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MBBS - Year 3 > Urology - Haematuria, Infection and Incontinance > Flashcards

Urology - Haematuria, Infection and Incontinance Flashcards

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1
Q

when are kidney stones most common

A

aged 20-50

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2
Q

once yoube had a stone what are the chances of having another stone in the next 5 years

A

50%

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3
Q

what is the most common cause of stones

A

calcium oxulate

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4
Q

who is more likely to have a kidney stone male or female

A

men
testosterone increases oxalate production

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5
Q

what foods help inhibit stone formation

A

citrate (lemons, oranges etc)

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6
Q

how much water should be drunk daily to stop stones

A

2 for women
2.5L for men

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7
Q

what colour should the urine be

A

clear or pale yellow

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8
Q

what diet is worst for stones

A

high animal protein and high salt

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9
Q

what are other types of less common stones

A

uric acid stones - gout
calcium phosphate
infection stones - soft branching stones
cystine - inherited form - cystine urea

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10
Q

what is an issue for uric acid stones

A

cant see on x ray

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10
Q

why do kidney stones form

A

get saturation of salt and waste production - precipitates out (crystals)

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11
Q

how do you increase the amount of salt a volume can take

A

add heat
more alkaline - dissolves more calcium oxulate, uric acid and cystine

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12
Q

what are specific risk factors for stones

A

overactive parathyroid gland - hyperparathyroidism - releases calcium form body (bone) - increase in excreted calcium

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13
Q

what symptoms do you get with kidney stone

A

loin to groin pain - loin cholic only if in the kidney
in/visible haematuria
nausea vomiting
recurrent UTI
sepsis

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14
Q

why do you get loin to groin pain

A

ureter innervated by the same dermatomes

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15
Q

what is a stone emergency

A

infection behind stone
infected obstruction
complete blockage (swollen) and sepsis risk
- needs draining (nephrostomy tube)

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16
Q

what are the 3 ways to view stones and which is best and where can they see stones

A

USS – in kidney, bladder NOT ureter ureter is deeper and near bone
Xray – 80-90% stones can be seen
CT – BEST – all stones visible – see size, placement and density

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17
Q

what is the best pain killer for stones

A

diclophenec anti-inflammatories (IV or rectal)

or IV paracetamol

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18
Q

do all kidney stones need to be removed

A

no 2/3 of people can have stones in a kidney and it stays and doesnt grow

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19
Q

what are treatments for kidney stones

A

Lithotripsy - sound waves crack stone into smaller pieces
operation - ureteroscpe - then laser

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20
Q

what do you do for large stones?

A

PCNL
staghorn stones - likely to be infection struvite stones

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21
Q

how do you prevent further chance of stones

A

Investigations
Serum calcium and urate - hyperparathyroidism
Lifestyle
Fluids - 2-3L add lemon or lime
Occupational adjustment
Diet
Animal proteins - reduce
Salt - reduce
Oxalate rich foods - chocolate, nuts etc
Calcium - recommended intake

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22
Q

what are the 4 types of epithelium

A

Cuboid epithelium
Columnar epithelium
Transitional cell epithelium
Squamous epithelium

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23
Q

what parts of the renal system are made up of transitional epithelium

A

urinary tract lining
renal pelvis
ureter
bladder
urethra - up to fossa navicularis

