GU System Quiz Flashcards
Pain Referral Patterns: Kidney
• Ipsi costovertebral angle
• T-L or L-S area
• Possible diffuse upper abdominal pain
Pain Referral Patterns: Ureters
• Upper: flank
• Mid: lateral to umbilicus
• Lower: groin and genitalia
Pain Referral Patterns: Bladder
-Over suprapubic region
Dysuria
• Defined as painful or uncomfortable urination
– Typically a sharp, burning sensation
– May cause painful ache over bladder or perineum
Dysuria is extremely common in _________
• Extremely common in women, but can occur in men also & at any age
Dysuria: Most Common Causes
– Cystitis
– Urethritis due to STD
• Other causes: interstitial cystitis, prostatitis, epididymo-orchitis, cervicitis, atrophic vaginitis, tumors
Dysuria: Red Flags
– Fever, flank pain, recurrent episodes, known urinary tract abnormality, male
Dysuria: Diagnosis
– No single uniform approach to testing
– Urinalysis (WBC’s), STD testing
– Sometimes will give antibiotics without testing in young, otherwise healthy person
Dysuria: Treatment
– Directed at underlying cause-antibiotics, STD
Dysuria: Key Points
– Not always caused by bladder infection.
– Consider STDs and cancer
Dysuria: Potential DDx’s
Cystitis, Urethritis, Interstitial cystitis, Tumor
Hematuria
• Red blood cells in urine
– May be visible (urine is red, bloody, cola colored)
– May not visible (may be microscopic)
Reddish color is not always due to RBCs
– Hemoglobin/myoglobin in urine, food, drugs
Hematuria: Can originate from (5)
– kidneys, ureters, bladder, urethra, prostate
Hematuria: Most common causes
– UTI
– Prostatitis
– Urinary calculi (in adults)
_______ can cause transient hematuria
Vigorous exercise
In patients over 50, hematuria may indicate:
Cancer or prostate disease
Hematuria: Potential DDx
-Infection
-Calculi
-Glomerular disease
-Polycystic kidney disease
-Genitourinary cancer
-Trauma
-Prostatic Hyperplasia
-Prostatitis
Polyuria is defined as urine output of ____/day
> 3L
Urinary Frequency
Need to urinate many times during the day or night but in normal or less-than-normal volumes.
Polyuria: Common Causes
– Taking diuretics (in adults)
– Uncontrolled diabetes mellitus
Polyuria: Red Flags
– Abrupt onset, night sweats, cough, weight loss (especially if there is a history of smoking)
Urinary Frequency: Common Causes
– UTI
– Urinary tract calculi
– Urinary incontinence
– BPH
Also: Caffeine intake
Urinary Frequency: Red Flags
– Lower extremity weakness or signs of spinal cord damage
– Fever and back pain
Acute Kidney Injury (AKI): Acute Renal Failure
• Described as the rapid decrease in renal function over days
(Reduced blood flow to kidney allows creatinine and urea build up, leading to fluid/electrolyte disorders)
AKI: Complications
Fluid build up in lungs, chest pain, kidney damage, death
Acute Kidney Injury: Initial Symptoms & Signs
-Weight gain & peripheral edema
AKI: Later symptoms & signs
-Oligouria
-Anorexia
-Nausea, vomiting
-Back pain
-Confusion, anxious, restless
-Diarrhea
-Fatigue, lethargy
-Hypertension
-Weakness
AKI: Diagnostics
-Increased uria & creatinine (takes 24 hours for creatinine to increase)
AKI: Treatment
-Immediate Care (Can be serious-lead to coma, death)
Kidney (Renal) Trauma
-Kidney is injured by outside force: Penetrating/Blunt Trauma
Kidney (Renal) Trauma: Possible other symptoms
– Hematuria
– Diffuse abdominal tenderness
– Flank contusion
– Lower rib fractures
– Skin wound
Kidney (Renal) Trauma: Exam
