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Phase 2a Green Conditions > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A
  • kidney stones
  • slightly more common in men → testosterone = increased oxalate
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2
Q

What are kidney stones made of?

A
  • calcium oxalate → radio-opaque
  • uric acid → radio-lucent
  • struvite → radio-opaque
  • cystine
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3
Q

Risk factors for nephrolithiasis

A
  • chronic dehydration
  • obesity
  • high protein/salt diet
  • recurrent UTIs
  • hyperparathyroidism → hypercalciuria
  • congenital abnormalities
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4
Q

Presentation of nephrolithiasis

A

renal colic

  • severe unilateral abdominal pain
  • starts in loin, radiates to ipsilateral groin/testicle/labia
  • sudden onset early in morning
  • restlessness
  • N&V
  • haematuria
  • dysuria
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5
Q

Investigations for nephrolithiasis

A
  • dipstick → haematuria, leukocutes, nitrites
  • bloods → FBC, CRP, U&E

GOLD STANDARD = non-contrast CT KUB

  • US in pregnancy
  • radio-opaque only visible on US
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6
Q

Management of nephrolithiasis

A
  • symptomatic relief → hydration, NSAIDs, opioids
  • small pass spontaneously

if too big:

  • ESWL → break stone into smaller fragments using shockwaves
  • uteroscopy
  • PCNL → percutaneous access, use nephroscope to remove stone
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7
Q

When should treatment be provided immediately for nephrolithiasis?

A
  • intolerable pain/vomiting
  • signs of obstruction/infection/AKI
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8
Q

What are the functions of the kidney?

A
  • water/hormone homeostasis
  • waste/toxin removal
  • RBC production
  • activated vitD
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9
Q

Risk factors of CKD and AKI

A
  • emergency surgery → risk of sepsis/hypovolaemia
  • CVD risk
  • diabetes
  • HF
  • age >65
  • liver disease
  • use of nephrotoxic drugs
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10
Q

Which drugs are nephrotoxic?

A
  • NSAIDs
  • aminoglycosides
  • ACEi
  • ARBs
  • loop diuretics
  • metformin
  • digoxin
  • lithium
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11
Q

What is AKI?

A
  • sudden decline in renal function
  • determined by increased serum creatinine +/- decreased urine output
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12
Q

Causes of pre-renal AKI

A
  • hypovolaemia secondary to D&V
  • renal artery stenosis
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13
Q

Causes of intrinsic AKI

A
  • glomerulonephritis
  • acute tubular necrosis ATN
  • acute interstitial nephritis AIN
  • rhabdomyolysis
  • tumour lysis syndrome
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14
Q

Causes of post-renal AKI

A
  • kidney stone in ureter or bladder
  • BPH
  • external compression of ureter
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15
Q

Presentation of pre-renal AKI

A
  • normal Na+
  • raised urea and creatinine
  • responds well to fluid therapy
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16
Q

Presentation of intrinsic AKI

A
  • T1DM
  • HTN
  • low urine osmolality
  • high urine Na+
  • high blood K+
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17
Q

Presentation of post-renal AKI

A
  • acute colicky pain radiating from loin to groin
  • microscopic haematuria
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18
Q

Diagnosis of AKI

A
  • rise in creatinine to 1.5-1.9 times baseline
  • >50% rise in creatinine over 7 days
  • fall in urine output to less than 0.5 for >6hrs in adults (8hr in kids)
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19
Q

Management of AKI

A
  • fluid balance
  • remove nephrotoxic drugs
  • treat hyperkalaemia → risk for arrythmia
  • treat underlying cause
  • RRT if no response to medical treatment
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20
Q

Complications of AKI

A
  • end stage renal failure
  • metabolic acidosis
  • uraemia
  • CKD
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21
Q

What is CKD

A
  • abnormal kidney structure/function
  • present for >3 months with implications for health
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22
Q

Causes of CKD

A
  • diabetes
  • HTN
  • glomerulonephritis
  • PKD
  • VHL
  • persistent pyelonephritis
  • obstruction → stones, BPH, tumours
  • nephrotoxic drugs
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23
Q

Presentation of CKD

A
  • often asymptomatic until ESRF
  • fluid retention → oedema, raised JVP
  • oliguria
  • uraemia → pruritus, uraemic frost, yellow-grey complexion, reduced appetite
  • cardiac arrythymias
  • pallor
  • bone pain
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24
Q