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24
what can cause haematuria
Cancer - Bladder - Kidney - Ureter - Urethra - Prostate Stones Infection - Lower UTI - Pyelonephritis Others - trauma, anticoagulants
25
what do you want to know in a history
Onset and duration Associated symptoms causes Risk factors Occupation Family history Fitness
26
what are some risk factors associated with bladder cancer
Age - 60-70 Sex - male **Smoking - MAIN ONE Occupational exposure Drugs - Cyclophosphamide, Phenacetin Chronic irritation - Stones - Catheter - Schistosomiasis Pelvic radiotherapy
27
what are some occupations associated with TCC
Rubber manufacture Dye manufacture Fine chemicals Retort houses of gas works Rope and textile manufacture Hairdressers Leather workers Plumbers Painters Drivers- Diesel exhaust
28
what is the examination
Abdomen External genetalia DRE- digital rectal examination Urine diptick MSU - mid stream urine - to stop contamination Cytology
29
how do you diagnose TCC
Investigation over age 50 Upper tracts Ultrasound IVU CT scan Bladder, urethra Cystoscopy MSU Cytology 90% sensitive in high grade TCC False negative 40-70%
30
how does bladder cancer present
Haematuria LUTS Storage symptoms Recurrent UTI Others Pneumaturia Pain Lower lib swelling Bone pain, anorexia, weight loss Anuria
31
how common is bladder TCC
4TH Commonest Ca 2nd commonest urological cancer 13000 new cases in UK/ year 5000 deaths Majority have curable disease
32
what is bladder caner staging
33
what is treatment and staging of bladder cancer
TURBT - transurethral resection of bladder tumour MRI/ CT pelvis and abdomen Chest x ray Bone scan
34
how is bladder cancer staged
35
how is the cancer classed
Number Single Multifocal Appearance Papillary 70% - Ta Solid 10% - T2 Flat 10% Mixed 10%
36
what is urinary diversion and what are the procedures
Ileal conduit - Orthotopic Neobladder Ileal Ileo colic Colonic Continent pouch Ureterosigmoidostomy
37
what is the survivability of different stages of bladder cancer
38
pain followed by haematureia
cancer
39
haematuria followed by pain
stone
40
what is staging of TCC
41
how des TCC spread
Usually papillary Direct extension to Renal vein Vena cava Lymphatic spread to Para aortic Para caval Pelvic Blood spread to Liver Lung bones
42
what is treatment of TCC
Curative Nephro-ureterectomy - remove ureter as it will likely develop cancer Uretero-renoscopic laser ablation Palliative Systemic chemotherapy Palliative surgery Arterial embolisation
43
what is 5 year survivability of TCC
5 year survival Organ confined 60-100% Locally advanced 20-50% Node positive 15% Pulmonary bone metastasis 10%
44
Why is kidney cancer increasing
More searching radiography We are living longer
45
What are common risk factors for cancer
Obesity and smoking
46
What is the most common type of kidney cancer
Clear cell (75-80%)
47
what is the 2nd most common type of kidney cancer
Papillary (type 1 and 2) (10-15%)
48
What is the 3rd most common renal cancer
Chromophobe (young females)
49
what are the rarest types of renal cancer
Medullary - sickle cell - very aggressive Collecting duct
50
What are other types of renal cancers
Urothelial - urothelium cancer - common Sarcomas Wilms - kids - surgery and chemo Benign and inflammatory lesions - oncocytomas surgery at 6-7cm - angiomyelolipoma - blood, fat and muscle - 4cm can spontaneously rupture - females in pregnancy - progesterone -
51
What are the 4 Bosnian classification of renal cysts
1. Benign simple cyst 2. Minimally complex cyst 2F - 2 follow in up - monitor for 5 years can become cancer (thick wall) 3. Indeterminate cyst mass - surgery maybe 4. Clearly malignant - surgery
52
Which cancers are associated with con Hipple-Lindau
Clear cell RCC Retinal angiomas Pheochromocytosis - adrenal gland Hemangioblastomas of the central nervous system
53
Why can you get a cough with renal cancer
Mass hits the bottom of the diaphragm and causes irritation
54
What is Stauffers syndrome
paraneoplastic presentation due to hepatomegaly
55
what endocrine does the kidney produce
1,25- dihydroxycholecalciferol, renin, erythropoietin, and various prostaglandins
56
What is poly cystic kidneys
Autosomal dominant- resulting I’m multiple cysts in the kidneys
57
How does PCK present
Pain, size (abdomen distended), haematuria (they pop), asymptomatic, hypertension,
58
Effect of ketamine on kidneys
Very dangerous - destroys kidneys - no major surgery
59
Diversion of urine methods
Nephrostomy Ilial conduit - use a bit of the ilium and similar to stoma Neobladder - continence system (retains urine - may need to self catheterise)
60
TURBT — when is it used
All bladder tumours - to have tissue to determine the staging of the bladder cancer
61
How do you determine the stage of bladder cancer
MRI CT TURBT - tissue to see the layers
62
What is urethral syndrome
Symptoms of a UTI without the UTI
63

MBBS - Year 3 (13 decks)

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