Urology > Misc > Flashcards

Misc Flashcards

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1
Q

Causes of red urine

A

Haematuria
Foods - beetroot/blackberries
Drugs = Rifampicin
Lead/Mercury poisoning

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2
Q

Causes of orange urine

A

Dehydration
Phenazopyridine (urogesic)
Sulfasalazine

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3
Q

Causes of brown urine

A

Urobilinogen
Porphyria
Metronidazole
Nitrofuratoin

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4
Q

Components checked on urine dipstick

A

Specific Gravity
pH
Blood
Protein
Glucose
Ketones
Urobilinogen
Leukocyte
Esterase
Nitrites

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5
Q

What is specific gravity, and what does it assess

A

Generally looks at concentration of urine
Tells you degree of hydration
As well as degree of renal concentrating ability

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6
Q

Normal range specific gravity

A

1.001 to 1.035

Less then 1.008 is dilute urine
More then 1.020 is concentrated urine

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7
Q

Causes of low/high specific gravity

A

Low SG
Increased fluid intake
Diabetes insipidus
Other causes loss renal concentrating ability

High SG
Decreased fluid intake
Uncontrolled DM with glycosuria
SIADH
Any condition causing dehydration

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8
Q

Normal range for urinary pH
And what is considered alkali/acidic

A

Normal pH = 5.5 - 6.5

Acidic = 4.5 - 5.5
Alkali = 6.5 - 8

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9
Q

Diagnosis of RTA by urine pH

A

inability to acidify the urine below a pH of 5.5 after administration of an acid load is diagnostic
of RTA.

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10
Q

Organism for Alkaline pH UTI and why
And pH cut off

A

Proteus
Because it is a urea splitting organism
-Urease enzyme converts urea to ammonia
pH > 7.5

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11
Q

How is blood detected on dipstick?

A

Based on peroxidase-like activity of blood

Haemoglobin catalises the reaction

Both myoglobin and haemoglobin will reative and cause a colour change.

small amounts of RBC will form dots to appear on pad
-Dots will coalesce when there are more then 250 erythrocytes/mL

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12
Q

How to differentiate glomerular haematuria

A

Haematuria + significant proteinuria = Renal cause
-Uro cause shouldnt cause proteinuria by itself.

Renal = Dysmorphic (squeeze out the RBCs)

Frequently associated with RBC casts

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13
Q

Problems with dipstick for detection RBC

A

Sensitivity is high >90%
But specificity low (lots of false positives)

Menstrual blood contamination in females
Significant dehydration (concentrates RBCs)
Vigorous exercise

Shouldnt use dipstick to assess for haematuria (guidelines)
Should use UFEME

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14
Q

Most common causes glomerular gross haematuria

A

IgA Nephropathy (with low grade fever and rash)
Mesangioproliferative GN
Focal segmental GN

Renal biopsy is often required

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15
Q

non surgical/medical causes of non glomerular gross haematuria

A

Papillary necrosis = In bad DM/Sickle Cell
Exercise induced haematuria (long distance runners)
Vascular diseases = AVFs, renal artery embolisms/thrombosis, renal vein thrombosis

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16
Q

Urine microscopy features non surgical non glomuerular gross haematuria

A

Isomorphic RBCs
No RBC casts
Often with proteinuria also

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17
Q

Urine microscopy features surgical non glomerular gross haematuria

A

Isomorphic RBCs
No RBC casts
No proteinuria

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18
Q

Definition AMH

A

Asymptomatic microscopic hematuria (AMH) is defined as the presence of 3 or greated red blood cells (RBCs) per high-power field (HPF) on a properly collected urinalysis without visible blood, infection, or symptoms

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19
Q

Different proteins in urine, and components by %

A

Total urine proteins:

30% albumin
30% Serum globulins
40% Tissue proteins - Of which major component is Tamm-Horsfall protein

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20
Q

What is Tamm-Horsfall protein?
Where released from

A

Produced exclusively by renal epithelial cells in the thick ascending limb of the loop of Henle. It acts as a vital protective agent against urinary tract infections (UTIs) and kidney stone formation, while forming the matrix of waxy renal casts

