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Medicine Notes Medicine and Surgery Notes

Urology Notes

Updated Urology Notes

Medicine and Surgery Notes

Medicine and Surgery

Approximately 143 pages

Theses are my latest set of notes for my first year as a clinical medic, complementing the 3rd year curriculum perfectly. Each topic is briefly but thoroughly covered with clear headings and colour co-ordination.

The notes use a great mix of words and diagrams in an eye-pleasing layout making revision easier for you with plenty of space to annotate.

Each system is clearly marked and most of the core diseases are covered and broken down into prevalence, aetiology, clinical features, managemen...

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The following is a more accessible plain text extract of the PDF sample above, taken from our Medicine and Surgery Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

GFR = KS [(PGC – PT) – ( π GC - πT)]

K = permeability of glomerular membrane

in nephrotic syndrome. Leads to GFR

S = surface area of glomerular membrane

when a kidney is removed; effective surface area falls if there is reduced renal blood flow (e.g. through partial blockage of a renal artery). Both situations lead to GFR

PGC = hydrostatic pressure in glomerular capillaries

when systemic blood pressure falls or when blood is diverted away from kidney. Leads to GFR (and vice versa)

PT = hydrostatic pressure in tubule (i.e. Bowman’s capsule)

if a blockage exists in renal tubules; e.g. kidney stone; tumour in, or close to, kidney. Leads to GFR because of ‘back pressure’

πGC = colloid osmotic pressure (C.O.P.) in glomerular capillaries

in nephrotic syndrome, liver disease, malnutrition. All lead to GFR

π T = C.O.P. in tubular fluid

in nephrotic syndrome. Leads to GFR

Type of Diuretic Example Site of Action Mechanism of Action Route of Administration Indications Contraindications Adverse Effects
Loop

Furosemide

Bumetanide

Torasemide

 Thick ascending segment of loop of Henle

Inhibits Na+/K+/2Cl+ co-transporter

Increasing the amount of sodium reaching the collecting duct

Increases K+ and H+ secretion

Oral

IV

Intramuscular

Acute pulmonary oedema

Oliguria due to acute renal failure

Hypertension

Severe renal impairment

Cardiac glycosides

Hypokalaemia

Hyponatraemia

Hyperuricaemia

Hypotension

Hypovolaemia
Thiazide

Chlorothiazide

Bendroflumethazide

Metolazone

 DCT

Inhibits Na+/Cl- transport

Increases K+ and H+ secretion and decreases Ca2+ excretion

 Oral 1-2 hours

Hypertension

Oedema secondary to CHF

Liver disease

Nephrotic syndrome

Hypokalaemia

Hyponatraemia

Hypocalcaemia

Cardiac glycosides

Diabetes mellitus, may cause hyperglycaemia

Hypokalaemia

Hyponatraemia

Hyperuricaemia

Hypercalcaemia
K+-sparing

Spironolactone

Amiloride

 Collecting tubules

Aldosterone antagonist, competing for receptors

Increase Na excretion

Decrease K & H excretion

 Oral

Managing heart failure

Hypertension

Maintain normal serum potassium levels

ACE inhibitors

Renal failure

GI disturbances

Hyperkalaemia

Hyponatraemia

Gynaecomastia
Type of Diuretic Example Site of Action Mechanism of Action Route of Administration Indications Adverse Effects
Carbonic anhydrase inhibitors Acetazolamide Proximal convoluted tubule Inhibits carbonic anhydrase Oral

Glaucoma

Prevention of altitude sickness

Drowsiness

Paraesthesias

Renal stones

Hypokalaemic
Osmotic diuretics Mannitol Tubules Poorly reabsorbed from the tubule and so holds water in the lumen by osmosis Oral

Reduces intracranial pressure

Haemolysis

Rhabdomyolysis

Hyponatraemia

Pulmonary oedema

Headache

N & V

Urinary tract infection

Lower UTI: urethritis, cystits, prostatitis

Upper UTI: pyelonephritis

  • Uncomplicated – normal renal tract function

  • Complicated – abnormal renal tract, voiding difficulty/ outflow obstruction

Glomerulonephritis

Common cause of end stage renal failure with diabetes & HTN

Damage to the glomerular filtration barrier causes a leak of protein +- blood into the urine

Nephritic syndrome – pores are large enough to allow blood & protein through

Nephrotic syndrome – pores only allow protein through

  • IgA nephropathy

    • Most common

    • Macro- or microscopic haematuria

    • Young male with haematuria after URTI

  • SLE

    • 1/3 patients will present with renal involvement

  • Anti-glomerular...

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