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GU/Renal: Hx, Exam, Labs, Imaging
GU: Hx, Exam, Labs, Imaging
161
Anatomy
Graduate
01/04/2012

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Term
definition of nocturia:
Definition
urinating more than once/night
Term
#1 reason for change in urine color/odor:
Definition
hydration status
Term
Oliguria definition. What should you always consider with this symptom?
Definition
- decrease in amount of urine being produced
- renal failure
Term
Anuria:
Definition
not producing any urine
Term
Blood in the urine can be red or brown, remember this b/c pts may say no blood, but it could be brown and don't know its blood.
Definition
Term
Associated symptoms with UTI:
Definition
- nausea
- vomiting
- distention
- bloating
- fatigue
Term
GU symptoms with fever, consider __ and __.
Definition
infection
cancer
Term
GU symptoms with fatigue, consider __ or __.
Definition
infection
anemia
Term
GU symptoms and weight loss, consider:
Definition
cancer
Term
GU symptoms and edema, consider:
Definition
renal disease
Term
GU symptoms and gynecomastia, consider:
Definition
endocrine d/o
Term
Pertinent past medical history with a GU patient:
Definition
- Hx of bladder/kidney infections
- Diabetes
- Hypertension
- Smoking
- Prostate abnormalities
- Congenital disorders
- Sterility
- Sexual dysfunction
- STDs
- Hx of cancer
- Past surgeries
Term
Smoking is correlated with what cancers related to GU?
Definition
- bladder cancer
- renal cell carcinoma
Term
__% of women have recurrent UTIs.
Definition
40%
Term
Why are DM pts more prone to UTIs?
Definition
- they tend to spill glucose in their urine and glucose feeds bacteria
Term
__ and __ both cause you to spill protein into urine, which can cause GU issues.
Definition
DM and HTN
Term
Male GU pain location:
Definition
- tends to localize in the mid-back, flank, lower abdomen, or groin, often radiates to groin
Term
Colickly GU pain in males indicate __ of the ureter.
Definition
obstruction (the back up of urine and stretching of the ureter is what causes pain)
Term
Constant GU pain is more suggestive of an ___ __.
Definition
- inflammatory cause- UTI (may be somewhat relieved with urination, but does not come and go as dramatically as kidney stone pain)
Term
Kidney pain is typically __ and __ and below the __rib.
Definition
- dull and constant
- 12th rib
Term
Kidney pain is caused by distention of the __ __, it spreads to the __ and __ __. The development of pain may be chronic or slow, can be painless.
Definition
- renal capsule
- umbilicus and lower abdomen
Term
Pple with kidney infections look really sick, not just a little back ache, usually nauseated/fever etc.
Definition
Term
Ureter pain is typically caused by __, it is __, __, and __.
Definition
- obstruction (stone)
- colicky
- severe
- RADIATES
Term
Ureter 3 areas of obstruction:
Definition
1. Uretopelvic Junction
2. Ureter crossing iliac vessels
3. Vesicoureteral Junction
Term
Symptoms of a stone lodged at the uretropelvic junction:
Definition
- flank/CVA pain, +/- radiation to groin
Term
Symptoms of a stone lodged in the ureter over the iliac vessels:
Definition
- flank pain
- lower abdominal quadrant pain
- +/- radiation to groin
Term
Symptoms of a stone lodged at the vesicoureteral junction:
Definition
- flank
- lower abdominal quadrant pain
- frequency and urgency
Term
f a stone is causing frequency and urgency, it is likely at the:
Definition
vesciouretral junction
Term
Ureteral pain is usually colicky but if the renal capsule is involved there may also be constant back pain.
Definition
Term
Acute urinary retention can cause agonizing ___ pain, whereas chronic bladder distention is usually ___.
Definition
- suprapubic pain
- chronic- painless
Term
Constant suprapubic pain unrelated to urination is not __ in origin.
Definition
not GU
Term
GU pain associated with infection is usually referred to the __ __.
Definition
distal urethra
Term
Prostate pain is often described as __ discomfort or __ in the perineal/rectal area.
Definition
- vague
- fullness
Term
"sitting on a golf ball"
Definition
prostate
Term
Prostate pain is usually related to __. It also may be associated with __, __, and ___. Lumbosacral referred pain is uncommon.
Definition
- inflammation
- dysuria, urgency, and frequency
Term
Testicular pain:
Definition
- usually localized
- due to trauma, torsion, or infection
- consider referred pain from obstruction
- consider inguinal hernia
Term
Testicular cancer is usually ___.
Definition
painless
Term
The __ __ deformity is associated with increased risk for testicular torsion. With this deformity the testes is not attached to the scrotal wall.
Definition
Bell Clapper
Term
Testicular torsion tends to occur at __ due to activation of the __ reflex.
Definition
- night
- cremasteric refle
Term
After fixing testicular torsion, an __ is performed to prevent it from occuring again.
Definition
- orchiopexy (suture testes to scrotal wall)
Term
With epididymis, pain can be felt in the __ or __ __. __ is the usual cause. It can be confused with ___.
Definition
- groin or lowr abdomen
- infection - usual cause
- confused with appendicitis
Term
Pt has a inflammed erythematous scrotum with pain in the groin and lower abdomen:
Definition
Epididymitis
Term
__ ___ account for most of the mimicry b/w GU and GI symptoms.
Definition
Renointestinal reflexes

