Urogen Lectures Flashcards

Question

What is the basic mechanism of diaylsis?

Answer 1

Through diffusion/osmoisis Blood is pumped around an extracorporeal circuit and through a semipermeable membrane (dialyser) before being returned to the circulation. In the dialyser dialysate flowing in the **opposite direction** is in close contact with blood. Small solutes (but not cells and larger-molecular-weight proteins) can cross the membrane, and move by diffusion down a concentration gradient. A trans membrane pressure allows controlled fluid removal by ultrafiltration (and with fluid, more solute removal by convection

Answer 2

Less than GFR 15 Acidiosis Intoxication Overload with fluid Electrolyte balance Uraemic symtoms

Answer 3

**When you have a transplant, it is important to:** * Reduce your risk for heart and blood vessel disease. * Manage high blood pressure, diabetes, high cholesterol. * Maintain a healthy weight. * Keep a healthy red blood cell count. * Reduce your risk for cancer and infection. * Take your immunosuppressant medications as prescribed

Answer 4

CVS disease

Answer 5

**Incidence:** 7th most common **Risk Factors:** * Smoking. Smoking increases the risk of developing renal cell carcinoma (RCC). ... * Obesity. People who are very overweight have a higher risk of developing RCC. ... * High blood pressure. ... * Family history of kidney cancer. ... * Thyroid cancer * Chronic renal failure and dialysis * Gender. ... * Race. ... * Certain medicines. **Age:** highest in people aged 90+ **Sex:** - 38% of kidney cancer deaths in the UK are in females, and 62% are in males **Geographical Distribution:**

Answer 6

**Incidence:** 10th most common **Risk Factors:** * **Smoking.** Smoking is the most important risk factor for bladder cancer. ... * Workplace exposures. Certain industrial chemicals like dye industry people, painters, gas workers, hairdressers and rubber industry people * Certain medicines or herbal supplements. ... * Arsenic in drinking water. ... * Not drinking enough fluids. ... * Race and ethnicity. ... * Age. ... * Gender **Age:** Age-specific mortality rates rise steeply (more so in males) from around age 55-59. **Sex:** White males and females more likely to get it. 32% of bladder cancer deaths in the UK are in females, and 68% are in males **Geographical Distribution:**

Answer 7

* Tumor (T): How large is the primary tumor? Where is it located? **TX, T0,** **T1-4** * Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? **NX, N0-3** * Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much? **M0,M1**

Answer 8

**Incidence**: in 8 men will be diagnosed with prostate cancer in their lifetime **Common Presentations:** * A painful or burning sensation during urination or ejaculation. * Frequent urination, particularly at night. * Difficulty stopping or starting urination. * Sudden erectile dysfunction. * Blood in urine or semen. **Risk Factors:** * Old Age * Obesity * Race * North American or northern European location. ... * Family history. ... * Hereditary breast and ovarian cancer (HBOC) syndrome. ... * Other genetic changes. ... * Agent Orange exposure. ... * Eating habits (high fat low fibre)

Answer 9

The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men When you have prostrate cancer there is an elevation of PSA.

Answer 10

Mutations in two genes Genes BRCA1 on chromosome 17 and BRCA2 on chromosome 13

Answer 11

If metastatic, it commonly spread to the bones like vertebrae or pelvis resulting in hip or lower back pain.

Answer 12

Prostrate cancer is detected by a rectal examination. Tumour would feel like a hard lump. Sometimes the tumour can be out of reach. Transrectal ultrasound or MRI to imagine the prostrate Diagnosis of prostate cancer requires a biopsy The cells in the biopsy will be scored using the Gleason grading system.

Answer 13

The Gleason scale identifies the two most common cell patterns within the prostate tissue and assigns a score between one and five to both. A score of 1 represents normal, and a score of 5 represents highly abnormal cells that barely resemble the normal prostate tissue. Primary and secondary patterns are both numbered and added together resulting in a score between 2-10

Answer 14

type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle. Hydrocele is common in newborns and usually disappears without treatment by age 1. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

Answer 15

) is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). A varicocele is similar to a varicose vein you might see in your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility

Answer 16

An epididymal cyst is a non-cancerous (benign) growth filled with clear liquid which is found at the top end of the testis (testicle) where the spermatic cord (vas deferens) is attached. This area is known as the epididymis. Men are most likely to develop these cysts around the age of 40

Answer 17

Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors (GCTs). Most of the remaining 5% are sex cord–gonadal stromal tumours derived from Leydig cells or Sertoli cells.

Answer 18

**Incidence:** Around 2,300 men are diagnosed with testicular cancer each year in the UK. about 1 of every 250 males will develop testicular cancer at some point during their lifetime. **Age:** The average age at the time of diagnosis of testicular cancer is about 33. **Risk Factors:** * An undescended testicle. * Family history of testicular cancer. * HIV infection. * Carcinoma in situ of the testicle. * Having had testicular cancer before. * Being of a certain race/ethnicity. * Body size.

