19-4 Flashcards
presence of blood in the urine, may not be visible to the eye, may be microscopic
Hematuria
blood in the urine, visible to the naked eye
gross hematuria
upper urinary tract source includes
kidneys and ureters
lower tract source includes
bladder and urethra
Microscopic hematuria in the male is most commonly from
benign prostatic hyperplasia
Initial hematuria, the presence of blood at the beginning of the urinary stream that clears during the stream, implies
anterior (penile) urethral source
Terminal hematuria, the presence of blood at the end of the urinary stream, implies
bladder neck or prostatic urethral source
Total hematuria, the presence of blood throughout the urinary stream, implies
bladder or upper tract source
Hematuria associated with renal colic suggests
ureteral stone
Irritative voiding symptoms in a young woman may suggest
acute bacterial infection and associated cystitis
absence of other symptoms, gross hematuria may be more indicative of…
tumor
Proteinuria and casts suggest…
renal origin
Irritative voiding symptoms, bacteriuria, and a positive urine culture in the female suggest…
urinary tract infection
responsible for most Urinary tract infections
Coliform bacteria
most common Coliform bacteria for UTI
E. coli
most common route of UTI
Ascending infection from the urethra
most uncommon route of UTI
Hematogenous spread to the urinary tract
Tx for Acute Cystitis
- Nitrofurantoin (Macrobid)
- Trimethoprim/sulfamethoxaz (Bactrim)
- Ciprofloxacin
- & Phenazopyridine (Pyridium)
Women who have more than how many episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy?
3
3 most commonly used oral agents for prophylaxis are:
1) Trimethoprim-sulfamethoxazole
2) Nitrofurantoin
3) Cephalexin
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis.
Pyelonephritis
what are the most common causative agents of Pyelonephritis?
Gram-negative bacteria
- Fever
- Flank pain
- Irritative voiding symptoms (urgency, frequency, dysuria)
- Rigors
- Nausea and vomiting
- Diarrhea
- Tachycardia
- CVA tenderness
S&S of Pyelonephritis
Treatment for Pyelonephritis
- Ampicillin & Gentamicin
- Ciprofloxacin
- Levofloxacin
- & Phenazopyridine (Pyridium)
Inflammation and infection of the prostate gland
Acute Prostatitis
Acute Prostatitis is usually caused by
gram-negative rods
E coli and Pseudomonas species
- Warm and often exquisitely tender prostate is detected on examination
- Perineal, sacral, or suprapubic pain
- Fever
- Irritative voiding symptoms
S&S of Acute Prostatitis
Tx for Severe Prostatitis
- Ampicillin & gentamicin
- 4-6 week course of therapy
Tx for Acute Prostatitis
- Ciprofloxacin (Cipro)
- Levofloxacin (Levaquin)
- Acetaminophen/NSAIDS
Chronic Bacterial Prostatitis
- Irritative voiding symptoms
- Low back and perineal pain
- Suprapubic discomfort
- Hx of UTIs
- Abnormal prostatic secretions
Tx for Chronic Bacterial Prostatitis
- Trimethoprim-sulfamethoxazole (Bactrim)
- Ciprofloxacin/Levofloxacin
- NSAIDS
- Sitz bath
- following heavy lifting, trauma, or sexual activity
- pain in the scrotum, radiates along spermatic cord or to the flank
- Fever
- Irritative voiding sx
- Scrotal swelling
- elevation of the scrotum improves pain
Epididymitis
Tx for Sexually transmitted Epididymitis
- Ceftriaxone (Rocephin)
- PLUS Doxycycline
Tx for Non-sexually transmitted Epididymitis
- Trimethoprim/sulfamethoxazole (Bactrim)
- Ciprofloxacin (Cipro)
- Levofloxacin (Levaquin)
- NSAIDS
- colicky stabbing ipsilateral flank pain
- severe localized flank pain
- nausea & vomiting
- occurs suddenly
- constantly moving to find comfortable position
- pain radiates over abdomen, referred to ipsilateral groin
Renal Calculi
Tx for Renal Calculi
- Alpha-blockers Tamsulosin
- NSAIDS
- Prednisone
Prevention for Renal Calculi
- Dietary mods:
- increase water intake
- decrease salt
- decrease protein intake
Tx for Erectile Dysfunction
- Phosophodiesterase-5 inhibitor:
- Sidenafil (Viagra)
- Vardenadil (Levitra)
- Tadalafil (Cialis)
Most common benign tumor in men and its incidence is age related…
Benign Prostatic Hypertrophy
At age 55, approximately what % of men report obstructive voiding symptoms?
25%
At age 75, what % of men report decrease in the force and caliber of the urinary stream?
50%
- obstructive or irritative voiding sx
- may have enlarged prostate on DRE
- sensation of incomplete bladder emptying
Benign Prostatic Hypertrophy
Labs for Benign Prostatic Hypertrophy
Prostate specific antigen test (PSA)
Tx for Benign Prostatic Hypertrophy
- AUA less than 7 watchful waiting
- Alpha-blocker (Tamsulosin)
- 5-alpha-reductase inhibitors (Finasteride)
- Phosphdiesterase-5 inhibitors (Tadalafil)
When should you refer Benign Prostatic Hypertrophy?
AUA score < 7
Most common non-cutaneous cancer in American men and second leading cause of cancer related death in men.
