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Flashcards in Urinary system & male genital tract Deck (24)
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1

Risk factors of urinary tract infections

Females>males
Sexual intercourse
Pregnancy
Diabetes
Urinary tract obstructions e.g. stones or catheters

2

Define a UTI

the presence of pure growth of >10^5 organisms in fresh urine
in urethra = urethritis
in bladder = cystitis
in prostate = prostatitis
in kidney = pyelonephritis
E.coli is the most common causative organism, staphylococcus and proteus also

3

What is bacteruria?

bacteria in the urine, may be symptomatic or asymptomatic

4

Cystitis

Frequency, dysuria, urgency haematuria, suprapubic pain

5

Pyelonephritis

fever, vomiting, loin pain and tenderness

6

Prostatitis

flu-like symptoms, few urinary problems, swollen and tender prostate

7

Manage of UTIs

drink plenty of fluids
urinate often
antibiotics
imaging
severe cases may require hospital admission

8

The kidneys

Maintenance of water, electrolyte and acid-base homeostasis
Excretion of toxic metabolic waste products (urea and creatinine)
Hormonal function:
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.
- functional unit is the nephron (glomerulus and renal tubule)
- filtration of most small molecules from the blood in the glomerulus.
- selective reabsorption in the renal tubule of most of the water and some molecules
- maintenance of the acid-base balance

9

Acute renal failure

A significant deterioration in renal function occurring over hours or days
low urine volume (<400ml/24 hours i.e oliguria)
rising plasma urea and creatinine levels
usually occurs in the setting of other severe illnesses

10

Stages of renal failure

Causes:
- Pre-renal
hypoperfusion, sepsis
- Renal
ATN damage to tubules due to ischaemia or nephrotoxins
- Post-renal
Renal tract obstruction (eg stones, tumours)

11

Acute renal failure management

find and treat the cause
treat exacerbating factors (hypovolaemia, sepsis)
stop nephrotoxic drugs (NSAIDs, ACE-I, gentamycin and Vancomycin)
may need renal replacement therapy (haemofiltration/dialysis)

12

Chronic renal failure

5 stages depending on GFR (volume of fluid from the glomerular capillaries into the Bowman's capsule per unit time)
symptoms usually occur by stage 4 - GFR 15-29

13

Causes of chronic renal failure

Diabetes
Renovascular disease
Hypertension
Glomerulonephritis
Polycystic disease

14

Glomerulonephritis

A group of disorders where there is damage to the glomerular filtration apparatus = leak of protein or blood into the urine.

15

Kidney stones

Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.
Peak age 20-40 years.
Male: female = 3:1
Risk factors: dehydration, dietary factors, drugs (loop diuretics, antacids, corticosteroids, theophylline and aspirin), renal tract abnormalities, recurrent UTIs, metabolic abnormalities

16

management of kidney stones

imaging
prompt pain relief
stones <5mm able to pass spontaneously within 48 hours
if >5mm = intervention

17

Renal cancer

Renal cell carcinoma -
- 85@% of all renal cancers
- 50-70yrs, 2;1 male predominance
- smoking an important risk factor, obesity, hypertension, hereditary
presents as haematuria, loin pain, abdo mass, hypercalcaemia, hypertension
treatment = radical nephrectomy +/- chemo

18

Transitional cell carcinoma of the bladder

Presentation:
-painless haematuria
-frequency, urgency and dysuria can occur
Tests:
-urine for cytology
-cystoscopy and biopsy
Treatment = depends on stage and ? spread
early stage - diathermy, cystoscopy
late stage - radical cystectomy, palliative chemo/radiotherapy

19

Prostate

located at the base of the bladder and around the first part of the urethra.
normal adults weighs around 20gm
helps in the secretion and maintenance of semen and spermatozoa.

20

Benign prostatic hyperplasia

increase in number of cells formation of nodules
prostate weighs 60-100gm
signs and symptoms: increased frequency, hesitancy, nocturia, terminal dribbling
increased risk of infection
enlarged prostate on PR
Treatment = alpha blockers , Transurethral Resection of the Prostate

21

Prostate cancer

risk factors: age, race, family history, hormone levels, diet (increased risk with fat consumption)
signs and symptoms: nocturia, hesitancy, poor stream and terminal dribbling, examination shows a hard irregular prostate
Diagnosis = raised PSA, biopsy
Treatment = radical prostatectomy, hormonal therapy, radiotherapy for advanced cases

22

Testicular torsion

Sudden onset of pain in 1 testis
Pain in abdomen, nausea and vomiting
Testis is hot, swollen and tender
The testis may lie high and transversely
Most common 11-30 years old
Tests: USS with Doppler, exploratory surgery
Treatment = surgery, urgent!!!

23

Testicular tumours

Most common malignancy in males aged 15-44 years old
Risk factors: undescended testis, infant hernia and infertility
Presentation: painless testicular lump often noted after trauma or infection
Treatment = orchidectomy, radiotherapy/chemo

24

What is dysuria?

Pain or discomfort when urinating