General Flashcards
How many days should uncomplicated UTI be treated for ?
3
How many days should a complicated UTi be treated for
7
What medication is used to tx pyleonephritis
-IV coamoxiclav +/- gent
+ fluid resus +/- drainage of obstructed kidney
List which Pt are considered to have complicated UTIs
Male Pregnant Children Catheterised Recurrent / persistent Urosepsis
What two factors are contraindications to nitrofuratoin in uti tx
Third trimester
Poor renal function
What are the causes of pyleonephritis
Ascending - catheter / intercourse
Heamatogenous
Lymphatic
What microorganisms can be responsible for UTIs
Ecoli (common - coliform , gram -ve bacillus , pink on McConkey agar)
Klebsiella - catheter aq
Proteus - associated with renal stones
Signs and symps of pyleonephritis
Lion pain
Pyuria
Pyrexic
RA tenderness
Would you treat assymptomatic 65+
No
Complications of catheters
Chronic inflam
UTIs
Renal stones
Investigations for pyleonephritis
Bloods + culture
MSU
Abdo exam -RA tenderness , exclude tubular, ovarian, appendix
USS
When should urolithesis be surgically removed?
Coexisting obstruction
Sepsis
What is the management of urolithesis confirmed by CT
Nsaids
Antiemetics
Hydration
(Alpha blocker ie, tamsulosin)
Differentials for renal colic
Bilary colic Chloecystitis Peritonitis Appendicitis Endometriosis
Investigations for renal colic
CT
Urinalysis
Bloods- FBC, U&E, Cr
Pregnancy test
Surgical treatment for urolithesis
Retrograde stent
Percutaneous nephrostomy
Shockwave lithrotripsy
Causes of heamaturea
UTI Acute pyleonephritis Bladder cancer Prostate cancer BPH Renal colic Mensuration Recent instrumentation of the urinary tract
Two factors that progression of CKD to ESRF relies on
Bp control
Underlying nephropathy
Causes of CKD
Primary Glomerulonephritis Atherosclerotic vascular disease PKD Progression from AKI SLE 20% idiopathic
RFs for CKD
Female Age Hypertension Diabetes Smoking AKI Chronic use of NSAIDs
What does GFR have to be below for CKD
<60ml/min (G3)
Complications of CKD and why
Anaemia (herceptin is not excreted so Fe cannot be absorbed from duo)
Heart failure due to fluid overload
5 kidney functions
Nitrogenous waste excretion Fluid electrolytes balance Vitamin D metabolism RBC production (erythropoietin synth) Acid base balance (metabolic compensation)
4 nephrotixic drugs
Metformin
NSAIDs
Acei
Diuretics
Treatment for stress incontinence
Pelvic floor exercises
Colposuspension/ sling surgery
Treatment for overflow incontinence
Tamsulosin
Intermittent catheterisation
Tx for OAB/ urge incontinence
Bladder training
No caffeine or alcohol
Distraction techniques
Antimuscarinics - oxybutanin / tolterodine
Botox injections
Tx of nocturia
Desmopressin
Two components of urodynamics
Flow rate+ residual volume
freq volume chart
2 causes of low flow rate
Detrusor under-activity
Obstruction
Parasympathetic innervation of voiding
- nerve roots
- function
S2-s4
Detrusor contraction.
Sympathetic innervation of voiding
- nerve roots
- function
T10-L2
Contraction of sphincter, inhibits detrusor contraction
Complications of BPE
Stones Infections Incontinence Retention Symptomatic voiding
Two components of BPH
Static - glandular and Stromal hyperplasia and-hypertrophy
Dynamic - sm contraction of prostrate
Incontinence investigations
Bloods- PSA, renal func
PR, abdo, genital exam
Urodynamics
MSU
BLADDER SCAN
TRUSS / flexible cystoscopy
What is the scoring system used for BPH
IPSS
International prostate scoring system
What is the normal post void residual volume
<12mls
What might you see on USS with a post mic residual volume of >250mls?
Hydronephresis- dilated ureters
What are the treatments for BPH and their SE/ complications
Finesteride tackles the static component - 5alpha reductase inhibitor - SE ED
Tamsulosin tackles the dynamic part - alpha adrenergic antagonist -SE postural hypotension, retrograde ejac
TURP- infection, haemorrhage, clots, ED
What is the surgical criteria forTURP?
RUSHES
Retention UTI Stones Heamaturia Elevated Cr Symptoms worsening
What is chronic retention+ low pressure a sign of
Detrusor failure
Pharma Treatment for HfrEF
Class 1- ACEI +Beta blocker
Class 2- above / ARB+ aldosterone antagonist
Class 3 - above + isosorbide dinitrate
Class 4- diuretic
None pharma tx of HFrEF
Refer to advanced HF programs
Refer for possible pacemaker
Tx of HFpEF
Blood pressure control
Symptom management I.e. diuretics for breathlessness
Treatment algorithm for hypertension
ACD <55: A A+Cor D A+C+D A+C+D+ MCRA(spirolactone) >55: C or D A2 / A+ C A+C+D
Secondary causes of hypertension
Coarctation of the aorta
OCP
Low K+ (underlying Cohns)
Vascular / congenital abnormalities
Renal artery stenosis - increased serum Cr
Thyroid disorder
Aldosteronism (sign= hypocalemia)
Iatrogenic drugs- sertoids, immunoSs, TCAs,
Lifestyle changes in hypertension
Low Na diet Reduce alcohol Stop smoking. Exercise Wt reduction
What is considered stage 2 hypertension
160-179/ 100-109
What stages of Hypertension do you treat
Stage 2+ or stage 1 if diabetic/ CVA / Hf/ renal probs
What symptom+sign in addition to Hx of hypertension requires admission
Headache
Papillodema
Hypertension investigations
ABPM ECG Urine Dip - ACR , protein/ blood fundoscopy Bloods= hba1c, LFTs , Cr U&E (end organ damage)
Name two thiazide diuretics
Bendroflumethiazide.
I dap Amie’s
SE of ACEi
Dry cough
Detrimental on Renal function, check this before starting in elderly
SE of amlodipine
ankle swelling
SE of diuretics
ED!
Thiazide diuretics can cause hyponatremia in the elderly