Prostate Cancer
3 Common Risk factors of Prostate Cancer:
- African-American
- FMHx Prostatic Cancer
- Hx of high dietary fat intake
- Prostatic firmness on DRE
- Asymptomatic
- May have systemic sx
Prostate Cancer
what % of men with 4.1 - 10 ng/mL will be found to
have prostate cancer?
8 - 30%
what % of men with <10 ng/mL will be found to have prostate cancer?
50% - 70%
what is the standard method for detection and confirmation of prostate cancer?
Transrectal ultrasound guided biopsy
Prostate specific antigen testing baseline at what age?
50 y/o
Prostate specific antigen testing w/ risk factors at what age?
40-45y/o
3 Common Risk factors for Prostate Cancer:
- African American male
- FMhHx of Prostate Cancer
- BRCA1 or BRCA2
Tx for Prostate Cancer
- Active surveillance
- Prostatectomy
- Radiation therapy
Tx for Scrotal Trauma
- Blunt or Penetrating refer to Urology
- Lacerations or avulsions can be repaired by IDC
Necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissues of the perineum often involving the scrotum.
Fournier’s Gangrene
- Pain out of proportion to exam
- tense edema
- fever
- scrotal, rectal, or genitalia pain
- abscess
- crepitus
Fournier’s Gangrene
Tx for Fournier’s Gangrene
- Ertapenem
- Fluids
- MEDEVAC
- dilation of the pampiniform plexus of spermatic veins, generally left sided
- Usually asymptomatic mass, separate from testis
- Feels like “bag of worms”
- Size increased by Valsalva maneuver.
Varicocele
- Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord
- Gradually enlarging painless cystic mass
- Transilluminates
Hyrdocele
- fluid filled cyst at the head of the epididymis that may contain nonviable sperm.
- Painless
- Palpated as distinct from the testis
- Typically transilluminates as cystic in nature
Spermatocele
diagnostic imaging of choice for scrotal and testicular abnormalities
Ultrasound
- Age 20-35 years
- Painless enlargement of the testes
- Sensation of heaviness
- Diffuse testicular enlargement
- Sensation of heaviness
Testicular Cancer
If you suspect a patient has a testicular tumor, you can run a…
urine hCG
Tx for Testicular Cancer for Diagnosis is made by…
inguinal orchiectomy
- Acute onset
- constant unilateral groin pain
- occurs after trauma or spontaneously
- unrelieved w/ elevation
- common in young adults
- nausea and vomiting
Testicular Torsion
Tx for Testicular Torsion
- Manual detorsion
- MEDEVAC if doesn’t detorse manually
- Fibrous constriction of the foreskin preventing retraction
- Can be the result of Balanitis, Balanoposthitis
- May cause urinary retention
Phimosis
Tx for Phimosis
- Foley catheter/Suprapubic catheterization
- Good hygiene
- Topical antifungal: Clotrimazole, Miconazole
Urologist can perform what to temporize Phimosis?
dorsal slit circumcision
Definitive treatment for Phimosis?
complete circumcision
- True Urologic emergency
- fixed constricted foreskin
- swollen and painful
- gangrenous
- urinary retention
Paraphimosis
Tx for Paraphimosis
- compress the glans 5-10min
- 2in elastic band for 5min
- icing area
- dorsal slit
- circumcision
increase in serum creatinine is characterized as…
Acute Kidney Injury
AKI can be divided into 3 categories:
- Prerenal
- Instrinsic kidney disease
- Postrenal
what AKI is (low blood flow or pressure)?
Prerenal
what AKI is (Obstructive)?
Postrenal
MOST common etiology of AKI is…
Prerenal
Most common electrolyte abnormality in hospitalized patients?
Hyponatremia
Hyponatremia is defined as serum sodium concentration less than
135
Tx for Hyponatremia
- Restriction of free water
- Dehydrated patient
- Lethargy
- Irritability
- Weakness
Hypernatremia
Hypernatremia is defined as serum sodium concentration more than…
145
Hypokalemia is defined as serum potassium concentration less than…
3.5
Severe hypokalemia may induce…
arrhythmias and rhabdomyolysis
- Muscular weakness, Fatigue, Muscle cramps
- Flaccid paralysis
- Hyporeflexia
- Hypercapnia
- Tetany
- Rhabdomyolysis
Hypokalemia
The most common cause of hypokalemia is…
gastrointestinal loss from infectious diarrhea
- Muscular weakness
- Fatigue
- Muscle cramps
- Flaccid paralysis
- Hyporeflexia
- Hypercapnia
- Tetany
- Arrhythmias
- Rhabdomyolysis
Hypokalemia
Hypokalemia will show what on EKG?
ST depression
Tx for Hypokalemia
- Oral potassium supplement
Hyperkalemia is defined as serum potassium concentration greater than…
5.0
what meds cause Hyperkalemia?
- ACE inhibitors
- Angiotensin receptors
- Potassium diuretics
- Muscle weakness
- Flaccid paralysis
- Ileus
Hyperkalemia
Hyperkalemia will show what on EKG?
Peaked T waves
V-Fib
Tx for Hyperkalemia
- withholding potassium
- insulin, bicarbonate, and beta-agonists
- Hemodialysis chronic kidney injury
- Loop diuretics: Furosemide
