HMM 4401– Genito-urinary tract diseases · maintain water and acid/base balance, Urinary symptoms...
Transcript of HMM 4401– Genito-urinary tract diseases · maintain water and acid/base balance, Urinary symptoms...
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HMM 4401–Genito-urinary tract
diseases
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Urine production
• Core elements: Glomerulus, proximal and distal convoluted tube, loop of Henle, collecting tubules, ureters, bladder, sphincter, uretra, and out……
• Urine: Filtration of 150-180 litres per day (as plasma, but without blood cells and proteins), reabosorption (water, glucose, salts) and excretion
• Vital functions: excrete waste products, maintain water and acid/base balance,
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Urinary symptoms• Infection: fever, sick feeling, back pain, frequent
urination• Stone: hematuria, pain• Frequent urination (at night nocturia): two
mechanisms• Enuresis• Hesitation• Hematuria: two types; macroscopic, microscopic• Bloody semen
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Diagnostics• History, symptoms• Palpation (kidneys, bladder)• Rectal or rectovaginal examination• Urine analysis: pH, protein, glucose, ketones, blood, nitrites, leucocyte
esterase, specific gravity, microscopy, bacteriological tests (culture)• Blood tests: urea, creatinine• Intravenous urography• Retrograde cystography/urography• Renal angiography• Ultrasound• Computed tomography (CT)• Magnetic resonance imaging (MRI)• Kidney biopsy
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Renal/kidney failure• Definition: Abnormal kidney function in which kineys fail to adequately
excrete toxic substances• Acute: trauma, toxins, injuries• Chronic: glomerulonephritis, diabetes• Diagnosis: history, thirst, fatigue, itching, nocturia, bad breath, edema,
elevated serum creatinine, anemia, other tests• Treatment: low-protein diet, peritoneal dialysis, hemodialysis,
transplantation
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Nephritis
• Definition: Inflammation of the kidneyscaused by infection or immune reactions (autoimmunity)
• Glomerolopathies: post-infections, nephrotic syndrome
• Pyelonephritis: chronic infection of thekidneys
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Urinary tract infection• Definition: Bacteria (from the urethra (or blood)) that cause
infection in otherwise sterile urine• Occurence: more frequent in females at all ages• Urethritis: infection of the urethra. Most ”famous”: neisseria
gonorrhoea, most common: chlamydia.• Cystitis: infection of the bladder• Pyelonephritis: infection of the kidneys• Symptoms: discharge from urethra, frequent urination, urgent
urination, pain, cloudy urine, chills, fever, back pain• Treatment: antibiotics
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Kidney stones• Urinary stones (urolithiasis) contain calcium, uric acid, cystine
and struvite.• Symptoms: intermittent pain (”renal colic”), nausea, vomiting,
hematuria• Diagnosis: history, urinalysis, intravenous urography• Therapy: NSAIDs intravenously, extra-corporal shock wave
lithotripsy, surgery• Prevention: drugs that interfere with the formation of stones,
avoid food rich in oxalate(rhubarb, spinach, etc)
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Hydronephrosis• Definition: A distention/dilation of the kidneys caused
by backward pressure from obstructed flow• Causes: structural abnormalities (kinks), stones,
tumor, pregnancy, ureterocele• Diagnosis: dull and aching pain, palbable mass,
urinary tract infection, hemauria, intravenousurography
• Treatment: surgery, treat underlying cause
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Urinary incontinence• Definition: uncontrollable loss of urine• Frequency: 1 of 3 elderly• Types: urge, stress, overflow, total• Complications: pressure sores, urinary tract
infections, depression• Therapy: regular urination, avoid coffee,
discontinue certain pharmaceuticals, pelvic muscle exercise, estrogen therapy, other pharmaceuticals, surgery,
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Urinary tract cancer• Definition: tumor of kidney or lower urinary tract.
Hypernephroma. 2% of all cancers, more often in men
• Causes: smoking• Symptoms: (microscopic) hematuria, pain in the side,
fever, • Diagnosis: CT, MR, biopsy, cytology, cystoscopy,
ultrasound, intravenous urography• Treatment: surgery, chemotherapy, radiation• Prognosis: kidney – not so good; bladder:
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Male reproductive system
• Penis, three erectile tissue/bodies• Testes: two functions: producing
sperm/semen and testosterone• Priapism – what is it
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Benign Prostatic Hyperplasia
• Definition: Benign growth of the prostate gland
• Cause: age, unknown• Diagnosis: hesitation, frequent urination,
nocturia, less urination force, dribble at end of urination, infections, rectal examination, cystoscopy, biopsy
• Treatment: expectation, drugs, transurethral surgery, abdominal surgery
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Prostatic Cancer• Definition: malignant tumor of the prostate
gland (found in 50% of men aged 70 and all men aged 90)
• Diagnosis: symptoms largely as for BPH, back pain (metastases), rectal examination, urinary retention, cystoscopy, biopsy, PSA
• Treatment: watchful waiting, brachytherapy, external beam radiation, radical surgery, orchidectomy, estrogen, other drugs
• Prognosis: fewer than 3% die from it
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Symptoms of the femalegenital organ
• Discharge/smell• Abnormal bleeding• Pain• Infertility• Undesired pregnancy• Diagnostics: gynecological examination,
cytologic test (Papanicolaou), colposcopy, biopsy curettage, ultrasound,
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Cancer of the female genital organs
• Uterus: age 50+, abnormal bleeding• Cervix: caused by sexual activity/virus,
abnormal bleeding• Ovaries: 40+, no symptoms, abdominal swell, • Diagnostics: colposcopy, curettage,
ultrasound• Treatment: conization, surgery,
chemotherapy, radiation
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Breast cancer• Symptoms/occurence: lump, 1/10,• Risk factor: age, genetics (BCA1-2), nullipareous,
amenorrhea, long menstruating period, late pregnancies, use of estrogens (but hardly p-pills), lack of physical activity
• Screening: mammography• Diagnosis: palpation, mammography, biopsy,
ultrasound, CT, chest X-ray, isotope examination• Therapy: surgery, radiation, chemotherapy, adjuvant
therapy
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