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3RD YEAR - Long Term Conditions/FOCP > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

When taking a prostate history, what are some symptoms of obstructive problems?

A

Poor flow
Hesitancy
Post micturitional dribbling
Incomplete voiding

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2
Q

When taking a prostate history, what are some symptoms of inflammatory problems?

A

Dysuria

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3
Q

What can cause acute urinary retention?

A
  • Prostatic obstruction
  • Urethral strictures
  • Anticholinergics
  • Constipation
  • Post-op
  • Infection
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4
Q

What can cause chronic urinary retention?

A
  • Prostatic enlargement (carcinoma, BPH)
  • Pelvic malignancy
  • CNS disease
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5
Q

What is BPH?

A

Nodular or diffuse proliferation of the prostate - typically the inner zone enlarges (in contrast to peripheral layer in carcinoma), fuelled by testosterone.

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6
Q

What are the symptoms of BPH?

A

Nocturia, frequency, urgency, dribbling, poor flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

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7
Q

How is BPH managed?

A

Conservative - avoid caffeine, alcohol
Medical - a-blocker, 5a-reductase inhibitors (finasteride)
Surgical - catheters, resection/incision of prostate

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8
Q

What investigations should be done in somebody with urinary symptoms, in which you suspect prostate problems?

A
  • International prostate symptom score
  • Urinalysis
  • FBC, U&E, PSA
  • Flow rate and residual volume
  • DRE
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9
Q

What are you assessing in a DRE?

A

Anal tone
Rectal wall and contents
Prostate surface, size, symmetry and consistency

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10
Q

What causes a raised PSA?

A

BPH, prostatitis, prostate cancer

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11
Q

What is prostatitis?

A

Inflammation of the prostate causing UTI, retention, pain, haematospermia and a swollen/boggy prostate

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12
Q

What organism commonly causes prostatitis?

A

E. coli and S. faecalis

Treat with levofloxacin

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13
Q

What is epididymo orchitis?

A

Pain, swelling and inflammation of the epididymus and testes, most commonly due to:

  • STD (gonorrhoea/chlamydia)
  • UTI (E.coli)
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14
Q

What is balanitis, and what is it associated with?

A

Acute inflammation of the foreskin and glans.

Associated with staph and strep infections and diabetes

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15
Q

What is phimosis and what is it associated with?

A

Narrowing of the foreskin so that it can’t be retracted, causing recurrent banalities.
Associated with painful intercouse

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16
Q

What is paraphimosis?

A

Foreskin can no longer be pulled forward over the penile tip, leading to oedema and ichaemia

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17
Q

Describe the typical prostate cancer, and its risk factors?

A

Adenocarcinoma, arising in the peripheral zone of the prostate

RF: family history, high testosterone

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18
Q

What are the symptoms of prostate cancer?

A

Nocturia, hesitancy, poor stream, terminal dribbling (immediate), obstruction

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19
Q

How would a prostate cancer feel on DRE?

A

Hard, irregular prostate

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20
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus, associated with subfertility

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21
Q

What is an epididymal cyst?

A

Cyst containing clear or milky fluid which lies above the testis

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22
Q

A boy comes in with acute, tender enlargement of the testis. What is the likely diagnosis?

A

Testicular torsion - this is a medical emergency

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23
Q

What does renal pain feel like and what causes it?

A

Dull ache from loin to groin

Causes - pyelonephritis, nephrotic syndrome, polycystic kidneys, renal infarction

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24
Q

What does renal colic feel like and what causes it?

