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49 Cards in this Set
- Front
- Back
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GU emergencies
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A. only a few situations in GU that are true emergencies
1. blood or protein in urine 2. acute uti with fever, chills, dysuria, flank pain 3. anuria B. hematuria 1. microscopic or gross 2. without pain a. renal, bladder, prostatic disease 3. with pain a. ureteral stone, nephritis, cystitis 4. with RBC casts a. GN 5. always refer to primary care provider if hematuria C. proteinuria 1. protein in urine seen on chem strip 2. causes a. increased plasma proteins b. increased tubular secretion of protein c. decreased tubular resorption of filtered proteins d. increased filtered proteins due to altered glomerular permeability 3. refer for evaluation |
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Urinary calculi Def + etiology
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A. stones in the urinary tract
B. etiology 1. supersaturation of urine with stone-forming salts 2. preformed nuclei of stones 3. abnormal crystal growth inhibitors 4. 70% calcium oxalate a. hypercalciuria b. hypocitruria c. hyperoxaluria i. consumption of foods high in oxalate . cocoa, tea, beer, rhubarb, dark leafy green vegetables, beans, beets, berries, nuts d. hyperparathyroidism e. diet high in meat, sugar, caffeine f. low water intake |
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Urinary calculi Sxs + sns
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1. asx
2. back pain, renal colic a. if renal calyces, renal pelvis, or ureters obstructed 3. suprapubic pain if in bladder 4. excruciating intermittent pain a. from flank or kidney area across abdomen along course of ureter b. possibly radiating into genitals and down medial thigh 5. nausea, vomiting, abdominal distention 6. chills, fever, hematuria, urinary frequency 7. CVA tenderness |
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Urinary calculi Diagnosis + tx
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D. diagnosis
1. clinical suspicion 2. UA a. ematuria b. increased crystals 3. non-contrast helical CT scan E. treatment 1. may pass spontaneously 2. calcium channel blockers, alpha blockers 2. ESWL - extracorporeal shock wave lithotripsy (US) 3. surgery 4. for calcium oxalate stones a. increase water intake b. dietary changes to reduce risk factors c. Mg 300 mg/d d. vit. B6 150 mg/d |
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Nephrotic syndrome def + etiology
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A. a specific sx complex that is due to a severe, prolonged increase in glomurular permeability for protein
1. excretion of greater than 3 gm protein/day a. normally less than 150 mg/day B. etiology 1. glomerular disease 2. DM 3. neoplasms 4. SLE 5. infections (HIV, HBV, EBV) 6. allergic (insect stings, poison ivy, poison oak) 7. congenital 8. drugs |
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Nephrotic syndrome sxs + sns
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1. frothy urine
2. proteinuria 3. anorexia, malaise 4. puffy eyelids 5. edema a. anasarca b. focal edema may bring in patient initially i. breathing difficulty ii. swollen knees iii. substernal chest pain from pericardial effusion 6. muscle wasting 7. abdominal pain 8. oliguria |
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Nephrotic syndrome lab + complications
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1. UA
a. marked proteinuria b. casts 2. decreased urine Na, increased urine K 3. lipiduria 4. hypoalbuminemia, lipemia, anemia E. complications 1. protein malnutrition 2. brittle hair and nails 3. alopecia 4. stunted growth 5. bone demineralization 6. myopathy 7. tetany 8. peritonitis 9. infections 10. hypertension F. treatment 1. ACE inhibitors 2. Na restriction |
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Acute Nephritic Syndrome def + etiology
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A. acute GN, postinfectious GN
B. inflammatory changes in the glomeruli C. etiology 1. group A, beta-hemolytic streptococci a. ag-ab complexes deposited in glomerular walls 2. bacterial endocarditis, pneumonia, varicella, visceral abscesses, SLE, HBV, syphilis, malaria |
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Acute Nephritic Syndrome sxs + sns
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1. PIGN most common >3 yrs old, young adults
