Patho week 12

Lakukan tugas rumah & ujian kamu dengan baik sekarang menggunakan Quizwiz!

Severity of a urinary tract obstruction depends on (5)

-Cause of the lesion -Duration of blockage -Location of blockage -Degree of completeness -Whether it involves one or both urinary tract systems

In a spermatocele, Ducts of epididymis become_______and form collections of________.

-Dilated -Collections of sperm containing fluid

Treatment for Cryptorchidism

-GnRH hormone therapy may trigger descent -If hormone therapy is unsuccessful, patient may need surgery

Problems of inadequate spermatogenesis (3)

-Impaired sperm quantity -Impaired sperm quality -Impaired sperm motility

2 specific signs of epididymitis

-Positive Prehn's sign (relief of symptoms with scrotal elevation) -May pyuria (WBC in urine)

AKI clinicaly measures by (4)

-decreased GFR -Increased blood urea nitrogen -increased serum creatinine -reduced urine output

a UTI is diagnosed by a urine culture of specific microorganisms with counts of

10,000/mL or more

Precocious puberty is very rare in males

1:50,000

Clinical manifestations of CKD are similar to AKI however they do not typically appear until after______ of renal function is lost

25%

Erections lasting longer than_________are medical emergencies.

4 hours

Most people with kidney stones will develop their first stones before the age of

50

Uncircumcised men have a ______increased risk of developing penile cancer

50

If torsion cannot be reduced manually, then surgery must be performed within_______ after the onset of symptoms to preserve normal testicular function

6 hours

Metabolic acidosis Decreased GFR Elevated BUN and creatinine

AKI

A specific clinical manifestation of a testicular torsion

Absent cremaster reflex (stroking inner part of thigh leads to contraction of cremaster muscle which pulls up the testes; absent in testicular torsion)

Inflammation of the glomerulus

Acute Glomerulonephritis

Leads to decreased glomerular filtration rate (GFR) due to decreased blood flow and scarring

Acute Glomerulonephritis

-Ascending infections of urinary tract; tends to occur in men 30-50 years of age -Symptoms are similar to UTI or pyelonephritis (fever, back pain, dysuria, incomplete bladder emptying, etc)

Acute bacterial inflammation

4 main categories of prostatitis

Acute bacterial inflammation Chronic bacterial inflammation Chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis

May be caused by immunological responses, ischemic injury, free radicals, drugs, toxins, infections, or as a consequence of chronic diseases such as diabetes or lupus

Acute glomerulonephritis

classic triad of HUS

Anemia Thrombocytopenia AKI

promotes glomeruli hypertension which may progress to tubulointerstitial fibrosis and scarring

Angiotensin II

Severely reduced urine output of less than 10 mL/hr or complete absence of urine production

Anuria

Discovered incidentally but completely asymptomatic and no indication of infection

Asymptomatic inflammatory prostatitis

Symptoms are associated with urethral compression Urge to urinate often Some delay in starting urination Decreased force of the urinary stream

BPH

-Also known as benign prostatic hypertrophy -Enlargement of the prostate gland via hyperplasia and hypertrophy, which are continuous processes throughout life

Benign Prostatic Hyperplasia (BPH)

Most common cause in men; enlargement of prostate leads to obstruction of bladder outlet

Benign prostate hypertrophy

its important to check for______ when a patient comes in with delayed puberty.

Brain tumors

Hypertension, glucose intolerance, inflammation, potassium abnormalities can all lead to increased risk of cardiovascular disease

CKD

Loss of plasma proteins including complement cascade' patients will be more likely to develop infections

CKD

Loss of protein leads to loss of plasma proteins including coagulation cascade; patients will be more prone to bleeding

CKD

Similar to AKI, can be clinically measured by decreased GFR, increased serum creatinine, increased blood urea nitrogen (BUN), degree of albuminuria, and reduced urine output

CKD

-HPG axis is working normally but prematurely -Need surveillance for possible brain tumor

Central precocious puberty

Recurrent urinary tract symptoms and presence of bacteria in urine or prostatic fluid

Chronic bacterial inflammation

Progressive loss of renal function; typically caused by underlying systemic diseases such as uncontrolled hypertension, diabetes, systemic lupus erythematous or intrinsic kidney disease

Chronic kidney disease

No pathogenic bacteria can be found Symptoms are similar to bacterial prostatitis but typically more mild

Chronic pelvic pain syndrome

-Hematuria (blood in urine) -dull and aching flank pain -palpable flank mass in thinner individuals

Clinical Manifestations

Edema, erythema, and tenderness of the prepuce with purulent discharge.