A

Extreme intermittent loin to groin pain, associated with fever and vomiting

Causes - renal stones, clots

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25
What can cause haematuria?
- GU malignancy - Infections - Glomerular nephritis - Kidney stones - Prostate disorders
26
What causes high urea?
``` Dehydration GI bleed (blood meal - releases urea) ```
27
What are the functions of the kidney (A WET BED)?
``` Acid-base balance Water removal Erythropoeisis Toxin removal Blood pressure control Electrolyte balance D (vit) activation ```
28
How much urine do the kidneys usually produce?
1ml/kg/hr (1.5L/day)
29
What is the definition of oliguria?
<400 ml/24 hours
30
What is the role of PTH?
Promotes calcium reabsoprtion in the distal convoluted tubule
31
What is the role of aldosterone?
Promotes sodium, chloride and water reabsorption in the distal convoluted tubule
32
What is the role of ADH?
Promotes water reabsorption in the collecting duct, by formation of aquapores
33
What are the actions of angiotensin II?
Secreted in response to low BP, causing: - Increased sympathetic activity - Tubular Na/CL reabsorption via aldosterone - Arteriolar vasoconstriction - Water reabsorption via ADH
34
What is an AKI?
Rapid deterioration or loss of renal function, causing urea and creatinine retention and subsequent fluid and electrolyte and acid-base imbalance
35
How is AKI diagnosed?
- Rise in creatine >26umol/L in 48hrs - Rise in creatinine >1.5x baseline - Urine output <0.5ml/kg/h for >6 hours
36
What are the symptoms and signs of an AKI?
Symptoms - dysuria, oliguria, anuria, haematuria, generally unwell with fever, nausea and vomiting Signs - hypo/hypervolaemia, leukonchyia, rash, AV fistula, polycystic kidneys
37
What are the pre-renal causes of an AKI?
HYPOPERFUSION (dehydration, hypotension, heart/liver failure)
38
What are the renal causes of an AKI?
Tubular damage - drugs Glomerular - autoimmune, drugs, infection (glomerulonephritis) Interstitial - drugs, infection Vascular - vasculitis, malignancy
39
What are the post-renal causes of an AKI?
Urinary tract obstruction causing pressure on the kidney - stones, BPH, stricutres
40
Name some nephrotoxic drugs (cause AKI but fine to use in CKD)
``` ACE inhibitors Diuretics NSAIDS Immunosuppresants Antibiotics (penicillins, quinolones, sulphonamides, aminoglycosides) Omeprazole ```
41
How should an AKI be managed generally?
- Assess volume status and aim for euvolaemia - Stop nephrotoxic drugs - MONITOR!!!! - Maintain nutrition
42
How should a pre-renal AKI be managed?
General measures + rehydration
43
What is acute tubular necrosis?
Hypoperfusion of they kidneys causing ischaemia, build up of nephrotoxins and renal tubular damage
44
What causes acute tubular necrosis?
``` Nephrotoxic drugs CT contrast Untreated pre-renal AKI Shock Rhabdomyolysis ```
45
How should a renal AKI be managed?
General measures + REFER and potential dialysis
46
How should a post-renal AKI be managed?
General measures + catheterise and CT renal tract
47
What are the complications of an AKI?
These require urgent dialysis: - Hyperkalaemia (>6.5) - Metabolic acidosis - Symptoms of uraemia (encephalopathy, pericarditis) - Fluid overload - Pulmonary oedema (SOB)
48
What is the definition of CKD?
Impaired renal function for >3 months based on abnormal structure of function OR GFR <60mL/min for >3 months with no evidence of kidney damage
49
What causes CKD?
- Diabetes Mellitus - Glomerulonephritis - Hypertension - AKI - Polycystic kidney disease (related to stroke) - Genetics - Alport syndrome
50
What is Alport's syndrome?
A rare inherited disorder affecting only MALES causing a triad of: 1. Kidney disease 2. Hearing loss 3. Visual problems
51
What are the symptoms of CKD and why do these occur?
Before stage 4 - asymptomatic Stage 4: - Low erythropoietin - weakness, fatigue, easily brushing, anaemia - Pulmonary oedema - breathlessness - Uraemic toxins - headaches, altered mental status, encephalopathy - Low vit D production - itching, bone pain, fractures
52
What blood tests are raised and decreased in CKD?
Raised - urea, glucose, phosphate, ALKP, PTH, ESR (increased inflammation) Decreased - Hb, calcium
53
What imaging should be done for CKD?
Renal USS, then biopsy if severe (although this will cause bleeding so should only be done if it will influence management) (also do MSU)
54
How is CKD staged?
``` Stage 1 (>90) Stage 2 (60-89) Stage 3a (45-59) b (30-44) Stage 4 (15-29) Stage 5 (<15) ```
55
How is mild CKD managed?
Lifestyle advice Blood pressure control (below 140/90) Low cholesterol (4.5) The main cause of death for CKD is cardiovascular
56
What medications should someone with severe CKD be on?
``` BP - aceinhibitors/ARB Cholesterol - statin Fluid overload - loop diuretic Bone - phosphate binder + VitD(alfacalcidol) Anaemia - ferrous sulphate/EPO Cramps - quinine sulphate ```
57
At what GFR should dialysis be considered?
GFR<8-10
58
How is dialysis set up?
Create AV fistula in the arm, or graft/catheter if not possible This will provide a strong access point for dialysis
59
How does haemodialysis work?
Blood is passed over a semi-permeable membrane, outside of the body, against dialysis fluid in the opposite direction
60
How does peritoneal dialysis work?
Uses the peritoneum as a semi-permeable membrane - add osmotic agents to the fluid to promote ultra-filtration
61
What are the absolute contraindications for renal transplant?
Active infection, cancer, severe comorbidity
62
What is glomerulonephritis?
Inflammation of the glomeruli and nephrons causing: 1. Restricted blood flow so BP increases 2. Damage to filtration mechanism, so proteinuria and haematuria 3. AKI
63
Name 4 types of glomerulonephritis
Nephrotic syndrome IgA nephropathy HSP SLE
64
What is nephrotic syndrome?
A triad of: 1. Proteinuria 2. Hypoalbuminaemia 3. Oedema
65
What is the pathophysiology behind nephrotic syndrome?
Damage to the podocyte causes heavy protein loss. | This is primary or secondary to hepatitis, diabetes, SLE or paraneoplastic
66
How do loop diuretics work, and when are they used?
Block the Na/K/2Cl cotransporters in the loop of henle --> reduce water reabsorption Uses - pulmonary/peripheral oedema, severe hypercalcaemia Eg. furosemide, bumetanide
67
How do thiazide diuretics work, and when are they used?
Block the Na/Cl transporter in the DCT --> reduce water reabsorption Uses - hypertension, heart failure Eg. bendroflumethiazide
68
How do potassium-sparing diuretics work and when are they used?
Spironolactone - aldosterone antagonists (slow onset) Amiloride - blocks Na channels in collecting tubules (fast onset) Uses - alongside other diuretics to control K+ wasting
69
How do osmotic diuretics work and when are they used?
Remain in lumen and hold water in by osmotic effect Uses - haemolysis, rhabdomyolysis, reduction in intra-ocular and ICP Eg. Mannitol
70
What is the most common cancer of the bladder?
Transitional cell carcinoma (can also arise n the ureter or renal pelvis)
71
How does a TCC present?
Painless haematuria, frequency, urgency, recurrent UTIs
72
How is TCC diagnosed?
Cystoscopy with biopsy
73
What is a KUB and what is it used for?
Kidneys, ureters, bladder x-ray Uses - Investigation of bowel obstruction, gallstones and renal stones
74
What is cystoscopy used for?
``` Bladder cancer Haematuria Frequent UTIs Chronic pelvic pain Urinary blockage Urinary incontinence ```
75
What is the causative agent for chancroid ?
Haemophilius ducreyi

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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