common autonomic and sensory innervations b/w the systems
Term
The right kidney is closely related to:
Definition
- hepatic flexure
- duodenum
- head of pancreas

enlarged/inflammed kidney could displace these structures and cause associated symptoms
- common bile duct
- liver
- gall bladder
Term
The left kidney is closley related to:
Definition
- splenic flexure
- stomach
- pancreas
- spleen

enlarged/inflamed kidney could displace these structures and cause associated symptoms
Term
normal bladder capacity:
Definition
400 ml
Term
Causes of urinary frequency:
Definition
- inflammation
- urinary retention
- loss of compliance
- reduced capacity
Term
Nocturia could be due to __ or __ disease.
Definition
renal
cardiac
Term
dysuria definition:
Definition
- painful urination, usually burning
Term
Dysuria is usually related to inflammation of the __, __, or __.
Definition
- bladder
- urethra
- prostate
Term
Dysuria with more pain associated with the end of urination suggests __ involvement, likely a spasm.
Definition
bladder
Term
Physiological enuresis occurs in kids up to age __.
Definition
3
Term
After age 3, a child can be diagnosed with __ enuresis, in which they have never had a 6 month period of continence. Or they can be diagnosed with __ enuresis, which occurs in children who were previously continent for 6 months or more.
Definition
- primary
- secondary
Term
If daytime wetting or other symptoms also occurs, there is probably some sort of issue going, check for infection or structural abnormality.
Definition
Term
If daytime wetting or other symptoms also occurs, there is probably some sort of issue going, check for infection or structural abnormality.
Definition
Term
Classic example of bladder outlet obstruction:
Definition
Benign Prostatic Hyperplasia (BPH)
Term
Symptoms of bladder outlet obstruction (BPH):
Definition
- hesitancy
- weak stream
- terminal dribbling
- sudden urgency
- urinary retention
- interruption of urinary stream
- sense of residual volume
Term
True incontinence:
Definition
urine loss without warning
Term
Stress incontinence:
Definition
- loss of urine associated with physical strain (cough/laugh)
- this is often seen in women who have had many babies> pelvic floor instability
Term
Type of incontinence seen in women who had many children:
Definition
Stress incontinence- weakened pelvic floor muscles
Term
Urge incontinence:
Definition
- loss of urine associated with urgency due to bladder spasms
Term
Overflow incontinence:
Definition
loss of urine due to a full bladder that can't hold anymore
Term
Things to consider with oliguria and anuria:
Definition
- consider acute renal failure
- may be shock/dehydration
- could be bilateral ureter obstruction
Term
Pneumaturia:
Definition
- gas in the stream
- look for fistula to bowel
Term
Cloudy urine:
Definition
- usually due to increase in alkalinity
- consider infection
Term
Hematuria:
Definition
- cannot be ignored
- MUST CONSIDER CANCER
- timing and color of blood can provide diagnostic clues
Term
Bright red blood in stream is probably from the:
Definition
- bladder
- ureter
- prostate
Term
Dark redish brown hematuria is probably from the ___.
Definition
kidneys
Term
Classic description of bladder cancer:
Definition
gross painless hematuria
Term
If blood comes out at the beginning of the urine stream, its probably from the ___.
Definition
ureters
Term
If blood comes out at the end of the urine stream, its probably from the __ or __.
Definition
- bladder or prostate
Term
If blood persists for the duration of the urine stream, its probably from the ___.
Definition
kidneys
Term
Hematospermia is usually __, if lasts longer than a month, then may be a problem.
Definition
benign
Term
How many Tanner Stages are there:
Definition
5

