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Reproduction, Nephrology and Urology > Week 4 > Flashcards

Week 4 Flashcards

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1
Q

What important points does The Equality Act 2010 impact on?

A

Fairness of access
Employers responsibility in discrimination against patients by members of staff and vice versa
Discrimination by employers against staff

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2
Q

Define diversity

A

Acknowledgement of alterity among people

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3
Q

Define equality

A

Fairness of opportunity and observing the rights of people so that their alterity is not discriminated against

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4
Q

Define equity

A

Treating equals equally and unequals unequally

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5
Q

What is the difference principle?

A

Justice necessitates that inequalities in society are met with asymmetrical measures in the form of counter-inequalities
so as to achieve equity

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6
Q

What are the levels in Allport’s scale of prejudice?

A

Anti-locution, avoidance, discrimination, violence, murder

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7
Q

What diversity strands are protected by The Equality Act 2010?

A

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race and ethnicity, religion and belief, sex, sexual orientation

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8
Q

What 3 conditions are always termed a disability?

A

Cancer, HIV infection, MS

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9
Q

Define disability

A

Physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal daily activities

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10
Q

What categories of discrimination are there?

A

Direct, indirect, associative, perceived, harassment, victimisation, instruction

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11
Q

What are the functions of the kidney?

A 
Metabolic waste excretion 
Control of solutes and fluid
Endocrine EPO regulation 
BP control 
Drug metabolism/excretion 
Acid-base balance
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12
Q

What is the normal percentage fluid distribution?

A

Intracellular - 63% (25L)

Extracellular - interstitial 30% (12L); intravascular 7% (3L)

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13
Q

Which component of extracellular fluid do the kidneys have control of?

A

Intravascular

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14
Q

What factors affect the afferent arteriole?

A

Sympathetic nervous system - vasoconstriction

Prostaglandins - vasodilation

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15
Q

What factors affect the efferent arteriole?

A

Angiotensin II - vasoconstriction

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16
Q

What percentage of filtrate is reabsorbed?

A

99%

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17
Q

What percentage of reabsorption occurs in the PCT?

A

70%

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18
Q

Outline the mechanism of the countercurrent multiplier

A

Thick ascending limb is impermeable to water but actively transports Na/K/Cl
Thick ascending limb provides a concentration gradient in the interstitium which promotes water reabsorption from the thin descending limb
Thin descending limb is freely permeable to salt and water
Vasa recta do not wash away the gradient due to countercurrent exchange

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19
Q

What is the mechanism of action of aldosterone and what drugs are used to block its actions?

A

Aldosterone produced in the zona glomerulosa of the adrenal cortex in response to angiotensin II/high K+ → epithelial Na channel insertion in CD → Na reabsorption and K loss
Spironolactone and amiloride

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20
Q

What information do urinary electrolytes give?

A 
Rare to request - collected over 24 hours
Na - induced natriuresis
Cl - diuretic abuse 
Ca - differentiate Bartter's/Gitelman's
K/urea - rarely used
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21
Q

What is the minimum and maximum daily urine output?

A

Minimum - 0.4 L/day

Maximum - 12 L/day

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22
Q

What is a syngeneic transplant?

A

Donor and recipient are genetically identical twins

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23
Q

What is an allogeneic transplant?

A

Donor and recipient are not genetically identical but are from the same species

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24
Q

What is a xenogenic transplant?