Clinical Manifestations of Phimosis

-Typically begins as small ulcerative or papillary lesion on penis that grows over shaft -Another early sign is leukoplakia (thick white plaque over meatus) -Later signs include penile pain and bleeding, weight loss, fever, general malaiseoCan metastasize

Clinical manifestations of penile cancer

Painless testicular enlargement• Associated with gynecomastia and epididymitis Need to differentiate between hydrocele and spermatocele (misdiagnosis is common)

Clinical manifestations of testicular cancer

Urethral tingling, itching, or burning sensation on urination (dysuria), urinary frequency and urgency; purulent or clear mucus-like discharge from the urethra

Clinical manifestations of urethritis

Gross (visible to the eye) hematuria which may be episodic and accompanied by other nonspecific urinary tract symptoms such as dysuria (pain while urinating), urgency, incontinence

Clinical manifestations of urothelial carcinoma

frequency, urgency, dysuria (pain while urinating), hematuria and/or cloudy foul-smelling urine, flank pain

Clinical manifestations of uti

Sudden onset varicocele in older man

Consider Renal tumors

Failure of one or more of the testes to descend from the abdominal cavity into the scrotum

Cryptorchidism

increased risk of testicular cancer, infertility, and pain

Cryptorchidism

what is used to screen for prostate cancer (2)

Direct Rectal examination Transcretal Ultrasound

intrarenal AKI

Direct injury of renal parenchyma or interstitial cells

Two most common pathogens for UTI

E.coli Staph saprophyticus

kidneys fail to ascend into abdomen from the pelvis

Ectopic kidney

3 other affects of CKD

Edema and fluid overload Decreased urinary excretion of potassium and phosphorous lead to electrolyte disturbances Patients develop altered protein, carbohydrate and fat metabolism

-Inflammation of the epididymis -Common in sexually active young men

Epididymitis

Urethral opening on the dorsal side of the penis

Epispadias

2 things that cause prostate cancer

Excess androgens may increase the risk of developing prostate cancer BRCA2 genetic mutations are also associated with prostate cancer

GnRH stimulates the release of_______ and______ which stimulates the maturation of the testes.

FSH LH (Bio 202 lab be like)

Nephrotic Syndrome

Glomeruli injury to the basement membrane leads to escape of proteins

Arterioles of the glomerulus become swollen and occluded with fibrin clots. This leads to further destruction of RBCs as they pass through the swollen glomeruli blood vessels

HUS

2 ways to preform dialysis

Hemodialysis Peritoneal Dialysis

Acute disorder characterized by hemolytic anemia, thrombocytopenia, and renal impairment

Hemolytic Uremic Syndrome (HUS)

Most common community-acquired cause of acute renal failure in children Associated with bacterial and viral endotoxin agents (especially E. coli O157:H7)

Hemolytic Uremic Syndrome (HUS)

5 risk factors of testicular cancer

High androgen levels genetic predisposition History of cryptorchidism Trauma infection

May occur in adults if there is an imbalance between fluid secretion and reabsorption in scrotal tissues

Hydrocele

Scrotal swelling caused by the collection of fluid in the tunica vaginalis (serous membrane that covers testes)

Hydrocele

AKI can cause electrolyte disorders such as

Hyperkalemia and hyperphosphatemia

3 clinical manifestations of nephrotic syndrome

Hypoalbuminemia, edema, and hyperlipidemia

urethral opening on the ventral side or under surface of the penis

Hypospadias

pre-renal AKI

Inadequate renal perfusion leads to eventual decrease in glomerular filtration pressure

Obstructions in the upper urinary tract lead to

Increased hydrostatic pressure Dilation of the ureter, renal pelvis, calyces, renal parenchyma, glomerulus

The bladder has a non voluntary_________ and a voluntary________.

