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GU Flashcards

1
Q

What are the 3 causes of obstruction hydronephrosis and what is the term nephrolithiasis

A
  1. Extrinsic (lymph nodes)
  2. Intramural (tumour)
  3. Interior (stones) - think stag horn calculus in middle aged elderly female

-Entire calyces system and pelvises occupied by a single calculus- stag horn

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2
Q

Describe the features of acute pyelonephritis

A
  • Ascending infection
  • Blood bourne
  • E.Coli
  • Loin pain and fever
  • Sepsis
  • Treatment abx

-Collections of neutrophil polymorphs through renal parenchyma

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3
Q

Describe the features of chronic pyelonephritis

A
  • Repeated infections
  • Polar scars - specific features involving the calyx
  • Obstructivie/ reflux aetiology
  • Thyroidisation of tubules
  • Calyces look cystic and renal parenchyma are dilated between calyces
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4
Q

Describe Acute polycystic kidney disease

Name the other congenital/ inherited kidney abnormalities

A
  • Autosomal dominant- presents in 3rd decade, usually hypertension or chronic renal impairment presentation
  • Can also have cysts elsewhere eg. on liver and susceptible to berry aneurysms

Horseshoe kidney
Duplex ureters
Agenesis

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5
Q

Discuss the epidemiology of renal tumours

A

More common in males than females
Occur in 5th decade
Associated with smoking
Risk factors: tuberous sclerosis, VHL disease, renal transplantation, dialysis (papillary cancer due to scarring)

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6
Q

What is the triad of presenting complains in renal cancer and what radiological investigations would you conduct

A
  1. Renal mass
  2. Haematuria
  3. Flank pain

Radiologu

  • Ultrasound
  • IVU
  • CT/ MRI
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7
Q

What are the features of a clear cells carcinoma

A
  • Genetic 3p deletion
  • Yellow/ pale
  • Sheets of clear cells with pyknotic (dense) nuclei
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8
Q

What are the features of a papillary carcinoma

A
  • Mutifocal and bilateral

* If they have it on one kidney they might have it on the other*

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9
Q

What is the staging involved in kidney cancer and how do you treat a renal cancer

A

pT 1-4

pT1: confined to kidney size <7
pT2: Confined to kidney size >7
pT3: renal vein/ vena cava
pT4: spread to adjacent organs

  • Radical nephrectomy - remove kidney, ureter, adrenal gland and hilar lymph nodes
  • Partial nephrectomy- tumours less than 4cm that don’t invade the collecting system
  • Chemotherapy- not too much benefit
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10
Q

Describe the features of transitional cell carcinoma of the kidneys

A
  • Hard to tell apart from renal cell carcinoma
  • Commonly in urinary tract- bladder and ureter
  • Papillary tumour attached to the wall of the renal pelvis
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11
Q

What is a Wilms tumour

A
  • A paediatric nephroblastoma

- Age 2-4 with abdominal mass

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12
Q

What is the presentation of glomerulonephritis

A
  • Nephrotic syndrome- protein loss in urine
  • Nephritic syndrome- Renal impairment
  • Acute renal failure
  • Chronic renal failure
  • Asymptomatic haematuria/ proteinuria
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13
Q

What are the features of nephrotic syndrome

A

Proteinuria over 3.5g/ 24 hrs
oedema
Hypercholesterolaemia
Hypoalbuminaemia

In children- due to minimal change disease
In adults - drug induced

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14
Q

What are the features of nephritic syndrome

A
  • Haematuria
  • Renal impairment
  • Hypertension
  • Active urine sediment - looking for casts and inflam cells

post strep - lot’s of neutrophil and polymorphs

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15
Q

What are the features of acute renal failure

A

Pre, renal and post causes

Features 
Oliguria/ anuria 
Sudden onset 
Elevated creatinine 
HTN
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16
Q

What are the features of chronic renal failure

A

Vascular disease, T2DM

  • Slow onset
  • Elevated creatinine
  • Irreversible
  • Requires dialysis at end stage
17
Q

What are the causes of primary glomerulonephritis

A
  • IgA nephropathy (very common)
  • Minimal change disease (children)
  • Membranous glomerulonephritis (adults)
  • Post strep GN
  • ANCA associated vasculitis
  • Good pastures
  • Membranoproliferative GN

Gold standard diagnosis is a renal biopsy to determine cause

18
Q

What are the risk factors for bladder and ureteric tumours

A

Smoking
Rubber industry
Males
Hydrocarbons

19
Q

How do bladder and ureteric tumours present

A

Lower urinary tract symptoms
Haematuria
Identified on cystoscopy, CT or MRI
Biopsy conducted or TURBT

20
Q

What types of bladder and ureteric tumours are there

A

Transitional cell carcinoma
Grade 1 - Some enlarged cells , grade 2 - intermediate, grade 3- more aggressive mitotic change

