PBL: Nephrotic syndrome

Keywords 5 y/o boy progressive swelling of lower limbs & puffy face (2 weeks) swelling of abdomen (1 week) Frothy urine easily tired, breathless on exertion examined by doctor: generalised oedema, hydrothorax, ascites, gross pitting pedal oedema CVS normal Hb low Urea & creatinine normal Serum albumin low Alkaline transaminase & alkaline phosphatase normal Urinalysis:…

Anatomy of the urinary tract – Part 2

Recap of the previous post : Location of the kidney coverings of the kidney muscles that are clinically related (quadratus lumborum etc) transpyloric plane – hilum differentiate kidney/splenic swelling (refer clinical notes) histology PCT, DCT –> difference in microscopic structure Surgical relations Left kidney Behind stomach lesser sac Infront left kidney : pancreas, splenic artery,…

PBL: End Stage Renal Disease

Theme: Love my cheesecake but hate my injections Keywords: 37 y/o woman visited nephrologist history of diabetes (since 15) & started on insulin injections (type 1) history of hypertension(2 years) & under control with Atenolol (B-blocker) Non compliant with her diet, insulin injections & doctor visits worried that might end up like mother with end…

Online Quiz – Tryout

Hey Yo! I’m trying out this online quiz app that might improve my revision. Absolutely great if you’re pressed for time, attempt the questions to refresh your knowledge and you will find that online quizzes are infact active learning. You’re bound to remember something easier when you’ve been asked (no matter whether you’ve got it…

Anatomy & Histology of the Urinary Tract

Important things to cover Gross anatomy of the kidney Surface anatomy Parts Clinically important relations Coverings of kidney Structures at sagittal section of kidney Blood supply of kidney Microscopic structure of the kidney Gross & microscopic structure of the ureter, urinary bladder & urethra Histology is important (look for atlas of histology) _____________________________________________________________________________________________ Basic anatomy…

Development of urinary tract & common abnormalities

Evolution of Kidney Development (3 stages) Note the image: pronephric system are at the superior (cervical region) portion, mesonephric system at the middle portion and the metanephric system at the inferior (sacral region) portion of the embryo) Mesonephric duct opens into the urogenital sinus. Yellow: endodermal (gut) Blue: intermediate mesoderm (kidney & genital) Each vertebrate’s…

PBL: Gigantism

Keywords: 12 year old student growing too tall too quickly (193cm) height increase last 2 years: 45cm gaining weight too excessively (over 150kg) occasional frontal headache (mass effect) need to pass urine frequently (too much AVP) visual acuity reduced High fasting blood sugar level High serum IGF-1 level High serum GH level High prolactin (stalk…

Tumours of the adrenal gland – Adrenal medulla

Pheochromocytoma Also known as: paraganglioma, chromaffinoma Intra-adrenal sympathetic paraganglioma Sporadic lesions: tend to be unilateral Familial lesions: tend to be bilateral 1.4-18% are incidentalomas Co-exist with extra-adrenal paragangliomas (can also occur outside adrenal medulla) Rule of 10 Pheochromocytoma associated genetic syndromes: Multiple Endocrine Neoplasia (MEN) type 2 Von-Hippel-Lindau (VHL) syndrome Neurofibromatosis (NF) type 1 Hereditary…

Tumours of the Adrenal Gland –Adrenal Cortex

OSPE: Refer histoloy of adrenal gland to identify the zones. TUMOURS OF THE ADRENAL CORTEX Adenoma Adenocarcinoma Adenoma Adenocarcinoma (malignant) Rare Hormonal symptoms (depending on the hormone hypersecretion) Virilization Hyperaldosteronism, Cushing’s Association with Li-Fraumeni syndrome (rare autosomal dominant hereditary disorder) Carney complex (autosomal dominant) CT scan. White: bone MRI. Bone is not white. _____________________________________________________________ Adrenal…

Adrenal Disorders – Congenital Adrenal Hyperplasia

It is an autosomal recessive syndrome: Insufficient cortisol syntesis Increased ACTH production –> increases cortisol to maintain circulating levels Stress cortisol – inadequate Mineralocorticoid synthesis affected 21 beta-hydroxylase deficiency & 17 alpha-hydroxylase deficiency for steroid hormone production 21 beta-hydroxylase deficiency: (refer diagram) Coding gene at chromosome 8 Mineralocorticoid defect results in hyperkalemia, hyponatremia & low…