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Lectures - URGENT Flashcards

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1
Q

Give 4 kidney functions

A

Production of EPO, activation of 25(OH)2 vitamin D (into 1,25 dihydroxyvitamin D), renin production (BP control), secrete toxic substances, blood pH homeostasis

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2
Q

How much cardiac output do the kidneys receive?

A

20%

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3
Q

What are the stages of CKD in terms of eGFR?

A

1 (>90), 2 ( to help, all are multiples of 15

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4
Q

Why do you get anaemia and bone disease in renal failure?

A

Because there is reduced functioning of the kidney - i.e. reduced vitamin D activation

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5
Q

What does eGFR use in its calculation?

A

serum creatinine (+ height, age, gender, race)

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6
Q

why is serum creatinine used in eGFR calculations?

A

It is excreted by the liver fully

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7
Q

What drug affects creatinine excretion?

A

Trimethoprim

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8
Q

What are the causes of coloured urine?

A

Jaundice (haemoglobinuria), beeturia, myoglobinuria, drugs (rifampicin - orange wee)

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9
Q

What are normal physiological causes of haematuria?

A

Strenuous exercise and menstruation

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10
Q

What should you ask a patient in their history concerning haematuria?

A

Whether the blood is early on or late in their stream? pain? unilateral loin pain? bilateral loin pain? FHx of bladder cancer? occupation?

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11
Q

What does MSSU and MC&S stand for?

A

Mid-stream sample of urine and microscopy, culture and sensitivity

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12
Q

give causes of haematuria

A

Bladder cancer, BPH, prostate cancer, post TURP, UTI,

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13
Q

What is the total body water? What does this split into in the compartments?

A

42L: i.c. fluid (28L), interstitial fluid (11L) and plasma (3L)

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14
Q

What occurs to potassium in renal failure?

A

It isn’t excreted - it is retained –> hyperkalaemia

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15
Q

What 3 things should you look out for in a patient with renal failure?

A

Hyperkalaemia, acidosis and volume overload (salt and water retention)

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16
Q

Give 3 pre-renal causes of oliguria

A

dehydration, HF + shock, blood loss

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17
Q

Give a renal causes of oliguria

A

Acute tubular necrosis

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18
Q

Give a post-renal cause of oliguria

A

Obstruction (prostate cancer, BPH, stones)

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19
Q

How do shock and HF lead to oliguria?

A

Reduced kidney perfusion

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20
Q

Why does someone with volume overload become hypoxic?

A

Pulmonary oedema

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21
Q

What two signs might suggest a patient is fluid overloaded?

A

raised JVP and pitting oedema (+ ascites)

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22
Q

Give 5 causes of fluid loss

A

Burns, surgery + blood loss, nephropathy, diarrhoea, bowel obstruction, vomiting

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23
Q

What is the criteria for SIRS?

A

2 of:

  • > 38 or 20
  • pCO2 12000 or
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24
Q

What is the definition of sepsis?

