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Flashcards in Urinary Deck (64)
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1
Q

Course of ureters

A

cross pelvic brim at bifurcation of common iliac. Runs along lateral pelvic wall. Turns obliquely at level of ischial spine and ends bladder posteriolaterally

2
Q

renal blood supply

A

renal to 3x segmental to interlobar to arcuate to interlobular to afferent

3
Q

where is bladder anatomically

A

posterior to pubic symphysis

4
Q

how does horseshoe kidney occur

A

kidneys ascend in development and can fuse and get stuck on IMA

5
Q

what is patent urachus

A

urine from umbilicus

6
Q

what is a common fistula of the bladder

A

exstrophy of bladder through abdo wall

7
Q

give anatomy of kidney

A

see book

capsule, renal column and pyramid, minor calyx, cortex, renal pelvis

8
Q

histo of PCT, thin AL, thick AL, DCT

A

PCT - cuboidal with brush border
thin AL - simple squamous
thick AL - cuboidal
DCT - cuboidal, larger lumen than PCT

9
Q

bladder histology

A

urothelium, LP, 3x SM, adventitia

10
Q

transporters in PCT

A

apical - NaH antiporter, SGLT1, AA vit symporters, Anion/cation exchangers
basolateral - NaKATPase

11
Q

Ascending loop transports

A

apical - NaKCl, ROMK (to lumen)

basolateral - NaKATPase

12
Q

DCT transporters

A

apical - NaCl symporter. Ca diffusion (PTH activated)

basolateral - NaKATPase

13
Q

principal CD and intercalated CD

A

principal - ENaC, AQP2

intercalaed - reabsorb Cl, secrete H+

14
Q

function of macula densa and location

A

lines thick AL. increase NaCl = constriction of afferent by adenosine. Decrease NaCl = dilate afferent by prostaglandin. NaCl detected by NaKCl

15
Q

how measure GFR and RPF

A

GFR - inulin

PFR - PAH

16
Q

what 4 mechanisms can be used to influence NaCl reabsorption

A

RAAS, sympathetic stimulation, ADH, Atrial natriuretic peptide (increase GFR and therefore increase excretion of Na)

17
Q

how RAAS works and effects

A

juxtaglomerular cells reelase renin in response to - decrease Na reaching macula densa, or sympathetic, or decrease perfusion pressure by baroreceptors
Renin converts AG1 to AG2 which increase aldosterone which; increases ENaC, constricts afferent and efferent arterioles, increase NHX, increase thirst via ADH, decrease bradykinin

18
Q

When and whereis ADH release

A
decreased pressure (by baroreceptors) or increased osmolarity.
detected by osmoreceptors in OVLT of hypothalamus but released by post pit
19
Q

effects of ADH

A

increase AQP2 in CD and increase NaKCl

20
Q

what is mild, moderate and severe HT

A

mild - 140-160 / 90-99

+20/10

21
Q

causes of secondary hypertension

A

NSAIDs, CKD, cushings

22
Q

what is symptoms and pathology of syndrome of inappropriate ADH. treaat?

A

increase ADH leads to increase BP. Retention of water but not solute results in hyponatremia which leads to N&V, lethargy, seizures
treat with ADH receptor anatgonists

23
Q

how is corticopapillary osmotic gradient made?

A

inner medulla has higher osmolarity than cortex or outer medulla

1) ascending limb impermeable to water and therefore solutes enter medulla. filtrate hypotonic
2) descending limb impermeable to salts and therefore water enters medulle. filtrate hypertonic.
3) vasa recta absorbs salt and water.

24
Q

where is calcium reabsorbed

A

10% in DCT under PTh. rest in PCT and LoH

25
Q

causes, symptoms and treat of hypercalcaemia

A

causes - PT tumour, malignancy making PTrH
symptoms - stones, bones (bone pain), groans (lethargy), moans (abdo pain), thrones (polyuria polydipsia), psychiactric overtones (depression)
treat - loop diuretics (increase ca excretion). treat underlying

26
Q

calcium stones risk factors

A

decreased urine, hypercalcaemia, high oxalate consumption

27
Q

renal stones symptoms

A

haematuria, pain colic

28
Q

how test for uti

A

urine dipstick increase nitrates and leukocytes esterases

29
Q

actiosns of loop, thiazide and K sparing diuretics and eg

A

loop - NaKCl. decresae Ca reabsorb. e.g. furosemide
thiazide - NaCl. increase ca reabsorb. e.g. bendroflumethiazide
K sparing:
1) ENaC blockers - e.g. amiloride
2) aldost antag - e.g. spironolactone

30
Q

what diuretic for HF, liver failure, HT, conns?