a. 1-6 wks after infection b. hx sore throat or impetigo 2. hematuria 3. edema 4. oliguria 5. hypertension a. HA 6. possible eventual renal failure |
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Acute Nephritic Syndrome lab + tx
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1. scanty, brown urine
2. UA a. RBC’s, WBC’s, tubular cells, casts i. RBC cast is pathognomonic for GN b. proteinuria 3. serum creatinine 4. urine creatinine clearance F. treatment 1. no specific standard tx 2. protein restriction |
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Chronic renal failure def + etiology
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A. insufficiency of renal regulatory and excretory function
B. etiology 1. any cause of renal dysfunction a. hypovolemia, cardiac failure, liver failure, sepsis, malignant hypertension, bacterial infections, drug reactions, metabolic disorders, bladder outlet obstruction, glomerulonephritis, SLE |
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Chronic renal failure sxs + sns
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1. asx with mildly decreased renal reserve
2. nocturia 3. uremia a. retention of nitrogenous wastes i. azotemia is more general term b. malaise, fatigue, decreased mental acuity c. muscular twitches, cramps, peripheral neuropathies, convulsions d. anorexia, nausea, vomiting, stomatitis, bad taste in mouth e. malnutrition f. hypertension from hypervolemia, CHF, pericarditis g. pruritis, yellow-brown skin discoloration |
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Chronic renal failure lab + tx
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1. increased creatinine, BUN
2. anemia 3. hypocalcemia, hyperphosphatemia 4. UA - casts E. treatment 1. find underlying cause 2. decrease dietary protein 3. vitamins 4. Ca supplementation 5. dialysis |
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Emergency - Acute Bacterial Pyelonephritis def + etiology
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A. acute pyogenic infection of the kidney
B. 20% of bacteremias from pyelonephritis C. etiology 1. ascending infection predisposed by obstruction a. strictures, calculi, tumors, BPH, neurogenic bladder, vesicoureteral reflux 2. elderly, DM, girls, after bladder instrumentation 3. E. coli in 75% |
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Emergency - Acute Bacterial Pyelonephritis sxs + sns
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1. rapid onset
2. chills, fever, flank pain, nausea, vomiting 3. dysuria, frequency in 1/3 4. CVA tenderness 5. tender kidney 6. possible abdominal rigidity |
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Emergency - Acute Bacterial Pyelonephritis dx + tx
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E. dx
1. clinical 2. urinalysis 3. urine culture with sensitivity G. treatment 1. refer for antibiotics |
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Cystitis def Etiology + epidemiology
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A. infection of the urinary bladder
B. etiology 1. E. coli C. epidemiology 1. between the ages of 20-50,10-50x more in women a. shorter urethra in women b. hygiene, sexual intercourse c. in men from prostatitis (usu) 2. increase in males after age 50 |
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Cystitis sxs + sns
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D. sxs & sns
1. rapid or gradual onset 2. frequent urgent urination 3. burning pain on urination at any point of flow (dysuria) 4. octuria 5. suprapubic and/or low back pain 6. low grade fever (<100deg) 7. turbid urine, possibly bloody |
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Cystitis lab + tx
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E. laboratory
1. mid-stream urine collection 2. UA a. pyuria, hematuria, bacteriuria 3. urine culture and sensitivity F. treatment 1. antibiotics 2. increase water intake 3. acidify urine a. vitamin C b. cranberry juice i. binds bacteria and prevents adhesion to bladder wall 4. d-mannose |
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Urethritis def + etiology
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A. infection of the urethra
B. etiology 1. Chlamydia trachamatis 2. Neisseria gonorrhoeae 3. herpes simplex 4. Candida albicans 5. Trichomonas vaginalis |
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UTI (cystitis) often....