Diagnosis of CKD

A
  • eGFR <60
  • eGFR <90, signs of renal damage
  • albuminuria >30, albumin:creatinine >3
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25
Management of CKD
- treat DM, HTN, glomerulonephritis - reduce risk of CVD → atorvastatin - manage complications
26
Managing complications of CKD
- mineral bone disease → low vitD - HTN - proteinuria - anaemia → ESA - RRT
27
When should renal replacement therapy be considered?
- ESRF - acidosis not responsive to bicarb - persistent electrolyte disturbances - persistent oedema - severe symptoms of uraemia
28
What are the types of RRT?
- haemodialysis - peritoneal dialysis - renal transplant
29
Physiology of prostate
- produces testosterone and dihydrotestosterone - production of PSA → liquefies semen
30
What is BPH?
- hyperplasia of inner transitional zone of prostate gland - partially blocks urethra - normal part of ageing for men
31
Presentation of BPH
LUTS storage - frequency - urgency - nocturia - urgency incontinence voiding - poor/intermittent stream - post-micturition dribbling - straining - incomplete emptying - hesitancy
32
Investigations for BPH
- DRE → smooth but enlarged prostate - PSA → not very accurate - bladder diaries
33
Management of BPH
- lifestyle → reduce caffeine/alcohol, relax when voiding 1. alpha blockers eg tamsulosin 2. 5-alpha reductase inhibitors eg finasteride - consider surgery if no response to drugs GOLD STANDARD = TURP - required if acute urinary retention, gross haematuria,
34
Features of prostate cancer
- most common male malignancy - most slow growing but can be aggressive/malignant
35
Risk factors for prostate cancer
- Afro-Caribbean - family history/genetics - increasing age - anabolic steroids
36
Presentation of prostate cancer
- LUTS - weight loss - fatigue - night sweats - bone pain
37
Whee does prostate cancer metastasise to?
- bone → sclerotic bony lesions - brain - liver - lung
38
Investigations for prostate cancer
- community → DRE, PSA - DIAGNOSTIC = transrectal USS and biopsy - gleason grading system
39
Management of prostate cancer
local - prostatectomy \<70 - active surveillance \>70, low risk - radiotherapy metastatic - chemo - radiotherapy - bilateral orchidectomy - goserelin - palliative care to relieve symptoms
40
What is urethritis?
- uretheral inflammation due to infectious or non-infectious cause - non-gonococcal uretheritis more common than gonococcal
41
Causes of urethritis
- N.gonorrhoea - chlamydia - trauma - urethral stricture - urinary calculi
42
Presentation of urethritis
- skin lesion - dysuria +/- discharge (blood/pus) - urethral pain - penile discomfort/pruritus
43
Investigations for urethritis
- STI testing - M&C urethral discharge - bood cultures - urine dipstick - urethral smear
44
Management of urethritis
- management of underlying cause → Abs, partner notification
45
What condition is important to think about with urethritis?
reactive arthritis - conjunctivitis - urethritis - arthritis can't see, can't pee, can't climb a tree
46
What is cystitis?
- infection of urinary bladder - most common in sexually active young women
47
Risk factors of cystitis
- history of UTI - diabetes - pregnancy - catheterisation
48
Microorganisms that cause cystitis
KEEPS - klebsiella - E.coli → most common - enterococci - proteus species - staph aureus
49
Presentation of cystitis
- dysuria - frequency - urgency - suprapubic pain - haematuria and polyuria - incontinence - confusion in elderly - cloudy smelly urine
50
Investigations for cystitis
1. urine dipstick → high leukocytes/nitrates, blood GOLD STANDARD = mid-stream MC&S
51
Management of cystitis
- trimethoprim/nitrofurantoin → 3 days (f), 7 days (m) - in pregnancy → amoxicillin, cefalexin
52
What is variocele?
- abnormal dilation of testicular veins in pampiniform venous plexus - left side more commonly affected
53
Presentation of variocele
- feels like a bag of worms - dragging/soreness/heaviness of scrotum
54
Management of variocele
- conservative - surgical repair if pain infertility, testicular atrophy
55
Diagnosis of variocele
US and Doppler
56
What is testicular torsion?
- medical emergency - twisting of spermatic cord with rotation of testicle
57
Presentation of testicular torsion
- acute severe pain - unilateral, swollen, tender - retracted upwards
58
Diagnosis of testicular torsion
examination - firm swollen testicle - rotation → epididymis is not in normal posterior position - Prehn's -ve can do US but not essential → whirlpool sign
59
Management of testicular torsion
de-torsion → orchiopexy
60
What is nephrotic syndrome?
issue with filtration barrier
61