– Look for any signs of trauma, contusion or redness
Kidney (Renal) Trauma: Lab Test
– Hematuria, low hematocrit
Kidney (Renal) Trauma: Treatment
– Depends on injury & situation
– May need surgery
– Most blunt trauma is low grade: Treatment is bed rest until gross hematuria resolved)
Chronic Kidney Disease
• Defined as long-standing, progressive deterioration of renal function
Chronic Kidney Disease: Risk Factors
– Analgesic use
– Hypertension
– Smoking
– Obesity
– African-American or Native American
– Older age
– Family history of kidney disease
Chronic Kidney Disease: Most common causes
• Diabetic nephropathy
• Hypertension
• Glomerulonephritis
Chronic Kidney Disease: Additional Causes
• Polycystic kidney disease
• Vesicoureteral reflux
• BPH
Chronic Kidney Disease: Possible Symptoms
(Typically asymptomatic or few symptoms)
• Anorexia
• Nausea, vomiting
• Nocturia
• Fatigue
• Pruritus
• Edema of feet/ ankles
• Urinary issues
• Muscle twitches and cramps
Chronic Kidney Disease: Complications
• Pulmonary edema, hyperkalemia, heart issues
• Central nervous system: difficulty concentration, personality change
Glomerular Disease
• Reduces kidneys ability to filter
• Red blood cells and protein may be excreted into the urine while toxins may be retained
Glomerular Disease: Basic Types
Nephrititic & Nephrotic
Glomerular Disease: Complications
• Hypertension, kidney failure
Nephritic Syndrome (glomerulonephritis)
• Bacterial or viral infection causes diffuse inflammation and damages the glomeruli
Nephritic Syndrome ( Glomerulonephritis): Epidemiology
– Most common in children (60% ages 2-12, 10% >40)
– Predominately males
Nephritic Syndrome (Glomerulonephritis): Causes
– Previous infections such as strep
– Other causes: lupus, polyarteritis nodosa, etc.
Nephritic Syndrome: Signs/Symptoms
▪ Hematuria
▪ Mild proteinuria (less than 3 g/ 24 hours)
▪ Edema
▪ Hypertension
▪ Oliguria
Nephritic Syndrome: Acute vs. Chronic Cases
-Acute: Abrupt onset of hematuria with mild proteinuria
-Chronic: May develop silently over months to years
Nephrotic Syndrome:
• Syndrome in which too much protein is releases in urine
Nephrotic Syndrome: MC secondary cause
Diabetes
Nephrotic Syndrome: Key Features
Massive proteinuria (and no hematuria)
-How we differentiate from nephritis
Nephrotic Syndrome: Signs/Symptoms
– Edema (most obvious clinical manifestation)
– Massive proteinuria (at least 3.5 g protein/ 24 hours)
– Hypoalbuminemia (<3 g/dl)
– Hyperlipidemia/hyperlipiduria
Nephritic vs. Nephrosis: Pathogenesis
-Nephritic Syndrome: Inflammation of Glomeruli
-Nephrosis Syndrome: Abnormal glomerular permeablility
Nephritic vs. Nephrotic: Causes
-Nephritic: Many causes; MC post-strep infection
-Nephrotic: Many causes; 2nd MC Diabetes
Nephritis vs. Nephrosis: Lab Findings
-Nephritic: Hematuria & proteinuria (mild)
-Nephrosis: No blood & proteinuria (>3.5g/24 hours)
Nephritic vs. Nephrosis: Clinical Findings
-Nephritic: Edema, Hypertension, Oliguria
-Nephrotic: Edema, Hypoalbuminia, Hyperlipidemia
Nepthritis vs. Nephrosis: Inflammation
-Nephritis: Inflammation
-Nephrosis: Non-Inflammatory
Nephritis vs. Nephrosis: Hematuria
-Nephritis: Hematuria
-Nephrosis: No Hematuria
Nephritis vs. Nephrosis: Proteinuria
-Nephritis: Proteinuria: <3.5g/day
-Nephrosis: Proteinuria: >3.5g/day
Polycystic Kidney Disease
• Genetic disorder: cluster of cysts develop in kidney
– Causes kidney to enlarge
– Reduces function
Cysts in PKD are:
Non-cancerous
PKD: Predominant age of diagnosis
