General Genitourinary History Flashcards
Name all questions in presenting complaint? (14)
- “How many times a day do you have to pass water on average?”
- “How many times do you have to get up at night to pass water?”
- “Do you feel you are passing more water than usual or do you just have to go more often?”
- “Do you find that when you get the urge to pass water, you have to rush to the toilet?”
- “Are you ever incontinent of urine?”
- “Is it painful to pass water? Any burning or stinging?”
- “Have you ever noticed blood in the urine?”
- “Do you have difficulty in starting to pass water?”
- Have you noticed a decrease in size of the stream?”
- “Do you ever get terminal dribbling?”
- “Do you have any suprapubic or loin pain?”
- “Have you had a fever or have you been shivering rigorously?”
- “Have you any history of headache, vomiting, fits drowsiness or peripheral oedema?”
- “Have you noticed any weight loss?”
What is needing to urinate more often than normal called?
Frequency
What is frequency due to?
Can be due to bladder being irritable, less compliant or due to bladder outflow obstruction.
What is it called when you’re passing more water than usual? What can it be due to?
Polyuria.
Polyuria can be due to ingestion of large volumes of fluid (especially alcohol), inability to concentrate the urine (CKD, hypercalcaemia or diabetes insipidus), DM or diuretics.
What is urgency a sign of and when can it occur?
Urgency is a sign of an unstable bladder. Can occur during UTI, bladder cancer or bladder irritability.
Two types of urinary incontinence? Describe the two?
Urge incontinence is characterised by urgency and frequency and is due to detrusor instability. Can be motor (where the urge to urinate before the bladder is full is due to an abnormality of the motor system, such as MS) or sensory (where irritation is making the bladder unstable).
Stress incontinence is where leakage occurs in response to increased abdominal pressure (coughing, laughing, sneezing) without contraction of detrusor. Damage to bladder neck supports during childbirth and stretching of ligaments during pregnancy predispose to stress incontinence.
Which question assesses whether dysuria is present?
- “Is it painful to pass water? Any burning or stinging?”
Most common cause of dysuria?
Cystitis. Can also be caused by stones and bladder cancer.
Three questions to assess voiding problems?
- “Do you have difficulty in starting to pass water?” HESITANCY
- Have you noticed a decrease in size of the stream?” POOR STREAM
- “Do you ever get terminal dribbling?” TERMINAL DRIBBLING
What are voiding symptoms a sign of?
Bladder outflow obstruction, usually a sign of enlarged prostated.
Associated symptoms of voiding problems?
Frequency and nocturia.
Causes of suprapubic or loin pain?
Pyelonephritis causes pain and tenderness in the renal angles, usually in association with urinary symptoms and systemic illness.
Renal stones can cause loin pain.
Ureteric stones can cause colicky pain radiating from loin to groin. This is an intense pain associated with nausea, vomiting and sweating.
Bladder stones cause dull suprapubic discomfort associated with dysuria and frequency.
When would pyrexia and rigors occur and why is this significant?
Pyelonephritis. Can progress to gram -ve septicaemia and is an emergency.
Signs of uraemia?
Headache, vomiting, fits, drowsiness, peripheral oedema.
What is weight loss a sign of?
Malignancy.