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21
Q

3 different categories of proteinuria, and which is the most common

A

Glomerular = Most common
Tubular
Overflow

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22
Q

What is tubular proteinuria, and causes

A

Failure to reabsorb normally filtered proteins that are lower molecular weight
-Eg Immunoglobulins

Commonly associated with conditions effeting proximal tubular dysfunction
-Eg glycosuria, aminoaciduria, phosphaturia, uricosuria (Fanconi syndrome)

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23
Q

What is glomerular proteinuria, and what is definition

A

Occurs in primary glomerular disease Eg. IgA Nephropathy or in DM Nephropathy

Should suspect when total protein excreted >1g
Almost certain when exceeds >3g

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24
Q

What is overload proteinuria, and causes

A

Not due to renal disease, but due to increased serum immunoglobulins and other low molecular weight proteins

Eg. Multiple myeloma (Bence Jone Proteins)

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25
How does dipstick detect protein
Dipstick has tetrabromophenol blue dye Dye reacts to pH of urine related to protein in urine Mainly due to albumin
26
False negatives with proteinuria on dipstick
Alkaline urine (so Tetrabromophenol blue dye doesnt react) Dilute urine Or when primary protein in urine is not albumin
27
How to distinguish glomerular and tubular proteinuria
Protein Electropheresis In glomerular proteinuria = WIll be majority albumin (70%) Tubular = Majority will be low molecular proteins like immunoglobulins
28
How is glucose detected in urine dipstick
Double sequential enzymatic reaction First reaction = Glucose reacts with glucose oxidase, forms gluconic acid and hydrogen peroxide Second reaction = Hydrogen peroxide reacts with peroxidase causing oxidation and colour change on dipstick This double reaction is specific for glucose only, and not other sugars
29
What ketones are excreted into urine
Acetoacetic acid β-hydroxybutyric acid
30
Which ketones are detected by dipstick
Only acetoacetic acid Will not detect β-hydroxybutyric acid
31
How does urobilinogen get into the urine
Bilirubin gets conjugated in the liver with Glucoronic acid Conjugated bilirubin then passed thru bile ducts into small intestine. Converted into urobilinogen 50% is reabsorbed, and in normal patient - Small amount is excreted into the urine
32
How does dipstick check for WBCs
Looks for leukocyte esterase = Produced by neutrophils -Remember this just checks for presence of WBC
33
How are Nitrites detected in urine
Many gram -ve bacteria convert nitrates into nitrites
34
What things should be checked for on microscopy (6 things)
Cells Casts Crystals Bacteria Yeasts Parasites
35
Why is it okay to send a bloody specimen for urine cytology?
Because RBCs are non nucleated So can just choose to look only at the nucleated cells
36
Different urinary casts and what they signify
Tamm-Horsfall mucoprotein = Basic matrix of all renal casts. Is always present in the urine RBC Casts = Cast containing many RBCs = Indicative of glomerular bleeding such as in glomerulonephritis White blood cell casts = Acute glomerulonephritis, acute pyelonephritis, and acute tubulointerstitial nephritis Sloughed renal tubular epithelial cells = Non specific renal damage Fatty casts = Nephrotic syndrome, hyperlipidaemia
37
Different crystals and what pH they occur
Acidic = Calcium oxalate, Urate, Cysteine Alkali = Calcium phosphate, Triple phosphate (struvite) pH Independant = Cholesterol crystals in hyperlipidaemia
38
How much bacteria is present in normal urine. And how to count how many bacteria
Usually there should be no bacteria on high power field microscopy (HFP) 5 bacteria per HPF = Colony count of 100,000m/L (count required for diagnosis of UTI)
39
2 common parasites in urine and what they cause
Trichomonas Vaginalis = Causes vaginitis in women, urethritis in men Schistosoma hematobium = Parasitic ova with terminal spike
40
Micoscopic of expressed prostatic secretions from infetion shows?
Oval fat macrophages
