GU conditions Flashcards
UTIs (women) Common causative organisms Risk Symptoms Diagnosis Treatment
Klebsiella pneumoniae (catheter ass.)
Escherichia Coli (moct common)
Enterococcal species
Proteus species
Staphylococcus species (haematogenous spread from spepsis)
Risk: female, sexual intercourse, catheters, diabetes mellitus, obstruction
Symptoms: dysuria, haematuria, frequency, urgency - fever/systemic symptoms/loin/renal angle pain if pyelonephritis (kidney infection)
Diagnosis: midstream urine dipstick shows leukocytes and nitrites, if uncomplicated (eg individual not pregnant/man/child/immunocompomised/recurrent) no culture needed and 3 day course antibiotics. If complicated send for culture, 7 day antibiotics
Treat:
uncomplicated, lower: 3 day nitrofurantoin/trimethoprim. Upper: 7+ dose co-amoxiclav
complicated = longer course, IV, MSU sent for culture
Urethritis
symptoms
diagnose
treat
Infection of the urethra
Can be gonoccocal (sexually transmitted) or non-gonoccocal (UTI)
Common complaint in men.
Usually symptomless in women - can cause dysuria, discharge, pain
Swab test + urine test performed
STI: from chlamydia (treat with azithromycin) or gonorrhoea (ceftriaxone + azithromycin)
UTI: nitrofurantoin/trimethoprim
Complications: reactive arthritis, epididimo-orchiditis
Prostatitis cause diagnose symptoms treat
Infection of the prostate
perform DRE, MSU for culture, STI screen, urine dipstick shows leukocytes and nitrites
Usually caused by STI/catheter
Systemically unwell, voiding LUTS (straining, hesitancy, intermittent stream, incomplete emptying, post micturition dribble, haematuria, dysuria)
Differentiate BPH, prostate cancer
Treat gentamycin + coamoxiclav, then 2-4wks ciprofloxacin
Acute kidney injury definition Cause Symptoms Diagnosis Treat
medical emergency? treat
Abrupt rise in serum urea and creatinine due to decreased GFE
Prerenal: decreased perfusion (hypovolaemia+/-hypotension)
Intrarenal: acute tubular necrosis (from preAKI/tumour lysis syndrome/nephrotoxins), glomerulonephritis, acute interstitial nephritis
Postrenal: obstruction (tumour/BPH/stones)
Symptoms:
oligouria, electrolyte imbalance: hyperkalaemia/uraemia, oedema, thirst, bruising/bleeding, postural hypotension
Diagnosis:
urine dip
albumin: creatinine ratio, GFR
USS bladder scan for stones
FBC/dipstick for infection
Renal biopsy for intrarenal
Treat underlying cause, correct electrolyte imbalance, fluid replacement, antibiotics - usually reversible. Severe - dialysis.
hyperkalaemia = medical emergency ass with AKI, treat with calcium gluconate to stabilise heart, insulin+dextrose red. K+ in blood, IV fluid
Chronic Kidney Disease main cause symptoms diagnosis treatment
Usually caused by hypertension, diabetes
Hypertension: walls of glomeular vessels thicken to withstand pressure, decreasing blood supply and causing ischaemia of cells in glomerulus. Immune cells -> glomerulosclerosis.
Diabetes: glucose damages efferent arteriole, making it stiff, high pressure to overcome = hyperfiltration eventually leads to glomerulosclerosis.
Diagnose
biopsy, GFR monitoring
eGFR <30
albumin creatinine ratio (creatinine excreted at a constant rate)
Symptoms:
Think roles of kidney in homeostasis(Blood vol, K+, acid/base), vit D/bone health, erythropoeitin production
Urea buildup = nausea/anorexia, encephalopathy/bleeds/pericarditis
Electrolyte imbalance = hyperkalaemia = arrhythmias, hypocalcaemia = bone resorption
Renin = hypertension
Erythropoeitin = decreased prod. RBCs, anaemia
Treat
underlying cause
fluid management
dialysis
transplant
Benign prostate hyperplasia what? symptoms diagnosis treatment - indications for surgery?
Benign nodular/diffuse proliferation of prostate glandular/musculofibrous tissue. Inner zone enlarges, unlike carcinoma where peripheral zone enlarges.
Symptoms
LUTS:
Frequency
Nocturia
Urgency
Hesitancy, Straining, intermittent stream, incomplete emptying, post micturition dribble, haematuria, dysuria
Diagnosis:
DRE reveals smooth enlarged prostate
PSA may be raised
Biopsy, endoscopy
Treat:
watchful waiting if minimal symptoms, lifestyle advice such as avoid alcohol/caffeine
Meds:
alpha-1-antagonist tamsulosin relaxes smooth muscle of bladder neck
5-alpha reductase finasteride prevents conversion testosterone to dihydrotestosterone (active, needed for prostate growth)
Surgery - for gross haematuria, renal insufficiency due to obstruction, acute urinary retention, failed medical treatment - TURP (transurethral resection of prostate). 14% impotent, 10% erectile dysfunction, 1% incontinent
Prostatic cancer
risk
Mostly adenocarcinoma (can have transitional/small cell). Proliferation of cells in peripheral zone - do not compress urethra until late stage. Metastasise to bone.
Risk:
obesity, high fat low fibre, BRCA1&2, age
Symptoms
Asymptomatic until compress urethra, LUTS. Metastatic: bone pain, anaemia, weight loss.
Diagnosis:
raised PSA
TRUS (transrectal ultrasound)
biopsy and histology- graded according to Gleason grading (degree of differentiation)
DRE - but won’t be palpable if tumour is anterior peripheral zone
treatment:
active surveillance if non-metastatic and symptomless, over 70yrs
radical prostatectomy
/chemo, radio
metastatic: the tumour is highly hormone sensitive, so androgen deprivation by orchidectomy is effective. LHRH agonist - goserelin
Kidney stones/calices, nephrolithiasis cause/formation types and cause presentation diagnose treat
Caused by urine becoming supersaturated (dehydration, or increased solutes), precipitates and crystals form. These may become lodged - commonly in in the pelviureteric junction, pelvic brim, vesicoureteric junction (sites of constriction).
Most stones are calcium oxalate, which are brown. They form in acidic urine. Others are:
calcium phosphate - dirty white, form in alkaline urine.
uric acid - red brown, form in gout/long term allopurinol use
struviate/infective: mixed components, formed after UTI eg proteus mirabilis makes urine more alkaline. Dirty white.
cysteine stones
Cause:
Calcium stones: hypercalcaemia due to increased absorption/primary hyperthyroidism. Hypercalcuria due to impaired renal absorption.
Gout - diet high in purines
hyperoxaluria - diet high in oxalate, eg rhubarb/choc/beer
Presentation:
renal colic - sharp, excruciating pain, can’t sit still (unlike peritonitis), dysuria, frequency, strangury. Subsides when stone reached bladder.
Diagnose:
XR is first line. NCCT KUB is gold standard.
Urinalysis, MSU for culture.
Treat
Hydration
Strong analgesia for colic - diclofenac
Antibiotic if obstruction –> pyelonephritis
If >5mm, can’t pass:, medical expulsion: nifedipine/tamsulosin.
Laser endoscopy, keyhole surgery.
