Y2B3 Cs- Prostatitis And Nephrolithiasis

Front 1

what are the 4 zones of the prostate? what 2 zones can you feel during a prostate exam?

Back 1

4 zones- transition, central, peripheral, and anterior fibromuscular stroma

2 zones: peripheral and central zone

Front 2

what percentage of adenocarcinomas and prostatitis are found in each zone?

Back 2

transition- majority of BPH and 20% of adenocarcinoma
central: 1-5% of adenocarcinoma
peripheral: 90% of all prostatitis, 70% of adenocarcinomas
fibromuscular--- negligable

Front 3

What are the three causes of prostatitis? what does it cause that can confuse it w/ a prognosis more worrisome? what population is effected most by prostatitis?

Back 3

3 causes: infection, trauma, or stasis (feels pain or bogginess of rectal exam)

-causes an increased PSA blood levels

number 1 urologic dx in men <50

Front 4

what are the two subcategories of chronic nonbacterial prostatitis? how do you distinguish between them?

Back 4

inflammatory- WBCs in semen
noninflammatory- no WBCs in semen

Front 5

36 year old male presents to your office w/ fever, chills, low back pain and N/V. On PE you feel a warm, tender prostate w/ induration. Dx and tx

Back 5

Dx: acute bacterial prostatitis

may also show bladder distention

tx: hospitalization w/ IV abx.

if not N/V give orals w/ G- coverage.

Front 6

40 year old male presents to your office complaining of pain in the groin region, dysuria, ejacylodynia and nocturia. On PE you notice a normal prostate. You have him do a UA and it comes back 10 x WBC in the VB-3. dx and tx

Back 6

dx: chronic bacterial prostatitis

tx: gram- coverage for 6 weeks

Front 7

40 year old male presents to your office complaining of pain in the groin region, dysuria, ejacylodynia and nocturia. On PE you notice a normal prostate. You do a UA and it comes back normal, the EPS comes back w/ WBCs, but no growth. DX and tx

Back 7

dx: chronic nonbacterial prostatitis (inflammatory)

tx: warm baths, prostatic massage for infrequent ejaculators and NSAIDs. Abx are controversial, but used.

Front 8

25 year old man presents to your office complaining of pain in the groin region, dysuria, ejacylodynia and nocturia. On PE you notice a normal prostate. UA, EPS and DRE are all normal. TX and Dx?

Back 8

dx: Chronic nonbacterial prostatitis (noninflammatory)- prostatodynia

tx: warm baths, prostatic massage for infrequent ejaculators and NSAIDs. Abx are controversial, but used. PLUS alpha blockers (to relax the smooth muscle capsule of the prostate and the detrusor muscle increasing urination ease) and antidepressants (to alter pain pathway)

Front 9

35 year old male pt presents to your ER complaining of colicky flank pain radiating to abdomen and then to the groin. He also mentioned that he had blood in the urine. Dx

Back 9

Nephrolithiasis

Front 10

what population is most commonly effected by nephrolithiasis? what are the hallmarks of nephrolithiasis? what is the issue of stones concerning recurrence?

Back 10

pop: 20-45 y/o men in developed countries
hallmarks: intense pain and hematuria w/ or w/o pyruria (WBCs)
reccurence: each successive stone you have has a 50% chance addition. 2nd stone- 75% chance of having another one

Front 11

what type of stone is the only one that cannot be seen on plain film?

Back 11

uric acid

Front 12

how do you distinguish pyelonephritis from nephrolithiasis?

Back 12

Lots of RBCs w/ lil WBCs- nephrolithiasis

lots of WBCs w/ lil RBCs- pyelonephritis

Front 13

what percentage of stones are calcium stones in nephrolithiasis? what percentage of those are calcium oxalate? which type of calcium stones require alkaline urine?

Back 13

calcium- 75%
calcium oxalate- 50% (acidic pH)
calcium phosphate stones require alkaline urine

Front 14

At what level are you considered to have hypercalciuria? what is the number 1 cause of hyerpcalciuria?

Back 14

>4 mg/kg/24 hr
#1 cause- increased intake

Front 15

how do you prevent calcium stones?

Back 15

increase fluid and fiber intake
use thiazide diuretics to increase distal tubular reabsorption of Ca+

Front 16

how do you tx hyperoxaluruia? how do you tx hypercalciuria?

Back 16

hyperoxaluria: tx w/ Mg and Ca supplements to bind oxalate in the gut. (calcium oxalate)

hypercalciuria: Decrease intake of Ca+ or use thiazide diuretics

ALWAYS TX UNDERLYING CAUSE!

Front 17

how do you tx uric acid stones?

Back 17

increased volume intake and alkalinization of urine w/ po NaHCO3 and diamox at night time. then redo the 24 hr urine test to see if you made a difference.

You can use ECSL to break up the stone

Front 18

35 year old female presents to your office complaining of stone like pain. She has a PMH including multiple UTI's d/t proteus and subsequential antibiotic tx. Dx, tx and what would you see on xray?

Back 18

DX: triple phosphate stone - Magnesium ammonium phosphate

d/t ammonium phosphate traps Ca and Mg resulting in those stones.

xray: Staghorn: Horns sticking off the stones

tx: UNDERLYING CAUSE.

Front 19

You look at an xray an notice hexagonal shaped crystals in the kidney. Dx and tx

Back 19

DX: cystine stones
TX: increased volume intake and alkalinization of urine. Ultrasonic lithotripsy is used.

Front 20

when does the pt feel pain when passing a kidney stone?

Back 20

only when the stone is moving.

Front 21

what is the diagnostic tests of choice for stones?

Back 21

IV pyelogram

can also use: Xray and US

do not use CT (only good for hydronephrosis)

Front 22

what percentage of stones will pass when between 4 and 7 mm? How do you tx stones that are 8mm or < in the proximal third of ureteral or renal pelvis? what about them being located in the distal 2/3rs of the ureter?

Back 22

4 and 7mm-- 50%
ECSWL for proximal 1/3 of ureteral or renal pelvis stones
US lithotripsy- distal 2/3 of ureter

Front 23

WHat do you do to your pt in order to prevent new stones from forming?

Back 23

catch the stone and perform a metabolic workup:
24 hr urine collection for volume
pH
creatinine
urea
Na
ca
phosphate
urate
oxalate
citate
cystine

Front 24

what is the string sign?

Back 24

stone at the base by the bladder that obstructs the dye in the ureter causes the ureter to look like a string.

normal ureter: will have paristalsis which will not all the dye to concentrate in the ureter, but will have a spotted effect.