1- preadolescent
5- mature
Term
Small yellow-white sebaceous cysts may be seen on the scrotum (normal)- can remove them but not necessary
Definition
Term
raw shallow ulcers:
Definition
herpetic lesions
Term
purulent penile discharge
Definition
gonorrhea
Term
With hypospadias, the meatus is __.
Definition
ventral (underneath the penis)
Term
cauliflower appearance:
Definition
condyloma acuminata (genital warts)
Term
Gummas are associated with __ __.
Definition
tertiary syphilis
Term
Balanitis is inflammation of the __ __. It is more common in ___ males and most commonly caused by a __ infection.
Definition
- glans penis
- uncircumcised
- fungal infection
Term
The kidneys are ___, and thus hard to palpate. The __ kidney is lower than the left kidney b/c of the liver.
Definition
- retroperiotoneal
- right
Term
An empty bladder is normally non-palpable
Percussion may be better at detecting distention and masses
In chronic retention, the bladder could extend above the umbilicus
Suprapubic tenderness may be due to cystitis
Definition
Term
Peyronie's disease is a condition in which __ form of the penis due to trauma or scarring, resulting in the penis deviating in one direction. Tmt is cosmetic.
Definition
plaques
Term
When you palpate the penis, you are looking for __ or __.
Definition
- plaques (Peyronie's disease)
- induration (strictures of the urethra tend to feel indurated- swollen and firm)
Term
descending of testes:
Definition
abdomen> internal inguinal ring> inguinal canal> external inguinal ring> prescrotal (prepubic)> normal position
Term
A hydrocele with __ __, whereas a mass or blood filled testes will be __ with __.
Definition
- transilluminate red
- dark with transillumination
Term
When examining a pt for an inguinal hernia, insert the __ finger into the lower scrotum and follow the __ __ superiorly. Insert finger through __ ring and into __ __. Place the other hand on the patient's body overlying the __ __. Ask patient to cough.
Definition
- index
- vas deferens
- external ring
- inguinal canal
- inguinal canal