41
What is PSA and what produces it
Also known as human kallikrein peptidase 3(hK3), is a serine protease and a member of the kallikrein gene family. Produced by prostatic luminal epithelial cells
42
Sensitivity and Specificity of urine cytology
Highly sensitive But specificity = 15.8 - 54.5% Only for high grace Urothelial Carcinoma
43
What % of urinary stones are radiopaque
About 70% So this tells you how accurate an XR KUB will be
44
Location of pfannensteil incision
2 finger breadths above the pubic bone
45
Steps of pfannensteil
Skin incision Open anterior rectus transversely Linea alba attachment to anterior sheath is taken down https://www.youtube.com/watch?v=mRSSua5MdTA&list=PLLDZEhkCcep3RY6HO0Eq7YQdzp1wP-8ep
46
Incision for renal transplant recipient and why
Gibson - Muscle splitting incision that gives great extroperitoneal access to pelvic vessels, lower ureter, and bladder
47
Landmarks for Gibson incision
Oblique or curvilinear incision From few cm medial to ASIS Extend down toward inguinal gold Finishes just lateral to rectum muscle, or above pubic symphysis
48
Steps of Gibson incision
Skin incision Split external oblique muscle Split internal oblique Split transversus abdominus Peritoneum identified and and mobilised medially -To maintain an extraperitoneal approach Can see the ureter crossing the iliac artery
49
Landmarks and position for thoracoabdominal incision
Patient is placed in exaggerated flank position (Not quite like lateral position in lap nephrec) Invision starts in abdomen, and extends up usually in between 9/10 rib Useful in large renal masses, IVC thrombus.
50
Landmarks for Chevron
Start from 2 fingerbreadths below costal margin Extend laterally, and can go as far as up to the tip of the 11th rib on both sides
51
Landmarks of true flank incision
Patient is in lateral position, area of incision over break - To open up this area Can be either 12th rib supracostal, 11th rib transcostal, or subcostal. If you take 12th rib supracostal or 11th rib transcostal then you need to take the tip of ribs using rib cutter
52
Incision for radical orchidectomy and inguinal varicocelectomy
Curvilinear or transverse incision Usually 5-7cm Starts 2cm above and lateral to pubic tubercle
53
Incision for inguinal lymph node dissection
Subinguinal incision Start from ASIS To 2cm below pubic tubercle, and parallel to the groin crease
54
Borders of the lumodorsal region
12th rib superiorly Iliac crest inferiorly Spinous processes of vertebral column medially Lateraly to imaginary line between ASIS and costal margin
55
Landmarks for lumbodorsal incision
Patient needs to be lateral position, with break in bed Start 2-3 fingerbreadths lateral to spine. Make a 3-5 cm incision, going inferolaterally Usually directly over quadratus lumborum
56
What was lumodorsal incisions used for?
Rarely used now Previously used in open upper tract urolithiasis Open renal biopsy Pre transplant nephrectomyI
57
Indications for perineal incision
Urethroplasties Perineal urethrostomy Male urethral slings Artificial urinary sphincters
58
How is a perineal incision performed
Start from perineoscrotal junction, and come vertically down.
59
Fascia that is cut through in perineal incision
Colle's fascia Skin then colles fascia THe colles fascia needs to be closed, usually in a continuous fashion
60
Three ways heat is lost from ptient
Radiation Conduction/convection Evaporation Also anaesthetic gases and spinal causes vasodilation, so more heat is lost
61
Component of surgicel and how it works
Oxidised regenerated cellulose agents (ethicon) Activates the bodys natural clotting cascade
62
Components of Tisseal/Variseal and how they work
They are fibrin sealants Human derived liquid preparations of fibrinogen, factor 12, thrombin and calcium. One synringe contains fibrinogen + Factor 12 The other contains thrombin and calcium Mixed together on injection to form a clot on tissue
63
Where do you not use non absorbable sutures
If concern for nidus of infection - As never goes away Stone formation - Dont use for any urinary/ureterointestinal anastamosis
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