Answer 19

The most common type of testicular cancer is germ cell testicular cancer, which accounts for around 95% of all cases. Germ cells are a type of cell that the body uses to create sperm. There are 2 main subtypes of germ cell testicular cancer. They are: * **seminomas** – which have become more common in the past 20 years and now account for 40 to 45% of testicular cancers. Slow growing and usually does not metastasize * **non-seminomas** – which account for most of the rest and include teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours. It is more aggressive and more resistant to radiation therapy. Less common types of testicular cancer include: * **Leydig cell tumours** – which account for around 1 to 3% of cases * **Sertoli cell tumours** – which account for less than 1% of casesSertoli cell tumours – which account for less than 1% of cases

Answer 20

* alpha-fetoprotein (AFP) * lactate dehydrogenase (LDH) * human chorionic gonadotropin (HCG).

Answer 21

Phimosis is a condition in which the prepuce cannot be retracted over the glans penis. True pathologic phimosis exists when failure to retract is secondary to distal scarring of the prepuce. ... In contrast, physiologic phimosis consists of a pliant, unscarred preputial orifice.

Answer 22

Uncomplicated UTI – infection in a healthy, non-pregnant, pre-menopausal female patient with anatomically and functionally normal urinary tract. A complicated UTI is an infection associated with a condition, such as structural or functional abnormalities of the genitourinary tract or the presence of an underlying disease, which increases the risks of acquiring an infection or of failing therapy.

Answer 23

Your urinary tract is made up of your kidneys, ureters, bladder, and urethra. Most UTIs only involve the urethra and bladder, in the lower tract. However, UTIs can involve the ureters and kidneys, in the upper tract. Although upper tract UTIs are more rare than lower tract UTIs, they're also usually more severe.

Answer 24

Sterile pyuria can be broadly defined as the presence of leucocytes in the urine in the absence of demonstrable urinary tract infection.

Answer 25

Asymptomatic bacteriuria is a condition in which larger than normal numbers of bacteria are present in the urine but symptoms do not result. (See also Overview of Urinary Tract Infections

Answer 26

Bacteria enter the urethra and colonise the bladder. 1. Contamination- bacteria contaminates the lower urinary tract. (E.coli) 2. Colonisation of urethra and bladder 3. Inflammatory response- triggered in the lower urinary tract 4. Neutrophils recruited in this area. 5. Bacteria multiply and evade immune system- this is because there are certain verlan factors. So E. coli can hide from immune cells. Eventually the bacteria produces biofilms (where the microorganisms stick together and adhere to surfaces) 6. Ascension to the kidneys 7. Colonisation of kidney 8. Bacteraemia- bacteria spreading to the circulation via renal vein causing things like sepic shock.

Answer 27

mainly E. coli but other include enterobacteria, proteus mirabilis and klebsiella

Answer 28

cystitis (inflammation due to infection of bladder) or prostatitis (infection of prostrate) or urethritis (infection of urethra).

Answer 29

* Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)- Usually used for uncomplicated lower UTI. Not safe in pregnancy * Fosfomycin (Monurol) * Nitrofurantoin (Macrodantin, Macrobid)- only for uncomplicated lower UTIs * Cephalexin (Keflex) * Ceftriaxone * Amoxicillin

Answer 30

Calcium stones, the most common type of stone 75-80%. Struvite stones, usually caused by an infection, like a urine infection15%. Uric acid stones, usually caused by a large amount of acid in your urine 5% and Cysteine stones (1%)

Answer 31

- means that a kidney does not fully develop in the womb. The affected kidney does not have normal function – which means that it does not work as well as a normal kidney. It is usually smaller than usual, and may have some cysts, which are like sacs filled with liquid

Answer 32

is the name given to a condition that is present at birth that is an absence of one or both kidneys. The kidneys develop between the 5th and 12th week of foetal life, and by the 13th week they are normally producing urine

Answer 33

Ectopic kidney (or “renal ectopia”) describes a kidney that isn't located in its usual position

Answer 34

Horseshoe kidney is when the 2 kidneys join (fuse) together at the bottom. They form a U shape like a horseshoe. It is also known as renal fusion

Answer 35

Children with a duplex kidney (also called a duplicated collecting system) have two ureters coming from a single kidney. These two ureters can drain independently into the bladder or connect and drain as a single ureter into the bladder. Duplex kidneys can occur in one or both kidneys.

Answer 36

is an inherited disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys to enlarge and lose function over time. Cysts are noncancerous round sacs containing fluid.