What is the characterising triad in nephrotic syndrome?
- proteinuria \>3 - hypoalbuminaemia → loss of albumin in urine - oedema → loss of oncotic pressure
62
Presentation of nephrotic syndrome
- frothy urine - infection - xanthelasma - xanthomata - athersclerosis - fatigue - dyspnoea - leukonychia
63
Pathophysiology of nephrotic syndrome
1. inflammation 2. damage to podocytes → protein leakage 3. increased liver activity → increases albumin and then cholesterol, coag factors 4. reduced oncotic pressure
64
Causes of nephrotic syndrome
occurs due to renal disease disrupting kidney function - minimal change disease - focal segmental glomerulosclerosis - membranous nephropathy
65
Secondary causes of nephrotic syndrome
- diabetic nephropathy - SLE - amyloidosis - hepB,C - HIV
66
Investigations of nephrotic syndrome
- urinalysis - urine protein:creatinine → degree of proteinuria - blood tests → renal function, elevated lipids GOLD STANDARD = needle biopsy and microscopy - looks for changes in glomerulus - gives cause
67
Management of nephrotic syndrome
- fluid/salt resuscitation - treat cause → 12 weeks prednisolone - treat complications - protein loss → ACEi/ARBs
68
Treatment of complications in nephrotic syndrome
- oedema → loop diuretics - hyperlipidaemia → statins - VTE → heparin - infection → Abs
69
Minimal change disease
- mainly kids - unclear cause → immune mediated - normal appearance in microscopy but abnormal function - diagnosis = biopsy → EM = loss of podocytes
70
Features of UTIs
- presence of microorganisms in the urinary tract - name depends on location - can occur from untreated urolithiasis
71
What are the 5 most common pathogens causing UTIs
KEEPS - klebsiella - e.coli → most common - enterococci - proteus - staph coagulase -ve
72
Presentation of UTIs
voiding symptoms = FUND - frequency - urgency - nocturia - dysuria
73
What is pyelonephritis?
- infection of kidneys/upper ureter - most commonly acquired by ascending transurethral spread - can be via blood or lympatics - majority caused by uropathic e.coli
74
Presentation of pyelonephritis
- triad of loin pain, fever, pyuria - costovertebral joint pain - severe headache - N&V - septic shock if advanced
75
Investigations of pyelonephritis
1. urine dipstick → WBC, microscopic haematuria - bloods → inflammatory markers - urgent US → stones, obstruction GOLD STANDARD = mid-stream MC&S → diagnosis of causative agent
76
Treatment of pyelonephritis
Abs - cefalexin 7-10 days - trimethoprim/amoxicillin if sensitive analgesia → PCM
77
What is prostatitis?
- inflammation and swelling of prostate gland - most common cause = e.coli
78
Presentation of prostatitis
- very tender prostate → seen on DRE - systemic symptoms → fever, chills, malaise - voiding symptoms
79
Investigations for prostatitis
- U&C → blood and WBCs, bacteria - bloods cultures if patients febrile
80
Management of prostatitis
Abs - ciprofloxacin/levofloxacin 14 days
81
Which Abs should you avoid in pregnancy?
- trimethoprim = teratogenic - nitrofurantoin → avoid at full term
82
What is nephritic syndrome?
syndrome presenting as inflammation within the kidney
83
Key features of nephritic syndrome
- haematuria → kidney inflammation - oliguria → decreased GFR - proteinuria - HTN → fluid overload
84
Causes of nephritic syndrome
- SLE - post strep glomerulonephritis - small vessel vasculitis - Goodpasture's - IgA nephropathy
85
Investigations for nephritic syndrome
DIAGNOSTIC = kidney biopsy → cause - urinalysis → haematuria - bloods → high ESR, CRP
86
Management of nephritic syndrome
- treat underlying cause - ACEi/ARB → reduced proteinuria, preserves renal function - corticosteroids → reduce inflammation
87
What is IgA nephropathy?
- AKA Berger disease - deposition of IgA into mesangium of kidney → inflammation and damage
88
Presentation of IgA nephropathy
- asymptomatic - microscopic haematuria
89
Diagnosis of IgA nephropathy
- biopsy - same management as nephritic syndrome
90
What is post strep GN?
- nephritic syndrome following infection 3-6 weeks before - deopsition of atrep antigen in glomeruli → inflammation and damage
91
What is post strep GN?
- nephritic syndrome following infection 3-6 weeks before - deopsition of atrep antigen in glomeruli → inflammation and damage
92
Presentation of post strep GN
- haematuria - acute nephritis diagnosed by evidence of strep infection
93
Presentation of post strep GN
- haematuria - acute nephritis diagnosed by evidence of strep infection
94
Treatment of post strep GN
- Abs to clear strep - supportive care

Phase 2a Green Conditions (10 decks)

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