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Interstitial cystitis (in wall of bladder) - probably autoimmune
- glucosamime sulfate (strengthen cell walls) -tumeric - argenine (increase vasodilation, thru increse nitric oxide) (6 mo course) |
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Urethritis Sxs + sns, Lab, Tx
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C. sxs & sns
1. mucopurulent discharge from urethra 2. burning on urination D. laboratory 1. 2 or 3 bottle urine specimen a. test 1st collection for urethra E. treatment 1. antibiotics 2. as in cystitis D-manose for urethritis or cystitis |
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Prostatitis def + sxs + sns
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A. infection of the prostate gland
B. sxs & sns 1. urinary frequency and urgency 2. dysuria - burning pain on urination 3. hesitancy, dribbling 4. nocturia 5. *high fever, chills 6. perineal and low back pain 7. possibly hematuria 8. tender, boggy prostate 9. may become chronic (no CvA tenderness like nephritis) 10. chronic nonbacterial prostatitis more common (cranberry powder study- significant improv in sxs) |
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Prostatitis lab + tx
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C. laboratory
1. 3 bottle urine specimen a. 3rd specimen obtained after prostatic massage (more infectious material found in this one) b. pyuria, hematuria, bacteriuria 2. urine culture and sensitivity D. treatment 1. antibiotics 2. zinc 50 mg/d 3. EFAs (prostatglandins - originally discovered in prostate) now we know they are everywhere (pro inflam pathway (1) and a few anti inflam pathways) |
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Epididymitis def, etiology, sxs + sns
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A. infection of the epididymis (post sup surface of testis)
B. etiology 1. secondary to urethritis or prostatitis (primarily) C. sxs & sns 1. pain in the scrotum 2. fever 3. urethral discharge, dysuria 4. tenderness, edema, induration of epididymis (when palpate) |
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Epididymitis Lab + tx
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D. laboratory
1. culture of urethral discharge E. treatment 1. bed rest with ice to scrotum 2. antibiotics |
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Benign Prostatic Hypertrophy (BPH) def + etiology
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A. benign enlargement (hyperplasia – adenomatous overgrowth) of the prostate gland
B. etiology 1. unknown 2. possibly alterations in hormonal balance associated with aging |
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Benign Prostatic Hypertrophy (BPH) sxs + sns
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1. sx of bladder outlet obstruction
2. urinary frequency and urgency 3. nocturia 4. hesitancy and intermittency with decreased force and size of stream of urine 5. terminal dribbling, sense of incomplete emptying 6. overflow incontinence 7. possible complete urinary retention 8. enlarged, rubbery prostate a. if tender - prostatitis b. if hard and/or nodular - carcinoma |
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Benign Prostatic Hypertrophy (BPH) diagnosis
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D. diagnosis
1. American Urological Symptom Score for BPH 2. clinical a. sxs b. DRE (digital rectal exam) 3. PSA - prostate specific antigen a. moderately elevated in 50% of BPH 4. transrectal biopsy with ultrasound |
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Benign Prostatic Hypertrophy (BPH) tx
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1. finasteride
2. surgery a. TURP 3. zinc 60 – 90 mg/d 4. flaxseed oil 1 – 2 tbsp/d a. often combined with sunflower oil or fish oil 5. saw palmetto (Serenoa repens) 160 mg BID 6. Pygeum africanum 7. Urtica dioica 8. prostatic massage 9. sitz baths |
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Kidney cancer def, etiology, Epidemiology
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A. renal cell CA
1. adenocarcinoma of kidney 2. 95% of all primary renal tumos B. epidemiology 1. ages 50 – 70 2. ratio 3:2, men to women C. etiology 1. cigarette smoking a. 30% increased risk 2. obesity |
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Kidney cancer sxs + sns + dx + tx
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D. sxs & sns
1. hematuria 2. flank pain 3. palpable mass 4. FUO 5. frequent pulmonary metastasis E. diagnosis 1. CT 2. MRI 3. chest x-ray F. treatment 1. surgery 2. good prognosis only if localized CA a. 5 year survival 20 – 95% |
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Bladder cancer epidemiology, etiology
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A. epidemiology
1. 4th most common cancer in men B. etiology 1. cigarette smoking a. 50% 2. chemicals a. certain dyes b. rubber manufacture |
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Bladder cancer sxs + sns + dx
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C. sxs & sns
1. hematuria (can b microscopic) a. anemia* (think colon cancer too) 2. dysuria, pyuria (WBC, pus) 3. urinary frequency and burning 4. possibly pain and palpable mass (too late) D. diagnosis 1. cystoscopy a. biopsy |
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Bladder cancer tx
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E. treatment
1. if small, resection of tumor - good prognosis 2. if large or metastatic, cystectomy - poor prognosis 3. radiation 4. chemotherapy a. intravesicular |
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Prostate cancer Def, etiology, epidemiology
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A. most common malignancy in men >50 years of age in U.S.