Adenocarcinoma
-Tubular structures formed at the dome of the bladder

Treatment : TURBT +/- BCG therapy
-Partial cystectomy or cystectomy and ill conduit

carcinoma in situ - full thickness dysplasia found in TCC treated with BCG

Renal pelvis and ureteric tumours can either be
-Transitional cell carcinoma -Squamous cell carcinoma -Adenocarcinoma

21
Q

What are the four main types of penis tumours

A
  • Squamous cell carcinoma- mostly from keratinising squamous epithelium of penile shaft or non keratinising from the glans and foreskin
  • Rarely malignant melanoma
  • Spindle cell carcinoma - glans penis
  • Adenosquamous carcinoma - mix of glandular and squamous patterns
22
Q

What are the risk factors for penis cancer

A
  • Poor hygiene
  • Uncircumcised
  • Phimosis
  • HPV
  • Smoking
  • Pre-neoplastic conditions
    1. Bowenoid papulosis - before developing carcinoma
    2. Erythroplasia de queyrat- elderly males- CIS in foreskin or glans
    3. Bowens disease - dysplasia can affect penis skin
23
Q

Describe the histology of the testes

A

Made of seminiferous tubules with germ cells. Lydia cells produce testosterone and sertoli cells give nutritional support
-In a biopsy check for abnormal preneoplastic change in spermatogenesis or intratubular germ cell neoplasia in the testis

24
Q

Describe the features of testicular torsion

A
  • Testis can go under infarction after portion
  • Medical emergency
  • Surgical treatment to prevent further torsion - untwist testis and suture it to the scrotal sac to prevent recurrence
25
Q

What are the features of testicular cancer

A
  • Germ cell tumours of the testis 90%
  • Young males 18-55
  • Good prognosis

Other types

  • Sex cord stromal tumours
  • Lymphoma/ leukaemia
26
Q

What are the 3 main types of germ cell tumours

A
  • Seminoma (most common)
  • Non-seminomatous GCTs (teratomas)
  • Mixed germ cell tumours ( seminoma + teratoma features)
27
Q

What are the features of a semimoma

A 
Aged 40-50 
Most common 
Radiosensitive 
Good prognosis 
pale tumour expanding out of testis 
lymphoid storm with granulomas in it, no spermatogenesis in tubules
28
Q

What are the features of a teratoma

A

Divided into 4 groups
MTD- Differentiated - can mimic normal structure- skin soft tissue resp bone teeth
MTI- Intermediate - more simple epithelium
MTU- undifferentiated - no mature elements
MTT - trophoblastic - rare

Their are -Malignant teratomas -Embryonal carcinoma

  • Choriocarcinoma (associated with haemorrhage) -Yolk sac tumour
  • Mixed forms
29
Q

What diagnosis and treatment is involved in testicular cancer

A
  • Painless testicular mass
  • Raised serum markers - AFP , HCG (teratomas) increased LDH (seminoma)
  • Mets -lymph node, lung, brain

Treatment
Radical Orchidectomy- done through inguinal canal
Radiotherapy to retroperitoneal lymph nodes in seminoma if involved
Chemotherapy - teratoma after initial surgery

30
Q

What are the factors that are considered in the prognosis of testicular cancer

A
  • Presence of embryonal carcinoma
  • Absence of yolk sac tumour
  • Lymphatic invasion
  • Vascular invasion

If 2 or more then give chemo

31
Q

Describe the features of benign prostatic hypertrophy

A
  • Outflow obstruction
  • Common with increase in age
  • Glandular and stromal increase
  • Imbalance in androgens and oestrogen will increase glands and stroma
  • Large nodule projecting up into the bladder obstructs urine flow
  • All elderly males will partially have this

Treatment
Drugs or TUP (removal of transition and central zone to get chippings that are examined for potential carcinoma)

32
Q

Discuss the features of prostate carcinoma

A
  • Most common tumour in males
  • Increased detection with serum PSA
  • May present with bony mets
  • Detect with core biopsy using TRUS needle

90% Cases= acinar - prostatic acini on the periphery of the gland
Ductal - around the periurethral zone

Presentation
Haematuria
Abnormal rectal exam
Elevated PSA

33
Q

What is a TRUS biopsy

A

Taken if a patient has elevated PSA
Ultrasound through rectum of prostate gland to detect abnormalities - use of ultrasound to direct cores to take biopsy
-Usually 7 core
-Needed for diagnosis

Also need a 
-TURP 
-MRI/CT 
-Bone scan 
for diagnosis
34
Q

What is the treatment for prostate cancer

A
  • Radical prostatectomy- not majority due to strict indications - only if PSA is under 15 and Gleason under 7 in males under 65
  • Hormonal therapy in poorly differentiated tumours or high gleason score
  • Radiotherapy (usually w chemo)
35
Q

What is the Gleason score

A

-Scores prostate cancers
Grade 1 = well differentiated grade 5= poorly differentiated (more common
-Score /10 as most prostate carcinomas show more than 1 pattern so scores are combined

Pathology (12 decks)

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