Usually diagnosed by 45
(Equal to both genders)
PKD: Complications
• Hypertension
• Recurrent UTI or pyelonephritis
• Kidney stones
PKD: Signs & Symptoms
-Flank, low back & abdominal pain
-Dysuria
-Hematuria
-Nocturia
-Polyuria
-Hypertension (might notice 1st)
-Hepatomegaly
PKD: Exam
• Possible increased size of abdomen
• Palpable kidneys
PKD: Treatment
-Supportive Care
-Possible kidney transplant
Nephrolithiasis
• Hard deposits that form in kidney
Kidney stones are ___ composed of calcium
85%
Nephrolithiasis: Epidemiology
Predominately male
Nephrolithiasis: Risk Factors
• Family history
• Dehydration
• Diet: high protein, salt, sugar
• Obesity
• Medications & supplements: Vitamin C, antacids
Nephrolithiasis: Other conditions
• Gastric by pass surgery
• IBD
• Chronic diarrhea
Nephrolithiasis: Other kidney conditions are known risk factors
– Repeated UTIs
– Polycystic kidney disease
– Previous history of stone
Nephrolithiasis: Alternate Names
– Urinary calculi
– Renal calculi
– Renal lithiasis
– Urolithiasis
Nephrolithiasis: Symptoms
• Sudden onset
• Colicky & agonizing flank pain
• Nausea, possible vomiting
• Hematuria
• Chills & fever
Nephrolithiasis: Discomfort
• May not be able to lie down
• Constantly shift positions
Nepholithiasis: Exam
• Tachycardia
• Abdominal tender w/ deep palpation
• Costovertebral angle tenderness
(+Murphy’s kidney punch)
Nephrolithiasis: Labs/Diagnostics
• Urinalysis
• Kidney ultrasound
Nephrolithiasis: Treatment
• If stone larger than 6 mm, may need intervention
– Pain medication, increased hydration, surgery
• 85% of time: pass stone with urination within 72
hours
Nephrolithiasis: Prevention
-Drink enough water
-Avoid large doses vitamin C
-Low oxalate diet
Low Oxalate Diet
– If stones made from calcium oxalate: limiting the amount of dietary oxalate may prevent stones
– Limit oxalate to 40-50 mg day
– High oxalate foods include spinach, beets, blackberries, etc.
Obstructive Uropathy
Obstructive Uropathy
Functional or anatomic obstruction of urinary flow
Obstructive Uropathy: Causes by age
-Young: Anatomic abnormalities
-Adults: Calculi (kidney stones)
-Older men: BPH and prostate cancer
Obstructive Uropathy: Consequences
Urine accumulates proximal to obstruction, causing distention which can cause pain
Obstructive Uropathy: Lower urinary tract symptoms
-Frequency, nocturia, incontinence, dysuria, hesitancy weak stream or straining to void
Obstructive Uropathy: Upper Urinary Tract Symptoms
Asymptomatic
-If caused by stone, can have renal colic (sudde, severe, flank pain that may radiate to groin)
Obstructive Uropathy: Vitals
-Hypertension
-Fever
Hydronephrosis
-Accumulation of urine in the kidney causes it to dilate; Usually due to an obstruction
Hydronephrosis: Most common cause in Adults
Nephrolithiasis (kidney stones)
Hydronephrosis: Other causes
-Acquired: prostate hyperplasia, cancer, neurogenic bladder
Hydronephrosis: Risk Factors
-Kidney stones
-Prostate hypertrophy/cancer
-Diabetes mellitus
-Analgesic abuse
Hydronephrosis: Upper Obstruction
Flank pain
Hydronephrosis: Lower Obstruction
May radiate to ipsilateral testicle/labia
Hydronephrosis other symptoms
Changes in urination, thirst, edema
Hydronephrosis: Exam
-Costovertebral angle tender
- (+ Murphy’s kidney punch)
-If severe, kidney may be palpable (also bladder)
-If caused by lower obstruction: Suprapubic area tender
Urethritis
Lower urinary tract infection in urethra
Cystitis
Lower urinary tract infection in bladder