Internal urethral sphincter External urethral sphincter

Most common cause of upper urinary tract obstruction is

Kidney stones

Delayed puberty is defined as

Lack of secondary sex characteristics by the age of 14 years old

The newly transplanted kidney may come from either a living or deceased donor and is placed in the

Lower abdomen near the pelvis

Immune complexes and inflammation at the glomeruli leads to increased permeability of glomerular filtration membrane

Nephritic Syndrome

Mild proteinuria (<3.5 g) with hematuria

Nephritic Syndrome

The functional unit of the kidney is referred to as the

Nephron

Urinary protein excretion of 3.5 g or more

Nephrotic Syndrome

Can be caused by lesions in the brain or spinal cord that lead to loss of coordinated neuromuscular contraction

Neurogenic bladder

3 common causes or a lower urinary tract obstruction

Neurogenic bladder Urethral stricture Benign prostate Hypertrophy

BPH is more common with

Older age

-Acute inflammation of the testes -Uncommon except as a complication of systemic infections (mumps) or as an extension to epididymis

Orchitis

Foreskin is retracted and cannot be moved forward (reduced) to cover the glans penis

Paraphimosis

Often diagnosed in men older than 55 years of age

Penile Cancer

Sex hormones are produced by some mechanism other than stimulation by the gonadotropins (gonadal tumors, exogenous steroids)

Peripheral precocious puberty

Penile foreskin (prepuce) is "too tight" and cannot be retracted back over the glans penis

Phimosis

Abnormal phimosis may occur due to (2)

Poor hygine chronic infections

The supersaturation of one or more salts leads to_______ and then________ or________ into a________.

Precipitation Crystallization Aggregation stone

Development of secondary sex characteristics before the age of 9 years old.

Precocious Puberty

Maintenance of fluid volume before and after surgery/diagnostic procedures when nephrotoxic drugs or contrast agents are used.

Prevention of AKI

Associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors or infections, penile trauma, and cocaine use

Priapism

Condition of persistent and prolonged penile erection lasting longer than 4 hours

Priapism

Treatment includes needle aspiration of blood from corpus or creation of vascular shunts

Priapism

Most commonly diagnosed non-skin cancer in men (lifetime risk estimated to be 15.9%)

Prostate Cancer

First appearing symptoms are caused by bladder outlet obstruction Slow urinary stream, urinary hesitancy, incomplete bladder emptying, increased urinary frequency, nocturia, dysuria Need to differentiate between benign prostatic hypertrophy

Prostate cancer

Risk factors include older age (very rare in men less than 50 years of age), family history, and race (increased rates in African Americans)

Prostate cancer

One of the most widely used methods but recently controversial Elevated PSA levels may occur in prostate cancer, BPH, prostatitis, or other conditions

Prostate specific antigen (PSA) Used to screen for prostate cancer

Inflammation of the prostate

Prostatitis

contributes to tubulointerstitial injury by promoting inflammation and progressive fibrosis

Proteinuria

Factors that contribute to advancing disease progression of chronic kidney disease include (2)

Proteinuria Angiotensin II

In Nephritic syndrome, urinary RBC and WBC cast with_________, and patients also develop_______.

Proteinuria Hypertension

Infection of upper urinary tract system (ureters, renal pelvis, kidneys)

Pyelonephritis

2 specific treatments for renal cell carcinoma

Radical nephrectomy: surgical removal of the affected kidney Partial nephron-sparing nephrectomy: for smaller tumors

The dilations in an upper urinary tract obstruction leads to (2)

Reduced glomerulus filtration rate (GFR) and reflexive dilation of structures (hydroureter,Hydronephrosis).

benign solid tumors of the renal cortex which can transform into malignant tumors

Renal adenomas

absence of one or both kidneys; remining kidney is typically normal but becomes hypertrophic and prone to developing CKD due to increased stress on organ

Renal agenesis

Adenocarcinomas from tubular epithelial cells Most common malignant renal cancer

Renal cell carcinoma

renal function reduced significantly

Renal failure

typically measured by certain factors such as serum creatinine levels, glomerular filtration rate (GFR), and albuminuria

Renal failure

renal function reduced by 25%

Renal insufficiency

consider inferior vena cava obstruction

Right sided varicocele

premature newborns sexually active and pregnant women women who are on certain antibiotics patients with indwelling urinary catheters patients with diabetes mellitus

