18 th Annual GLOMW Toronto, Ontario Y. Helen Yang / Patrick King Ontario Storm Prediction Centre
Phase 2 Patrick King
-
Upload
nelle-atkinson -
Category
Documents
-
view
15 -
download
2
description
Transcript of Phase 2 Patrick King
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
The Peer Teaching Society is not liable for false or misleading information…
Structure of urinary tract
The Peer Teaching Society is not liable for false or misleading information…
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
The Peer Teaching Society is not liable for false or misleading information…
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 - ?
The Peer Teaching Society is not liable for false or misleading information…
Acute Kidney Injury
Cause: Diabetes, hypertension, old age, drugsStage 1-5 depending on eGFR, 1/2 very common (1/10)
The Peer Teaching Society is not liable for false or misleading information…
Chronic renal failure
The Peer Teaching Society is not liable for false or misleading information…
The prostate
The Peer Teaching Society is not liable for false or misleading information…
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
The Peer Teaching Society is not liable for false or misleading information…
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?