Management
- NSAIDs (analgesics) - e.g. IM diclofenac, IV Paracetamol - Anti-emetics - e.g. Metoclopramide (for nausea & vomiting) - Tamsulosin ( alpha-blocker - aid Passage of Stones) - Antibiotics - for infections
68
Management to reduce risk of renal stone reoccurrence
→ Potassium Citrate → Thiazide diuretics (eg. Indapamide)
69
Polycystic Kidney Disease
Genetic Condition where kidneys develop multiple fluid filled cysts. - There is Autosomal dominant (more common) & Autosomal recessive type
70
Types of PKD
- Autosomal Dominant: PKD-1 PKD- 2 - Autosomal Recessive: Gene on Chromosome 6
71
Autosomal Dominant Manifestations
- Cerebral aneurysms - Hepatic, Splenic, Pancreatic, Ovarian & Prostatic cysts - Cardiac valve disease (mitral regurgitation) - Colonic diverticula
72
Autosomal Dominant PKD Complications
- Chronic loin pain - Hypertension - Cardiovascular disease - Renal stones - Haematuria
73
Autosomal Recessive PKD
- Oligohydramnios in Pregnancy → low amniotic fluid - which leads to underdevelopment of the lungs → results in resp. failure - underdeveloped ear cartilage, flat nasal bridge, end- stage renal failure
74
PKD management
Tolvaptan (vasopressin receptor antagonist) - Slow renal failure in autosomal dominant PKD. - Antihypertensives - Analgesia for renal colic - Antibiotics for infection - Dialysis - Renal transplant
75
Bladder Cancer Ix Tx
Ix = Flexible Cystoscopy Tx = Transurethral Resection of the Bladder Tumour Mitocycin C → given with TURBT BCG → For higher risk, non- muscle invasive cancers Methotrexate, Vinblastine, Cisplatin → Muscle- Invasive Cancers
76
?Post Streptococcal Glomerulonephritis Diagnosis
Urinalysis - has protein & blood (infection) | Kidney Biopsy
77
Bladder cancer Symptom Type of cancer
Haematuria Lethargy Usually present with history of schistosomiasis → Squamous cell carcinoma
78
Gonorrhoea Symptoms Diagnosis Treatment
Neisseria gonorrhoea Gram - ve diplococci bacteria ``` Man= Urethral discharge, dysuria, Epididymo-orchitis Women= Abnormal vaginal discharge, Painful sex ``` Nucleic acid amplification test = swab TX= Ceftriaxone & Azithromycin
79
Pyelonephritis Symptoms Diagnosis Tx
Inflam. of kidney due to bacteria. Usually E. Coli. & Klebsiella Fever, Loin pain, Polyuria Ix: Midstream Urine sample Tx = Cefalexin, Co-amoxiclav, Trimethoprim, Ciprofloxacin
80
Bladder nerve supply
Sympathetic = Hypogastric nerves (T12-L2) Parasympathetic = Pelvic nerve (S2-S4) - Contraction of detrusor muscle (when urinating) Somatic = Pudenal nerve (S2-4) - Innervates external urethral sphincter
81
Testicular Cancer
Symptoms = Gynaecomastia, Testicular discomfort, feeling of mass in testis. Dx = Raised Serum alpha-fetoprotein
82
Renal cancer (Renal cell carcinoma) Sx: Ix: Tx:
SX: Weight loss, loin pain, Painless haematuria, Loin mass Ix: CT /MRI Tx: Chemo., Transplant
83
Why does Person have hypertension with renal cancer?
Renin secretion → Increase in BP due to Raas system
84
Diuretics & their mechanism
→ Thiazide = Inhibit of Na+ & CI- → Loop diuretic = Inhibit Na+ / k+ / CI → K+ Sparing diuretic = Inhibits Na+ reabsorption & k+ secretion
85
Hypercalcaemia Presentations
- Stones - Groans - Bones - Moans
86
Erectile Dysfunction - Associated conditions - Management
- Diabetes, MI, Renal failure, Liver disease | - > Phosphodiesterase e.g. Sildenafil

Phase 2a Revision (9 decks)

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