Risk factors for UTI

smoking aromatic amines arsenic in drinking water

Risk factors for Urothelial Carcinoma

Tumors kidney stones neurogenic bladder

Risk factors of Post renal AKI

acute tubular necrosis exposure to nephrotoxic contrast dye acute glomerulonephritis graft rejection

Risk factors of intrarenal AKI

hypotension of any cause hypovolemia from acute blood loss/hemorrhage renal vasoconstriction caused by NSAIDs (ibuprofen)

Risk factors of pre renal AKI

female gender kidney stones vesicoureteral reflex pregnancy neurogenic bladder instrumentation and sexual trauma

Risk factors of pyelonephritis

male gender smoking obesity hypertension renal failure

Risk factors of renal cell carcinoma

-Benign cystic collection of epididymis fluid located between the head of the epididymis and the testis - Also known as epididymal cyst

Spermatocele

Clinical manifestations are similar to hydrocele (swelling of testes) however aspiration demonstrates a milky fluid

Spermatocele

the production of male gametes or sperm

Spermatogenesis

Diploid germ cells that divide to form spermatocytes and then haploid spermatids

Spermatogonia

Treatment for Varicocele

Surgical treatment includes ligation of the spermatic vein or occlusion of the vein by percutaneous methods (balloon catheter or sclerosing fluids)

2012 review by USPSTF demonstrated regular PSA screening had little to no reduction in prostate cancer-related mortality but increased harmful consequences due to further evaluations and treatments Some more recent evidence point in the other direction Now recommended not to screen in men >70 years of age and selective screening based on patient history and shared decision-making in men 55-69

TRUE

In renal transplants, the old kidneys are typically left in place (except in cases of renal carcinoma)

TRUE

Severe paraphimosis is a medical emergency

TRUE

Among the most curable cancers Common in men between 15 and 35 years of age

Testicular Cancer

Rotation of a testis causing twisting of the blood vessels in the spermatic cord which leads to vascular engorgement and reduced circulation of the testes

Testicular Torsion

Spermatids require_______ to mature into sperm

Testosterone

three surgical treatments for prostate cancer

Total prostatectomy, transurethral resection of the prostate (TURP), cryotherapy

Bed rest, scrotal support, elevation of the scrotum, hot or cold compresses, analgesic agents for relief of pain

Treatment for orchitis

Obstructions can be further classified as

Upper urinary tract Lower urinary tract

Infection, surgery, or injury leads to narrowing of urethra

Urethral stricture

-Inflammation of the urethra -Can also have nonsexual origins (urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma)

Urethritis

the interference with the flow of urine at any site along the urinary tract

Urinary tract obstruction

Post renal AKI

Urinary tract obstruction leads to increased intratubular pressure and decreased GFR

cancer of uroepithelial cells of the inner lining of the ureters, bladder, and urethra

Urothelial carcinoma

-Typically occurs on left scrotum and often described as a "bag of worms" -Can cause infertility due to decreased blood flow to testes

Varicocele

Inflammation and dilation of the veins in the spermatic cord caused by inadequate or absent valves in the spermatic veins

Varicocele

in epididymitis, pathogenic microorganism reaches the epididymis by ascending via the________ from an already infected______ or______.

Vas deferens Bladder Urethra

malfunctioning valve allows backwards flow of urine; common presenting symptoms are frequent UTIs

Vesicoureteral reflux:

2 things the kidneys produce

Vitamin D Eythropoietein

Malignant embryonal tumor of the kidney also known as nephroblastoma Most common solid tumor of childhood Peak incidence is around 2-3 years of age Can develop sporadically or from genetic inheritance

Wilms Tumor

As mass grows, child may experience vague abdominal pain, hematuria, fever, and hypertension

Wilms tumor

The two hit hypothesis states that

Wilms tumor-suppressor genes WT1 and WT 2 are located on chromosome 11 Children who inherit a mutation in one allele of a tumor-suppression gene require just one more somatic mutation for a tumor to form

Lower urinary tract obstruction relates to the

ability of the bladder to empty into the bladder outlet

Sudden decline in kidney function

acute kidney injury

2 main clinical manifestations of pyelonephritis

acute onset of systemic symptoms (fever and chills) may have costovertebral angle tenderness

