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Urinary Flashcards

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1
Q

Course of ureters

A

cross pelvic brim at bifurcation of common iliac. Runs along lateral pelvic wall. Turns obliquely at level of ischial spine and ends bladder posteriolaterally

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2
Q

renal blood supply

A

renal to 3x segmental to interlobar to arcuate to interlobular to afferent

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3
Q

where is bladder anatomically

A

posterior to pubic symphysis

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4
Q

how does horseshoe kidney occur

A

kidneys ascend in development and can fuse and get stuck on IMA

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5
Q

what is patent urachus

A

urine from umbilicus

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6
Q

what is a common fistula of the bladder

A

exstrophy of bladder through abdo wall

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7
Q

give anatomy of kidney

A

see book

capsule, renal column and pyramid, minor calyx, cortex, renal pelvis

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8
Q

histo of PCT, thin AL, thick AL, DCT

A

PCT - cuboidal with brush border
thin AL - simple squamous
thick AL - cuboidal
DCT - cuboidal, larger lumen than PCT

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9
Q

bladder histology

A

urothelium, LP, 3x SM, adventitia

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10
Q

transporters in PCT

A

apical - NaH antiporter, SGLT1, AA vit symporters, Anion/cation exchangers
basolateral - NaKATPase

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11
Q

Ascending loop transports

A

apical - NaKCl, ROMK (to lumen)

basolateral - NaKATPase

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12
Q

DCT transporters

A

apical - NaCl symporter. Ca diffusion (PTH activated)

basolateral - NaKATPase

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13
Q

principal CD and intercalated CD

A

principal - ENaC, AQP2

intercalaed - reabsorb Cl, secrete H+

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14
Q

function of macula densa and location

A

lines thick AL. increase NaCl = constriction of afferent by adenosine. Decrease NaCl = dilate afferent by prostaglandin. NaCl detected by NaKCl

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15
Q

how measure GFR and RPF

A

GFR - inulin

PFR - PAH

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16
Q

what 4 mechanisms can be used to influence NaCl reabsorption

A

RAAS, sympathetic stimulation, ADH, Atrial natriuretic peptide (increase GFR and therefore increase excretion of Na)

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17
Q

how RAAS works and effects

A

juxtaglomerular cells reelase renin in response to - decrease Na reaching macula densa, or sympathetic, or decrease perfusion pressure by baroreceptors
Renin converts AG1 to AG2 which increase aldosterone which; increases ENaC, constricts afferent and efferent arterioles, increase NHX, increase thirst via ADH, decrease bradykinin

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18
Q

When and whereis ADH release

A 
decreased pressure (by baroreceptors) or increased osmolarity.
detected by osmoreceptors in OVLT of hypothalamus but released by post pit
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19
Q

effects of ADH

A

increase AQP2 in CD and increase NaKCl

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20
Q

what is mild, moderate and severe HT

A

mild - 140-160 / 90-99

+20/10

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21
Q

causes of secondary hypertension

A

NSAIDs, CKD, cushings

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22
Q

what is symptoms and pathology of syndrome of inappropriate ADH. treaat?

A

increase ADH leads to increase BP. Retention of water but not solute results in hyponatremia which leads to N&V, lethargy, seizures
treat with ADH receptor anatgonists

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23
Q

how is corticopapillary osmotic gradient made?

A

inner medulla has higher osmolarity than cortex or outer medulla

1) ascending limb impermeable to water and therefore solutes enter medulla. filtrate hypotonic
2) descending limb impermeable to salts and therefore water enters medulle. filtrate hypertonic.
3) vasa recta absorbs salt and water.