1. adenocarcinoma (grows slowly) B. epidemiology 1. age (17% risk in US,rural china 2%) 2. African American men 3. family hx 4. where one lives (sun exposure, low vit D = > risk) 5. aggressive CA (usu if get it when young, <50) a. smoking b. lack of dietary vegetables c. high BMI (doesnt differentiate fat/muscle) controversial d. sedentary lifestyle e. high calcium intake (don't want too much) f. African American men g. family hx C. etiology 1. unknown 2. possibly hormonal ( over age 50 ) |
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Prostate cancer sxs + sns
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1. slowly progressive
a. asx for a long time 2. sx of bladder outlet obstruction as with BPH 3. pyuria, hematuria 4. bone pain a. common metastasis to pelvis, ribs, vertebrae 5. stony hard, nodular, irregular prostate |
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Prostate cancer diagnosis, prognosis
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1. clinical suspicion based on hx and digital rectal exam
2. PSA a. 4 ng/ml b. free PSA, velocity, density c. elevated in 25-92% of CA depending on tumor size d. good for monitoring progression and tx but still unsure of role in early detection 3. transrectal US (TRUS) with needle biopsy 4. Gleason score a. microscopic grading of abnormal cells E. prognosis 1. localized CA a. little difference with or without dx 2. aggressive or metastatic CA have poor prognosis |
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Prostate cancer tx
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F. treatment
1. active surveillance 2. definitive therapies a. prostatectomy b. cryotherapy c. radiation d. brachytherapy e. orchiectomy 3. palliative therapies a. anti-androgen b. chemotherapy c. corticosteroids d. ketoconazole 4. prevention a. exercise b. no cigarette smoking c. calorie reduction d. decrease fat in diet e. avoid charred or processed meats f. eat more of certain foods i. fish ii. olive oil iii. tomatoHes aa. lycopene iv. cruciferous vegetables aa.. broccoli v. green tea g. calcium less than 1,500 mg/day |
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Testicular cancer etiology, sxs + sns,
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A. etiology
1. unknown 2. incidence 20x higher with hx of cryptorchidism B. sxs & sns 1. scrotal mass with a progressive increase in size a. often firm b. must accurately determine origin of scrotal masses i. most masses from testes malignant ii. most extratesticular scrotal masses benign 2. occasional testicular pain 3. occasional hemorrhage into rapidly expanding tumor a. exquisite local pain and tenderness |
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Testicular cancer dx + prognosis, tx
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C. diagnosis
1. physical exam 2. US 3. inguinal and scrotal exploratory surgery 4. biopsy 5. abdominal, pelvic, thoracic CT for metastasis D. prognosis 1. survival rate depends on histological type and extent 2. 50 – 95% E. treatment 1. orchiectomy 2. lymph node dissection 3. radiation 4. chemotherapy |
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GU history
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A. frequency of urination
B. polyuria, dysuria, hematuria, nocturia C. urgency, hesitancy, incontinence 1. trouble starting, stopping, or holding the flow of urine D. frequent urinary infections E. hx of kidney stones F. male genitalia 1. testicular pain or masses 2. hernias 3. penile discharge, sores, masses 4. hx of sexually transmitted diseases G. past, or present, hx 1. hypertension, DM, SLE, RF, trauma to GU system H. family hx of any renal diseases |
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KD physical exam
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1. palpation
a. patient supine, stand on patient’s right side b. left hand under patient between rib cage and lilac crest c. right hand inferior to costal margin d. press hands together e. reach over patient with left hand and perform same maneuvers for left kidney f. now palpate internal and external inguinal rings i. hernias - masses, tenderness aa. direct through external ring bb. indirect through internal ring ii. Valsalva to make possible hernia stand out 2. CVA tenderness a. patient seated b. pound firmly just lateral to transverse process of T12-L1 |
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Penis physical exam
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1. inspection
a. ulcers, nodules, discharge 2. palpation a. gloves b. tenderness, masses, induration |
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Scrotum physical exam
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1. inspection
a. edema, inflammation, nodules 2. auscultation a. if mass present, auscultate for bowel sounds 3. palpation a. structures b. tenderness, masses, edema c. hernias i. loose scrotal skin with finger up to slit-like opening of external inguinal ring ii. patient strains or coughs 4. transillumination a. shine light through scrotum if enlarged or mass present b. blood or tissue does not transilluminate |
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GU serum labs
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A. serum
1. CMP changes not specific 2. serum creatinine 3. BUN - blood urea nitrogen 4. usually together as BUN/creatinine ratio |
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GU urinalysis labs
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B. urinalysis
1. chem strip a. pH, leukocytes, nitrites, specific gravity, protein, glucose, ketones, blood 2. microscopic exam of urinary sediment a. urine centrifuged, sediment looked at b. leukocytes, erythrocytes, epithelial cells c. crystals d. casts i. cylindrical outlines of renal tubules |
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GU urinary albumin, cultures, Renal fx tests
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C. urinary albumin
1. microalbuminuria a. 30 – 300 mg/day b. DM, HTN D. urine cultures E. renal function tests 1. GFR a. creatinine clearance |
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GU imaging
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IV. Imaging
A. CT B. MRI C. neither urography, angiography, venography, nor US very useful D. renal biopsy |