A

conns - aldost antag
HF - loop e.g. furosemide
liver failure - aldost antag and loop
HT - thiazide e.g. bendroflumethiazide

31
Q

pathology and causes of conns

A

increased aldosterone leads to increase Bp and hypokalaemia. Vision, headaches, strokes, MI, AKI
cause - adrenal adenoma, adrenal hyperplasia

32
Q

thiazide ADRs

A

hypokalaemia, hypercalcaemia, hyperuricaemia, ED

33
Q

aldost antag ADRs

A

hyperkalaemia, gyno

34
Q

all diuretics ADRs

A

hyponatremia, hypovolemia, anaphylaxis

35
Q

acidic and alkalemic symptoms

A

acidic - hyperkalaemia, arrhythmia, decrease hepatic function
alkalemia - tetany, parasthesia, death

36
Q

how is hydrogen buffered in urine

A

phosphate and ammonia.

37
Q

how hyper and hypokalemia affects ph?

A

hyper is acidosis

hypo is alkalosis

38
Q

effects of aldosterone on K. How doe K stimulate aldosterone release

A

increases K excretion

high K in plasma stimulates aldosterone release

39
Q

what is internal and external balance of K

A

internal - in and outof cells

external - kidneys

40
Q

K shift into cells

A

alkalosis via KHX, exercise, insulin, aldosterone, increase K ecf

41
Q

K shift out of cells

A

acidosis, decrease K ECF, trauma, plasma hyperosmolarity

42
Q

causes of hypokalaemia

A

alkalosis, vomiting, diarrhoea, diuretics, conns

43
Q

symptoms, ECG and treat hypokalaemia

A

symptoms - paralytic ileus, muscular weakness, CD dysfunction
ECG - shallow T wave to prominent U wave to ST depression
treat - oral/IV K, K sparing diuretic

44
Q

hyper Kalaemia causes, ECG and treat

A

causes - CKD, NSAIDs, acidemia
ECG - tall tented T waves, prolonged PR, widened QRS, VFib
treat - IV calcium gluconate, insulin, oral K binding resin, decrease intake

45
Q

Bladder PS, somatic and symp innervations

A

PS - S2-4
somatic - S2-4 pudendal
symp - T10-L2 hypogastric

46
Q

what controls micturition

A

pontine micturition centre

47
Q

what is stress urge and overflow UI

A

stress - excess pressure on bladder leads to leaking
urge - urgent desire + leaking
overflow - no urge to pee, overfull bladder + leaking

48
Q

how manage UI

A

less caffeine, weight loss, stop smoking, bladder training, botulism, B3 agonist, anticholinergic, sling, artifical urinary sphincter

49
Q

AKI pre renal causes

A

hypovolemia, NSAIDs, ACEi

50
Q

AKI renal causes

A

renal artery occlusion, glomerulonephritis, toxins (gentamicin), pre-eclampsia

51
Q

AKI post renal causes

A

tumour, BPH, ureteric stricture, megaureter

52
Q

AKI investigation

A

FENa, BP, urinalysis, imaging

53
Q

AKI management

A

IV fluids
if high K - calcium gluconate
if acidosis - protein restrict and bicarb

54
Q

causes of macroscopic haematuria

A

myoglobin, IgA nephropathy

55
Q

symptoms of nephrotic and nephritic

A

nephrotic - oedema, hypoalbuminaemia, proteinuria, hyperlipidaemia

nephritic - haematuria, increase BP, small proteinuria, oligouria

56
Q

causes of nephritic

A

PIG ARM - IgA nephropathy, good pastures, alport, rapidly progressive Gn, membrane proliferative GN

57
Q

causes nephrotic

A

Mum Fight Me im SAD

Membranous GN, FSGS, Minimal change GN, SLE, Amyloidosis, diabetic nephropathy

58
Q

pathology and type of hypersensitivity of membranous GN, diabetic neph, IgA neph, alport, goodpasture, vasculitis

A

membranous GN - IgG depostion. T3HS
diabetic neph - thick BM, microvascular disease, mesangial sclerosis
IgA neph - IgA in mesangium. T3HS
alport - abnormal collagen IV and therefore abnormal BM. deafness, X linked
good pasture - IgG targets collagen IV. T2HS
vasculitis - ANCA leads to BV damage. T2HS

59
Q

gene affecting prostate cancer. symptoms. diagnosis

A

BRCA2 gene
symptoms - asymptomatic till late. haematuria, bone pone of mets.
diagnosis - DRE, serum PSA, USS

60
Q

TNM staging

A

size/4, nearby lymph/3, mets/1

61
Q

caues of CKD and symptoms

A

causes - infection, hypertension, diabetes, polycystic kidney disease, alport
symptoms - acidosis, pericarditis, anemia, osteomalacia, hypervolemia, osteitis fibrosa cystic (increase phosphate reduces calcium reabsorb increases PTH). Fatigue, breathlessness, pain, N&V, coma

62
Q

CKD investigate and manage

A

investigate with 24 hour creatinine clearance

manage - lifestyle, ACEi, statin, treat BP

63
Q

sensory inervation of kidneys and ureter

A

kidneys - T10-11

ureter - T12-L2

64
Q

blood supply of ureter

A

1/3 - renal arteries
2/3 - common iliac, AA, gonadal
3/3 - internal iliac