Treatment for uncomplicated hydrocele

aspiration of the fluid and injection of a sclerosing agent into the scrotal sac

This urine is then collected in the______ and_______ to be transported to the_______.

calyces renal pelvis ureter

If left untreated, acute glomerulonephritis can become chronic and eventually lead to

chronic kidney disease

Frothy brown-tinged urine ("cola-colored") from hematuria and proteinuria Low serum albumin due to loss in urine Edema caused by decreased intravascular oncotic pressure Severe or progressive glomerular disease can lead to eventual oliguria (urine output <30 mL/hour)

clinical manifestations of Acute Glomerulonephritis

Kidney stones are masses of (3)

crystals proteins mineral salts that form in the urinary tract

The most common type of UTI is

cystitis, or inflammation/infection of the bladder

Tends to be familial or associated with other chronic illnesses (cystic fibrosis, chronic kidney disease) or poor nutrition

delayed puberty

Most commonly chronic glomerulonephritis is due to secondary causes such as

diabetes or lupus

Most common clinical manifestation of wilms tumor is

enlarging asymptomatic upper abdominal mass in a healthy, thriving child

UTI are typically caused by

genitourinary bacterial flora which overgrow or travel backwards into the host's body (retrograde movement)

The nephron produces urine by filtering plasma through the

glomerulus

Toxic build up of end-products of metabolism leading to hypertension, anorexia, nausea/vomiting, diarrhea, constipation, malnutrition, weight loss, seizures, cardiovascular disease, etc

hyperuremic syndrome

Immunological responses regarding acute glomerulonephritis are most often

immune complex mediated (type III hypersensitivity) but may also be type II or IV

Patient who receive solid-organ transplants will need to be on life-long_____________ to prevent allograft rejection from occurring

immunosuppressant therapy

Clinical manifestations include renal pain and signs/symptoms of urinary tract obstruction

kidney stones

End stage renal disease

less than 10% of renal function remains

CKD can develop into

life-threatening hyperuremic syndrome

large kindey stones may have to be treated via

lithotripsy: shockwaves or laser to externally break down stone into smaller pieces

Renal cell carcinoma is a

localized disease

Increase in filtration pore size leads to

loss of proteins, WBC, and RBCs in the urine

Some kidney stones may travel to the bladder and cause a

lower urinary tract obstruction

In HUS, bacterial toxin causes

lysis of RBCs and activation of coagulation cascade and platelets

In HUS toxins also travel to the kidneys were it causes

lysis of endothelial basement membrane cells of the glomeruli

The primary function of the kidneys are to

maintain optimal internal environments for tissue and cell metabolism

SRY gene on the Y chromosome codes for

male characteristics

Injury to the glomeruli can also lead to

nephritic and nephrotic syndromes

he study of kidneys and kidney-related diseases is referred as

nephrology renal

another way to treat/prevent AKI is to avoid

nephrotoxic medications

Causes of acute kidney injury can be divided into 3 main categories

pre-renal intrarenal Postrenal

Classic manifestation of HUS

prodromal gastrointestinal illness with diarrhea followed by sudden onset of severe HUS symptoms 1-2 weeks later

Chronic renal failure

progressive renal failure typically caused systemic disease process

Oliguria

reduced urine output of less than 30ml/hour

Some substances may be reabsorbed or filtered through the

renal tubules

Kidneys regulate blood pressure via

renin-angiotensin-aldosterone system

movement of testes out of scrotum in response to cold temperature or physical activity; typically self-limited and does not require treatment

retractile testes

-male gender -inadequate fluid intake -geographic location (high temperature/humidity -dietary patterns

risk factors for developing a kidney stone

human papillomavirus (HPV), smoking some treatments for psoriasis (UV light)

risk factors for penile cancer

Sperm are produced in the

seminiferous tubules

most penile cancers are a form of

squamous cell carcinomas

Acute renal failure

sudden onset; may be temporary or irreversible depending on underlying cause

Chronic dilation in an upper urinary tract obstruction leads to

tubulointerstitial fibrosis and apoptosis, which further affect kidney function

The study of the bladder and bladder-related diseases is referred to

urology

allograft rejection

when a recipients body rejects a donors kidney


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