A

Donor and recipient are from different species

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25
What tissues/organs can be donated from living donors?
Haematopoietic stem cells Kidney Liver lobe Lung lobe
26
What tissues/organs can be donated from deceased donors?
``` Kidney Liver Pancreas Heart Lung Cornea ```
27
Who decides how transplants are allocated?
NHS Blood and Transplant directorate ensure organs are matched and allocated in an unbiased way Takes into account clinical need, waiting time and compatibility
28
What antigen, antibody and donor compatibility does a patient with blood type A have?
Antigen - A Antibody - anti-B Donors - A, O
29
What antigen, antibody and donor compatibility does a patient with blood type B have?
Antigen - B Antibody - anti-A Donors - B, O
30
What antigen, antibody and donor compatibility does a patient with blood type AB have?
Antigen - A, B Antibody - / Donors - O, A, B, AB
31
What antigen, antibody and donor compatibility does a patient with blood type O have?
Antigen - / Antibody - anti-A, anti-B Donors - O
32
What is the consequence of blood group incompatibility?
Hyperacute rejection of transplanted organ immediately after connection of blood vessels May be overcome by immunoadsorption/plasma exchange/immunosuppression
33
What is the major histocompatibility complex?
Group of genes on chromosome 6 associated with the acceptance and rejection of transplanted material from genetically different donors
34
What are the HLA classes?
Class I - HLA-A, HLA-B, HLA-C | Class II - HLA-DR, HLA-DQ, HLA-DP
35
What is the structure of HLA genes?
Single polypeptide chain associated with β2 microglobulin Polymorphisms at exons 2 and 3 encode α1 and α2 domains which are most distal and responsible for the function of the HLA molecule Cleft of HLA binds peptides from degradation of cellular proteins which signals T cells
36
How do class I HLA present protein to CD8 T cells?
1. Peptides formed by proteolytic degradation 2. Peptides transported by TAP from the cytoplasm to ER 3. MHC associates with TAP accessory molecules (tapasin) 4. Assembled MHC transported via Golgi to cell surface to interact with CD8+ T-cells (normal peptide = no response; abnormal peptide = immune response) Intracellular proteins
37
How do class I HLA present protein to CD4 T cells?
1. Proteins assembled partially in ER; α and β chains join in association with the invariant chain polypeptide (stabilises and stops peptide binding in the ER) 2. HLA transported via Golgi to vesicles where HLA-DM aids association of antigenic peptides to the molecule 3. HLA protein is transported to the cell surface when an optimum peptide has bound to the binding groove so it can interact with CD4+ T-cells Extracellular and cell surface proteins
38
What cells do class I MHC molecules present to?
CD8 T cells
39
What cells do class II MHC molecules present to?
CD4 T cells
40
Where are class I and class 2 molecules expressed?
Class I - all cells and platelets | Class II - APCs, activated T cells, distressed cells
41
What is the main advantage and disadvantage of HLA polymorphism?
Increase chances of human survival | Makes transplantation more difficult
42
How is HLA matching used for kidney, liver and cardiothoracic transplants?
Kidney - match A, B and DR; avoid transplant in presence of donor-specific antibody Liver - not matched; immunoprotected Cardiothoracic - HLA matching important but not logistical due to time constraints; avoid transplant in presence of donor-specific antibody Immunosuppression used in all of the above
43
How can patients posses antibodies against non-self HLAs and what does this mean for transplantation?
Pregnancy, blood transfusion, previous transplant, cross-reactivity of viral infection Contraindication to transplantation if these antibodies match the donor
44
What is hyperacute rejection?
Rejection of a transplant within minutes-hours Should not happen as patients are monitored, cross-matching occurs and antibodies are checked Extremely rare Complement activation, inflammation and thrombosis
45
What is acute rejection?
Rejection of a transplant within weeks-months Immune mediated (T-cells (cellular) and B-cells (antibodies)) Treated with modulation of immunosuppression Risk factor for chronic allograft nephropathy
46
What is chronic allograft nephropathy?
Rejection within months-years Occurs in all transplants eventually Painless but progressive form of primarily immunological injury to graft, more slowly compromises organ function than acute rejection Influenced by immunological and non-immunological
47
How are kidney transplants from heart-beating donors allocated?
National scheme Priority to 3, 4 and 5 according to points score based on waiting time, HLA match, age difference, location and blood group match 1. Paediatric patients (HLA match), highly sensitised (priority given based on waiting time) 2. Other Paediatric patients (HLA match) (priority given based on waiting time) 3. Adult patients (HLA match), highly sensitised 4. Other adult patients (HLA match and favourable m/m) 5. All other eligible patients
48
What tests are important to perform prior to transplantation?
HLA typing of the patient and donor Patient screening for pre-formed HLA antibodies Cross-matching of patient and donor to ensure no negative reaction
49
What is the function of the bladder?
Store urine at a low pressure without much sensation Empty fully at a socially convenient time Allow reciprocal contraction and relaxation of bladder and urethra
50
What is the normal capacity of the bladder?
400-500 ml
51
What ligaments hold the neck of the bladder in place?
Puboprostatic/pubovesical ligaments
52
What ligament is attached to the superior surface of the bladder?
Median umbilical ligament
53
How many layers does the detrussor muscle have?
3 - longitudinal, circular, spiral
54
What is the trigone of the bladder?
Smooth triangular area where the ureteric orifices are
55
What sphincters are present in the bladder/urethra?
Smooth muscle at bladder neck Intra-mural striated muscle (rhabdosphincter) with small slow twitch fibres - along length of urethra in women and at the base of the penis in men Peri-urethral striated muscle (pelvic floor) with larger fast and slow twitch fibres - just before urethral opening in women and at the base of the penis in men
56
What factors contribute to urethral closure?
Muscular occlusion by rhabdosphincter Transmission of abdominal pressure to proximal urethra Mucosal surface tension Anatomical configuration at bladder neck Submucosal vascular plexus Inherent elasticity Urethral length
57
What arteries supply the bladder?
Superior and inferior vesical arteries (branches of internal iliac artery)
58
What is the venous and lymphatic drainage of the bladder?
Rich plexus of veins draining into the internal iliac vein | Lymphatics drain into vesical, external iliac, internal iliac and common iliac lymph nodes
59
What is the afferent innervation of the bladder?
Simple nerve endings - in lamina propria and detrussor ascend with parasympathetics to the pontine and micturation centres; sense bladder filling, stretch and pain (polymodal) Sympathetic - hypogastric nerve; sense pain, touch and temperature
60
What is the efferent parasympathetic innervation of the bladder?
Sacral preganglionic parasympathetic nuclei in intermediolateral columns of S2/3/4 run with pelvic nerves via pelvic plexus to bladder wall - cholinergic excitatory input to detrusor Noradrenergic terminals in pelvic ganglia - nerve mediated detrusor inhibiton
61
What is the efferent sympathetic innervation of the bladder?
Preganglionic sympathetic nerves from T10-12 and L1-2 travel in hypogastric nerve to innervate trigone, blood vessels and smooth muscle of prostate in men/sparse innervation of bladder neck and urethra in women Some postganglionic sympathetic nerves terminate in ganglion - inhibitory, gating theory
62
What is gating theory?
Afferent input to SC is cancelled out by inhibitory interneurons, restricting transmission to preganglionic parasympathetic cell bodies Postganglionic sympathetic nerves exert inhibitory effect in parasympathetic ganglia Therefore postganglionin parasympathetic fibres are protected from afferent input until threshold is reached
63
How is the urethral sphincter innervated?
Dual innervation - preganglionic somatic fibres (striated muscle) and parasympathetic nerves from S2-4 (Onuf's nucleus); run via perineal branch of pudendal nerve
64
What additional arteries supply the bladder in the female?
Vaginal and uterine arteries

Reproduction, Nephrology and Urology (4 decks)

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