phase 2 patrick king the peer teaching society is not liable for false or misleading information…
TRANSCRIPT
Phase 2
Patrick King
The Peer Teaching Society is not liable for false or misleading information…
To cover aetiology, presentation, diagnosis and treatments of common urological problems such as: UTI, AKI, chronic renal failure, BPH and prostate cancer
The Peer Teaching Society is not liable for false or misleading information…
Aims
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Structure of urinary tract
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Lower Urinary tract infectionE.Coli, Klebsiella spp., proteus spp.,enterococci spp., staphylococcus saprophyticus
Symptoms: suprapubic pain, dysuria, frequency, foul smelling urine, nocturia, incontinence, fever, delirium
Investigations: ?
Treatment: Nitrofurantoin or trimethoprim
Recurrent UTI (>=3 UTIs in a year) warrants investigation – renal ultrasound, cystoscopy, KUB-XR
Cause: ascent of LUTI, obstruction, bladder dysfunctionSymptoms – “loin to groin” pain, fever/rigors, vomiting, lower UTS, haematuria. Unwell.Investigation – U&Es, urine sample, catheter, CTKUB, blood culturesTreatment – ABCDE, rehydration, IV antibiotics, drain hydronephrosis e.g. percutaneous nephrostomy/catheter
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Upper UTI
Cause: split into pre-renal, renal and post-renalPresentation: 1st – reduced urine output (<0.5ml/kg)
2nd – raised creatinine, urea, K+, ↓eGFR3rd – confusion, vomiting, overload
Treatment: pre-renal - ? Renal – biopsy, steroids, removal, dialysis
Post-renal - ?
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Acute Kidney Injury
Cause: Diabetes, hypertension, old age, drugsStage 1-5 depending on eGFR, 1/2 very common (1/10)
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Chronic renal failure
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The prostate
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Benign prostatic hyperplasiaThe prostate grows throughout life in response to testosteroen. It doubles in size every 4.5 years between 31 and 50. 90% at 90 will have symptoms.Symptoms: ?Can cause acute/chronic retention – catheteriseAsk about cancer symptoms, DRETreatment: alphablockers e.g. doxazocin, 5-alpha-reductase inhibitors e.g. finasteride, TURP
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Prostate cancer80% of men in 80s have prostate cancer but only causes 13% of all cancer deaths.Symptoms: as before + bony pain, weight loss.PSA – 1000 screened: how many deaths prevented?
how many false positives?Investigation – TRUS-prostate, radioisotope/MRITreatment – watchful waiting & monitor
anti-androgen therapyprostatectomy/radiotherapy – complications?
Quiz?• Which other structure in
the retroperitoneum may have pathology that mimics upper UTI and needs urgent treatment?
• Why do middle aged women have more UTIs?
• A 120kg man on the ward has a urine output of 45mls in the last hour. Does this worry you?
• Name two hormones produced/activated in the kidney.
• A patient develops AKI 1 day post-op. What are 3 possible causes?
• What 3 areas of the ureter provide anatomical narrows likely to stop stones?
Quiz?• Management of an AKI
patient with a K+ of 7.9.• What two structures
may be damaged in a prostatectomy and what complications must the patient be warned of?
• A 75 year old man comes in with chronic retention. Name one examination, one investigation and one intervention that should be done soon?
• Is PSA a good screen for prostate cancer?