A

SIRS + confirmed or suspected infection

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25
What defines septic shock?
infection/sepsis with persistent hypotension
26
What is the most likely source of sepsis?
UTI
27
What is the treatment for sepsis?
SEPSIS 6: High flow 100% O2, IV fluid resuss, blood culture, IV Abx, serum lactate (+FBC + U+E), monitor urine output by putting in a catheter
28
When should you treat asymptomatic bacteruria?
If the patient is PREGNANT
29
Give 6 causes of urinary tract obstruction
Within the lumen: calculus, tumour (renal pelvis or ureter), blood clot, sloughed renal papillae Within the wall: congenital abnormalities, stricture, neuropathic bladder Outside: BPH, prostatic tumour, pelvic tumours, AAA
30
What is hydronephrosis?
Dilatation of renal pelvis + calyces
31
What does urinary tract obstruction lead to?
Inflammation, haemodynamic and functional changes to the kidney
32
What happens to the size of the kidney after prolonged obstruction of the urinary tract?
Enlarges? or shrinks?
33
What are the symptoms of an upper urinary tract obstruction?
Pain in the flank region, anuria (if bilateral obstruction)
34
What are the symptoms of lower urinary tract obstruction? (LUTS)
Terminal dribbling, hesitancy, poor stream , frequency, sense of incomplete emptying, retention with overflow, UTI
35
What signs might you find on examination for urinary tract obstruction?
Pelvic tumour, rectal exam (BPH or tumour), enlarged bladder, enlarged liver
36
What investigations might you order to investigate urinary tract obstruction?
Urine: dipstick, MC&S Blood tests: FBC, U+E Imaging: US, CT, XR
37
What might USS show in urinary tract obstruction?
Hydronephrosis
38
What is the 1st line treatment usually for urinary tract obstruction?
surgery
39
What is the 2nd line treatment usually for urinary tract obstruction?
Catheter
40
Who should you avoid NSAIDs in?
Renal insufficiency or GI bleeds
41
Why should NSAIDs be avoided in patient's with renal insufficiency?
Because NSAIDs vasoconstrict the afferent arteriole of the nephron (they prevent the production of PG needed to dilate the afferent arteriole)
42
What is a risk after re-establishing urinary flow in patient with
Post-obstructive diuresis
43
What else might you do in the management of urinary obstruction?
Fluid resuscitation
44
What is the definition of haematuria?
>3 RBCs/hpf (high powered field)
45
What bacteria can induce kidney stones?
proteus mirabilis
46
What predisposes to testicular torsion?
Bell clapper deformity (congenital)
47
What is the pathophysiology of testicular torsion?
Spermatic cord twists reducing the blood supply to the ipsilateral testis - ischaemia --> infarction (testicular loss)
48
What are the symptoms and signs of tesicular torsion>
Symptoms: sudden and severe pain, associated abdominal pain, nausea, vomiting, fever Signs: 1 testis is swollen, tender, hot and has an absent cremesteric reflex
49
How would you treat testicular torsion?
Analgesia (morphine), anti-emetic (ondasetron) Salvagable: surgerical detorsion unsalvagable: orchidectomy
50
What is surgical removal of testis called?
Orchidectomy
51
What is an epididymal cyst?
A fluid filled sac of the epididymus
52
What are the symptoms and signs of an epididymal cyst?
Asymptomatic signs: well defined + separate lump from the testis; transilluminates
53
How and why would you investigate a epididymal cyst?
USS - to rule out other lesions (e.g. cancer)
54
How would you treat an epididymal cyst?
No treatment
55
What differentiates epididymal cysts, hydrocoeale and varicocoeale from a testicular tumour?
Testicular tumour doesn't transilluminate
56
What is a hydrocoeale?
Fluid within the TUNICA VAGINALIS
57
What are the causes of a hydrocoeale?
Primary: patent processus vaginalis Secondary to: trauma, testicular cancer, infection (epididymo-orchitis), testicular torsion
58
What are the clinical features of a hydrocoeale?
scrotal swelling, pain only if infected, testis palpable within the hydrocoeale, transilluminates
59
What investigations would you carry out to diagnose a hydrocoeale and why?
To look for a cause: - USS - serum AFP and hCG
60
What is the treatment for a hydrocoaele?
aspiration or surgery
61
what is a varicocoaele?
Dilatation of pampiniform plexus veins
62
What side are varicocoaele more common on and why?
L side as the L testi drains into the L renal vein (backpressure from L renal vein)
63
What are the symptoms of a varicocoaele?
Dull ache, infertility
64
What would you feel on examination in someone with a varicocoaele?
"Bag of worms"
65
What complication is varicocoaele associated with?
Subfertility
66
What investigations might you carry out for a varicoale?
Sperm count
67
What is the treatment for varicocoeale?
If pain --> ablation/embolisation or surgery Sperm bank tight fitting + supportive underwear
68
If you're unsure of a diagnosis of testicular torsion what investigation would you do?
Doppler USS - shows lack of blood flow to the testicle
69
What are the two types of lower urinary tract symptoms?
Storage and voiding symptoms
70
What are the storage lower urinary tract symptoms?
Frequency, urgency, nocturia, overflow incontinence
71
What are the voiding lower urinary tract symptoms?
Terminal dribbling, hesitancy, poor stream/flow, inadequate emptying, straining
72
What are lower urinary tract symptoms caused by?
Obstruction (BPH)
73
What is the differential diagnosis of BPH?
Prostatic cancer, stone, prostatitis, overactive bladder, bladder cancer...
74
Which part of the prostate does BPH first affect?
transitional zone
75
What are the red flag symptoms of prostatic tumour that distinguish it from BPH?
Back pain, haematuria, weight loss
76
What assessment is used to determine the impact symptoms of BPH have on someone's quality of life?
IPSS - international prostate scoring system
77
What are the 3 zones in the prostate? Which does BPH and prostatic cancer affect more?
Transitional (inner) zone (BPH), central zone, peripheral zone (Cancer)
78
Describe the pathophysiology of BPH
5-alpha reductase converts testosterone into its active form: DHA. DHA stimulates hyperplasia of prostatic cells
79
What is the definition of hyperplasia?
Enlargement of a tissue due to increase in the number of cells
80
What are the symptoms of BPH?
LUTS (nocturia, hesitency, terminal dribbling, frequency, urgency, incomplete emptying of the bladder)
81
What examination would you perform on a patient (older male) who comes in with LUTS? What would you find if the cause was BPH and prostatic cancer?
DRE: - BPH --> smooth enlarged prostate - Prostatic cancer: craggy, hard and nodular enlarged prostate
82
What are the signs of BPH?
DRE --> smooth enlarged prostate
83
What investigations would you carry out to diagnose BPH?
PSA, MSU/dipstick, U+E (kidney function), cystoscopy (LUT endoscopy), TRUSS
84
What diseases are PSA levels raised in?
BPH, prostatic cancer, prostatitis
85
What is the conservative management for BPH?
Reduce coffee + alcohol intake | Change diuretic to another anti-hypertensive
86
What is the medical management of BPH
Alpha blockers
87
Give an example of an alpha blocker. What are the side effects of alpha blockers?
Doxazosin SEs: dry mouth, hypotension, drowsy, ejaculatory failure
88
Give an example of a 5-alpha reductase inhibitor. What are the side effects?
Finasteride SEs: decreased labido, ED
89
What are the surgical treatments for BPH?
TURP (TULIP + TUIP)
90
What are the complications of TURP?
TUR syndrome, haemorrhage, infection, sepsis, ED, incontinence
91
What are the indications for surgery to correct
RUSHES: - Retention - UTIs - Stones - Haematuria - elevated creatinine

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