may feel something hit finger or push out on hand> either one= hernia
Term
when examining for hernia use right hand on right side and left hand on left side
Definition
Term
When checking for inguinal hernia, you feel bowel contact the TIP of your finger:
Definition
- Indirect Inguinal Hernia
Term
When checking for inguinal hernia, you feel bowel medial to the inguinal canal:
Definition
Direct Inguinal Hernia
Term
When checking for an inguinal hernia, you feel bowel protrude inferior and lateral to the inguinal canal:
Definition
- Femoral Hernia
Term
Most inguinal hernias are not visible.
Definition
Term
Indirect inguinal hernias go through the __ __.
Definition
inguinal canal
Term
Direct inguinal hernias go through __ __.
Definition
Hesselbach's Triangle
Term
Femoral hernias go through the __ __.
Definition
femoral ring
Term
The epididymis is __ and __ to the testis. It should be palpated for size and induration.
Definition
superior and posterior
Term
Small spermatoceles may be present on the ___. These are __ __ masses often at the head of the __. These are normal and benign.
Definition
- epididymis
- small painless
- epididymis
Term
Chronic painless induraction of the epididymis suggests:
Definition
- schistosomiasis
- TB
- other chronic infection
Term
Chronic painless induraction of the epididymis suggests:
Definition
- schistosomiasis
- TB
- other chronic infection
Term
A painful and tender epididymis usually indicates ___.
Definition
infection
Term
The prostate normally feels __ with an average size of __ cm, or 20 grams, a walnut.
Definition
- rubbery
- 4 cm
Term
If the prostate feels mushy, it is likely __.
Definition
congested
Term
If a prostate feels indurated, it is likely ___.
Definition
infected
Term
If a prostate feels stone-hard, it is likely ___.
Definition
cancer
Term
Malignant tumors of the testicles spread to what lymph node?
Definition
left supraclavicular node- Virchow's node
Term
Tumors of the prostate can spread to the :
Definition
left supraclavicular node- Virchow's node
internal abdominal lymph nodes
Term
Tumors of the bladder spread to what lymph nodes?
Definition
internal abdominal lymph nodes
Term
Cancers of the penis, glans penis, scrotal skin, and distal urethra mets to what nodes?
Definition
inguinal nodes
Term
If you want to know what is qualitatively present in urine:
Definition
urinalysis
Term
If you want to know what is quantitatively present in urine?
Definition
urine microscopy
Term
If you want to know what is quantitatively present in urine?
Definition
urine microscopy
Term
If you want to know antibiotic sensitivity of a UTI, what lab do you order?
Definition
urine culture
Term
BUN (blood urea nitrogen) is produced by the __ when __ is broken down. The __ is then carried to the ___ to be excreted in urine. If kidneys are not functioning well, the BUN will be ___.
Definition
Term
Is BUN in the bmp and cmp?
Definition
yes
Term
Limitations to BUN:
Definition
- affected by diet (high protein diet will result in elevated BUN)
- affected by hydration status (if dehydrated> not sending as much blood to kidneys> BUN builds up)
Term
Examples of decreased blood flow to kidneys resulting in elevated BUN (even when kidneys are fine):
Definition
- Congestive Heart Failure
- Shock
- Dehydration
Term
If uncertain about why BUN is elevated, look at the ___ __. If the ratio is ___ than ___, it means you have __ ___ __ to the kidneys, so the kidneys are __.
Definition
- BUN:Cr ratio
- greater than 20:1
- decreased blood flow
- kidneys are fine
Term
Creatinine is a waste product produced in your __ from the breakdown of ____. It is created at a ___ rate and all is __ and __ by the kidneys.
Definition
- muscles
- creatine
- constant rate
- filtered and excreted
Term
Doubling of creatinine represents __ ___ in ___.
Definition
- 50% decrease in GFR
Term
If the creatinine has doubled, the GFR is ___.
Definition
halved

BAD
Term
If the kidneys are not functioning well, the creatinine will be ___.
Definition
elevated
Term
Glomerular Filtration Rate (GFR) is the amount of blood filtered by the __ per ___.
Definition
glomeruli per minute
Term
A blood test can estimate GFR using the patient's __ __, __, __, and __.
Definition
- serum creatinine
- age
- sex
- race
Term
Best test to measure kidney function:
Definition
GFR
Term
Best test to determine stage of kidney disease:
Definition
GFR
Term
GFR less than __ for __ or more months is considered chronic kidney disease.
Definition
- less than 60
- 3 or more months
Term
There are __ stages of chronic kidney disease (CKD) categorized based on __.
Definition
5
GFR
Term
Patients with a GFR less than or equal to __ should see a nephrologist.
Definition
30
Term
Any kind of kidney damage lasting for 3 or more months, even when normal kidney function is considered:
Definition
chronic kidney disease
Term
GFR DOES NOT COME ON BMP OR CMP- HAVE TO ORDER IT SEPARATELY IF YOU WANT IT
Definition
Term
Cr and BUN are part of CMP and BMP, but GFR is NOT.
Definition
Term
Used to evaluate rate and efficiency of kidney filtration:
Definition
Creatinine Clearance
Term
For our purposes Cr Clearance is the same thing as __.
Definition
GFR
Term
Cr clearance is amount of creatine cleared from blood in a given time, but almost all cr gets cleared from blood, so if you’re measuring how much gets cleared you are basically measuring GFR.