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24
Q

where is calcium reabsorbed

A

10% in DCT under PTh. rest in PCT and LoH

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25
causes, symptoms and treat of hypercalcaemia
causes - PT tumour, malignancy making PTrH symptoms - stones, bones (bone pain), groans (lethargy), moans (abdo pain), thrones (polyuria polydipsia), psychiactric overtones (depression) treat - loop diuretics (increase ca excretion). treat underlying
26
calcium stones risk factors
decreased urine, hypercalcaemia, high oxalate consumption
27
renal stones symptoms
haematuria, pain colic
28
how test for uti
urine dipstick increase nitrates and leukocytes esterases
29
actiosns of loop, thiazide and K sparing diuretics and eg
loop - NaKCl. decresae Ca reabsorb. e.g. furosemide thiazide - NaCl. increase ca reabsorb. e.g. bendroflumethiazide K sparing: 1) ENaC blockers - e.g. amiloride 2) aldost antag - e.g. spironolactone
30
what diuretic for HF, liver failure, HT, conns?
conns - aldost antag HF - loop e.g. furosemide liver failure - aldost antag and loop HT - thiazide e.g. bendroflumethiazide
31
pathology and causes of conns
increased aldosterone leads to increase Bp and hypokalaemia. Vision, headaches, strokes, MI, AKI cause - adrenal adenoma, adrenal hyperplasia
32
thiazide ADRs
hypokalaemia, hypercalcaemia, hyperuricaemia, ED
33
aldost antag ADRs
hyperkalaemia, gyno
34
all diuretics ADRs
hyponatremia, hypovolemia, anaphylaxis
35
acidic and alkalemic symptoms
acidic - hyperkalaemia, arrhythmia, decrease hepatic function alkalemia - tetany, parasthesia, death
36
how is hydrogen buffered in urine
phosphate and ammonia.
37
how hyper and hypokalemia affects ph?
hyper is acidosis | hypo is alkalosis
38
effects of aldosterone on K. How doe K stimulate aldosterone release
increases K excretion | high K in plasma stimulates aldosterone release
39
what is internal and external balance of K
internal - in and outof cells | external - kidneys
40
K shift into cells
alkalosis via KHX, exercise, insulin, aldosterone, increase K ecf
41
K shift out of cells
acidosis, decrease K ECF, trauma, plasma hyperosmolarity
42
causes of hypokalaemia
alkalosis, vomiting, diarrhoea, diuretics, conns
43
symptoms, ECG and treat hypokalaemia
symptoms - paralytic ileus, muscular weakness, CD dysfunction ECG - shallow T wave to prominent U wave to ST depression treat - oral/IV K, K sparing diuretic
44
hyper Kalaemia causes, ECG and treat
causes - CKD, NSAIDs, acidemia ECG - tall tented T waves, prolonged PR, widened QRS, VFib treat - IV calcium gluconate, insulin, oral K binding resin, decrease intake
45
Bladder PS, somatic and symp innervations
PS - S2-4 somatic - S2-4 pudendal symp - T10-L2 hypogastric
46
what controls micturition
pontine micturition centre
47
what is stress urge and overflow UI
stress - excess pressure on bladder leads to leaking urge - urgent desire + leaking overflow - no urge to pee, overfull bladder + leaking
48
how manage UI
less caffeine, weight loss, stop smoking, bladder training, botulism, B3 agonist, anticholinergic, sling, artifical urinary sphincter
49
AKI pre renal causes
hypovolemia, NSAIDs, ACEi
50
AKI renal causes
renal artery occlusion, glomerulonephritis, toxins (gentamicin), pre-eclampsia
51
AKI post renal causes
tumour, BPH, ureteric stricture, megaureter
52
AKI investigation
FENa, BP, urinalysis, imaging
53
AKI management
IV fluids if high K - calcium gluconate if acidosis - protein restrict and bicarb
54
causes of macroscopic haematuria
myoglobin, IgA nephropathy
55
symptoms of nephrotic and nephritic
nephrotic - oedema, hypoalbuminaemia, proteinuria, hyperlipidaemia nephritic - haematuria, increase BP, small proteinuria, oligouria
56
causes of nephritic
PIG ARM - IgA nephropathy, good pastures, alport, rapidly progressive Gn, membrane proliferative GN
57
causes nephrotic
Mum Fight Me im SAD | Membranous GN, FSGS, Minimal change GN, SLE, Amyloidosis, diabetic nephropathy
58
pathology and type of hypersensitivity of membranous GN, diabetic neph, IgA neph, alport, goodpasture, vasculitis
membranous GN - IgG depostion. T3HS diabetic neph - thick BM, microvascular disease, mesangial sclerosis IgA neph - IgA in mesangium. T3HS alport - abnormal collagen IV and therefore abnormal BM. deafness, X linked good pasture - IgG targets collagen IV. T2HS vasculitis - ANCA leads to BV damage. T2HS
59
gene affecting prostate cancer. symptoms. diagnosis
BRCA2 gene symptoms - asymptomatic till late. haematuria, bone pone of mets. diagnosis - DRE, serum PSA, USS
60
TNM staging
size/4, nearby lymph/3, mets/1
61
caues of CKD and symptoms
causes - infection, hypertension, diabetes, polycystic kidney disease, alport symptoms - acidosis, pericarditis, anemia, osteomalacia, hypervolemia, osteitis fibrosa cystic (increase phosphate reduces calcium reabsorb increases PTH). Fatigue, breathlessness, pain, N&V, coma
62
CKD investigate and manage
investigate with 24 hour creatinine clearance | manage - lifestyle, ACEi, statin, treat BP
63
sensory inervation of kidneys and ureter
kidneys - T10-11 | ureter - T12-L2
64
blood supply of ureter
1/3 - renal arteries 2/3 - common iliac, AA, gonadal 3/3 - internal iliac

PPE (18 decks)

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