Exam 4: Urinary

Question 1

What is the most common urinary tract infection? The most common bacterial cause?

Answer 1

• Most common UTI is bacterial

* Most common bacterial cause: E. coli; also Proteus, Klebsiella, Enterobacter, Serratia, Staphylococcus

Question 2

What are risk factors for UTIs?

Answer 2

• Urinary obstruction and/or reflux
• Pregnancy
• Female > males
• Elderly
• Sexually active, esp. women
• Diabetes
• Poor hygiene
• Invasive procedures/instruments
• Immunosuppression
• Upper urinary tract obstruction

Question 3

Describe acute vs chronic pyelonephritis.

Answer 3

• Pyelonephritis- infection of kidneys and renal pelvis
• Acute
o Predisposing factors: catheters and instruments, reflux, pregnancy, increased susceptibility to infection, neurogenic bladder
o S/Sx.: abrupt onset with chills and fever, headache, lower back pain with CVA tenderness, general malaise with urinary frequency, urgency and dysuria
• Chronic
o Chronic, progressive condition
o Severe hypertension- contributing factor, leads to scarring and deformation of kidneys
o Manifestations similar to acute pyelonephritis

Question 4

Describe anatomic vs functional urinary obstructions. What is the most prevalent cause of urinary obstruction?

Answer 4

• Anatomic – calculi, BPH, pregnancy

* Functional- neurogenic bladder, infrequent voiding, detrusor muscle instability, constipation

Question 5

Define the 4 types of renal calculi and conditions leading to their formation.

Answer 5

• Most common cause of obstruction
• Magnesium Ammonium Phosphate Stones- form in alkaline urine and in presence of bacteria with enzyme urease
• Uric acid stones: form with increased concentration of uric acids (gout)
• Cystine stones- rare, genetic defect

Question 6

What is a neurogenic bladder? Name conditions leading to a neurogenic bladder.

Answer 6

•	Neural control of bladder interrupted
•	Etiology:
o	Stroke
o	CVA
o	Spinal cord lesions or injury
o	Diabetic neuropathies, multiple sclerosis, Parkinson’s 
o	Surgery

Question 7

Describe renal and bladder cancer including the common manifestations of each.

Answer 7

•	Bladder Cancer
o	Pathophysiology 
	Not completely understood
	Carcinogens causing changes of urothelium cells that line bladder
o	Clinical manifestations
	Painless hematuria
	Occasional urinary frequency, urgency and dysuria
•	Renal Cancer
o	Type of kidney cancer beginning in lining of tubules in kidney
o	Exact cause is unknown
o	Clinical manifestations:
	Abdominal pain and swelling
	Back pain
	Hematuria
	Swelling of veins around testicle
	Flank pain
	Weight loss
	Excessive hair growth in females
	Pale skin
	Vision problems

Question 8

What is BPH and what are the consequences of BPH?

Answer 8

•	Benign Prostatic Hyperplasia
o	Prostate gland enlargement
•	Consequences
o	acute urinary retention
o	urinary incontinence
o	UTI
o	Prostatitis
o	Hydronephrosis
o	Erectile dysfunction

Question 9

Define the 4 types of prostatitis.

Answer 9

• Acute bacterial – ascending bacteria up urethra; urinary reflux into prostate ducts
• Chronic bacterial- subtle disorder of recurrent UTIs
• Chronic prostatitis- inflammation without infection, may be autoimmune disorder OR noninflammatory symptoms of nonbacterial prostatitis but no inflammation of prostate
• Asymptomatic inflammatory prostatitis

Question 10

Describe the etiology, risk factors, diagnostic exams, and manifestations of prostate CA.

Answer 10

•	Etiology
o	Unclear
o	Thought to be involving genes that control cell differentiation and growth
o	Theories of hormonal influence- androgens
•	Risk factors
o	Family history- esp. 1st degree relative
o	Increasing age
o	African American 
o	Dietary influence- high fat
•	Manifestations
o	May be asymptomatic
o	Prostate feels hard upon rectal exam
o	Acute urinary retention
o	Hematuria
o	UTI
o	Anemia
o	Back/hip pain radiating to testicular area
o	Lymphedema
o	Lymphadenopathy
•	Diagnosis
o	Surgery
	TURP
	Radical prostatectomy
	Radiation seed therapy
	Watch and wait
	Chemotherapy
	Estrogen therapy