With GFR and Cr Cleareance, you don’t randomly order these, order these if you suspect kidney problems.
Definition
Term
The amount of creatinine cleared from the body depends on the ___ at which __ is carried to kidneys and its __ of the glomeruli to __ that blood.
Definition
- rate at which blood is carried
- effectiveness of the glomeruli to filter that blood
Term
Cr clearance can be affected when something has damaged the __ preventing them from filtering properly or when there is __ in blood to the kidneys.
Definition
- glomeruli
- decreased
Term
Urine test that measures amount of albumin excreted:
Definition
Microalbumin
Term
Healthy kidneys do not excrete albumin
Damaged kidneys can allow albumin to leak into the urine
Definition
Term
Microalbumin:
Definition
30-300 mg albumin/ L urine
Term
Albuminuria:
Definition
greater than 300mg/L urine
Term
Microalbumin/Cr ratio compares amount of albumin in urine to amount of Cr in urine. The body creates Cr at a constant rate, this allows you to tell if body is excreting albumin at increased rate.
Definition
Term
KUB:
Definition
- plain film of kidneys, ureters, and bladder
- size and position of kidneys
- may see calcifications and stones with calcium
Term
Excretory Urography is used to outline the __ __.
Definition
- collecting system
- give pt IV contrast or injected contrast into bladder- it will highlight renal pelvises and ureter and bladder, can show blockages, this isn’t done very often
- mostly been replaced by ultrasound, CT, and MRI
Term
Voiding cystourethrogram- through a catheter, insert contrast into the bladder and then take films as they urinate, and as they urinate it should come out through urethra, but do this test to check for reflux of urine back up into ureters and kidneys (this can cause infections)
Definition
Term
Phlebolith is a calcification in a __ that may confused with a ureteral stone. A phlebolith has __ edges with a central __. Phlebotliths are usually closer to the ___ of the pelvis than ureteral stones would be.
Definition
- vein
- round
- translucencny
- margin

(these are not dangerous and benign)
Term
Ureteral stones have __ edges and are in the ___, which lies closer to the __ of the pelvis.
Definition
- jagged
- ureters
- center
Term
IVP: intravenous pyelogram. Take films as contrast going through. Here the stone is blocking the contrast flow.

These are done when something doesn't get better in a reasonable amount of time.
Definition
Term
What test besides CT or MRI could you use to assess renal blood supply?
Definition
angiography (largely replaced by CT and MRI)
Term
What would you use to assess kidneys, prostate, testis, and penis?
Definition
ultrasound
Term
what would you use to assess bladder?
Definition
cystoscopy
Term
used to detect renal mass (cystic vs. solid), might show engorgement of calcices due to obstruction of ureter:
Definition
Renal ultrasound
Term
Bladder Ultrasound
Bladder volume
Wall thickness
Bladder calculi
Bladder tumors
Definition
largely replaced by cystoscopy
Term
Used to assess testicular inflammation, inguinal hernia, and testicular torsion:
Definition
- ultrasound of tesis- excellent resolution, good for assessing masses and blood supply
Term
Used in evaluation of flank pain, hematuria, infection, trauma, and to characterize and stage carcinoma?
Definition
Renal CT
Term
Should you use contrast with renal CT if you think they have a stone?
Definition
no
Term
would you use contrast with renal CT if suspected renal carcinoma?
Definition
yes
Term
Used in bladder tumor staging and to assess for bladder rupture following trauma?
Definition
Bladder CT
Term
CT Also useful in evaluation of prostate CA, undescended testes, lymph nodes (cancer spread), renal vasculature, etc.
Definition
Term
Uses of MRI in GU:
Definition
- congenital abnormalities
- renal vein thrombosis
- cancer staging
- characterize adrenal tumors
Term
Used to evaluate hematuria when considering bladder tumor?
Definition
cystoscopy
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