Answer 37

**Autosomal Dominant ADPKD** causes cysts to form only in the kidneys and symptoms of the disease may not appear until a person is between 30 and 50 years old. **Autosomal recessive PKD (ARPKD)** is a much less common form of PKD. ARPKD causes cysts to form in both the kidneys and the liver

Answer 38

1st nerve- pelvic nerve 2nd nerve- pudendal nerve 3rd nerve- hypogastric nerve

Answer 39

A **flow rate** test is a test to measure the rate at which you pass urine and the amount you pass. It is carried out to assess the changes you have experienced in your usual flow of urine. After your flow rate test, you may also need to have an ultrasound scan of your bladder (bladder scan), • 3 types of machine • mass • rotating disc • capacitance

Answer 40

Voiding time (Vt) Maximum flow rate (Qmax) Average flow rate (Qra) Voided volume (Vv) Pattern of voiding curve Accompanied by a Post-micturition residual volume (PMRV) measurement

Answer 41

A urodynamic study is a special test which measures the pressure within your bladder and urethra (waterpipe). This is performed as an outpatient procedure in the Urology department by either a doctor or a specialist nurse

Answer 42

Hypospadias (pronounced hype-oh-spay-dee-us) is a birth defect in boys where the opening of the urethra (the tube that carries urine from the bladder to the outside of the body) is not located at the tip of the penis

Answer 43

Epispadias is a rare defect that is present at birth. In this condition, the urethra does not develop into a full tube. The urethra is the tube that carries urine out of the body from the bladder.

Answer 44

Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect the adrenal glands, a pair of walnut-sized organs above the kidneys. The adrenal glands produce important hormones, including: Cortisol, which regulates the body's response to illness or stress

Answer 45

Imperforate hymen is when the hymen covers the whole opening of the vagina. Imperforate hymen is the most common type of blockage of the vagina.

Answer 46

A transverse vaginal septum is a horizontal “wall” of tissue that has formed during embryologic development and essentially creates a blockage of the vagina. A transverse vaginal septum can occur at many different levels of the vagina.

Answer 47

A longitudinal vaginal septum (LVS) is sometimes called a double vagina because it creates two vaginal cavities separated by a vertical wall of tissue. One vaginal opening may be smaller than the other. During development, the vagina begins as two canals.

Answer 48

Women with PCOS often have high levels of LH secretion. High levels of LH contribute to the high levels of androgens (male hormones such as testosterone), and this along with low levels of FSH contributes to poor egg development and an inability to ovulate. Women with PCOS may have increased oestrogen level

Answer 49

* irregular periods or no periods at all. * difficulty getting pregnant as a result of irregular ovulation or failure to ovulate. * excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks. * weight gain. * thinning hair and hair loss from the head. * oily skin or acne.

Answer 50

No single test exists to diagnose PCOS. Instead, doctors must rely on symptoms, blood tests, a physical exam, and sometimes a pelvic ultrasound to determine whether you have polycystic ovary syndrome – rather than another condition that can trigger similar signs and symptoms

Answer 51

**Clomifene** encourages the monthly release of an egg from the ovaries (ovulation).

Answer 52

The menopause is when a woman stops having periods (for 12 months) and is no longer able to get pregnant naturally. Periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly. It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Answer 53

Oestrogen- During perimenopause, levels fluctuate and become unpredictable. Eventually, production falls to a very low level. Progesterone- Production stops during menstrual cycles when there is no ovulation and after final menstrual period Testosterone- Levels peak in a woman’s 20s and decline slowly thereafter. By menopause, level is at half of its peak. Ovaries continue to make testosterone even after oestrogen production stops. Testosterone production from adrenal glands also declines with aging but continues after menopause Gonadotropin secretion increases dramatically after menopause. Follicle-stimulating hormone (FSH) levels are higher than luteinizing hormone (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. The FSH rise precedes the LH rise

Answer 54

Premature or early menopause can occur at any age, and in many cases there's no clear cause. Sometimes it's caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down's syndrome or Addison's disease

Answer 55

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40. Many women naturally experience reduced fertility when they are about 40 years old.

Answer 56

* Genetic disorders such as Fragile X syndrome and Turner syndrome. * A low number of follicles. * Autoimmune diseases, including thyroiditis and Addison disease. * Chemotherapy or radiation therapy. * Metabolic disorders. * Toxins, such as cigarette smoke, chemicals, and pesticides.

Answer 57

Diagnosis usually involves a physical exam, including a pelvic exam. Your doctor might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery.

Answer 58

The long-term health risks of POI are infertility, osteoporosis, cardiovascular and neurologic diseases, and an increased risk of premature death. Women with the diagnosis of POI also present psychological problems including irritability, forgetfulness, insomnia and poor concentration

Answer 59

Hormone replacement therapy (HRT)- * combined HRT (oestrogen and progestogen) – for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer) * oestrogen-only HRT – for women who have had their womb removed in a hysterectomy

Answer 60

cervical ectopy, is when the soft cells (glandular cells) that line the inside of the cervical canal spread to the outer surface of your cervix. The outside of your cervix normally has hard cells (epithelial cells) Individuals who have already had menopause rarely get cervical ectropion. Taking the contraceptive pill: Taking birth control pills affects hormone levels and may cause cervical ectropion.

Answer 61

After menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.

Answer 62

In this condition, the lining of the uterus thickens.