Pyelonephritis
Upper urinary tract infection in kidney
Prostatitis
Infection in prostate
UTI: Epidemiology (Adults 20-50 yoa)
-Far more common in female
UTI: MC Types in Female
Cystitis or pyelonephritis
UTI: MC types in Male
Urethritis or prostatitis
UTI: MC Cause
MC Cause: Bacteria
Urethritis: MC Cause
STI: Gonorrhea, chlamydia
Urthethritis
Infection of the urethra
Urethritis: Complications
-Can cause urethral scarring & stricture
-May spread into bladder
-May spread into gender organs
Urethritis: Signs & Symptoms
-Dysuria
-Discharge (penile, vaginal)
-Itching/tenderness
-Edema, inflammation
Urthethritis: Female symptoms
Vaginitis, cystitis, cervicitis
Urethritis: Risk Factors
-Multiple partners
-STI history
-Unprotected intercourse
Urethritis: Labs
Perform STI testing
Cystitis
Inflammation of bladder mucosa due to infection or irritation
Cystitis is more common in
Women
Cystitis: Causes
Acute infection (E. coli 90% of time)
Cystitis: Risk factors/causes
-Sexual activity, pregnancy, incomplete bladder emptying
-Previous UTI, STI (chlamydia)
-Catherization
Cystitis: Symptoms & Signs
-Burning or pain during urination
-Urgency, frequency
-Sense of incomplete bladder emptying
-Blood in urine
-Offensive odor
-Nocturia
-Lower abdominal or back pain, tenderness or cramping
Cystitis: Lab
Urinalysis
Cystitis in Men
-Uncommon <50 yoa
-Usually result of ascending infection from urethra or prostate
Cystitis in Men: Risk Factors
-Catherization, Urethral strictures
Cystitis in Men: If Fever
Concomitant pyelonephritis or prostatitis
Pyelonephritis
Acute, diffuse infection of kidneys or one or both kidneys
Pyelonephritis: Epidemiology
More common in females
Pyelonephritis: Risk Factors
-Frequent bladder infections
-Anything causing obstruction
-DM
-Other: Neurogenic bladder, vesicoureteral reflux
Pyelonephritis: Symptoms shared w/ Cystitis
-Dysuria
-Urinary Frequency
-Hematuria
Pyelonephritis: Unique symptoms
-Location of Pain: Flank Px, colicky abdominal pain
-High fever
Pyelonephritis: Exam
-Murphy’s kidney punch: Positive on affected side
-Kidney may be palpable and tender if enlarged
Pyelonephritis: Diagnostic Procedures
-Urinalysis, urine culture
-CT, US
Interstitial Cystitis
-Non-infectious bladder inflammation
Intersititial cystitis is more common in:
Women (90%)
Intersitial Cystitis: Triggers
-Excess caffeine
-Tobacco, alcohol
-Food w/ high potassium, spicy
-Seasonal allergies, menstruation, stress, sexual intercourse
Interstitial cystitis may be initially
Asymptomatic
Interstitial Cystitis: Sx/SI
(Similar to UTI)
-Dysuria
-Increased frequency
-Urgency
-Pressure in bladder/pelvis
-Nocturia
-Pelvic floor dysfunction/tension
-Pain w/ intercourse
-General discomfort
Interstitial Cystitis: Differentials
UTI, overactive bladder, urethritis, urethral syndrome, prostatitis
Interstitial Cystitis: Labs
Normal unless another condition is involved
Neurogenic Bladder
-Bladder dysfunction caused by neurologic damage
Neurogenic Bladder: Many causes
CNS, PNS, Other
Neurogenic Bladder: Different Types
-Flaccid Bladder: Contractions absent
-Spastic Bladder: Involuntary contractions
-Mixed patterns: Both
Neurogenic Bladder: Symptoms
-Flaccid: Overflow incontinence
-Spastic: Frequency, nocturia, urgency, leakage
Neurogenic Bladder: Common complications
-Recurrent infections
-Vesicoureteral reflux
Loss of bladder control
Urinary incontinence
Urinary incontinency is more common in
Elderly and women
Urinary incontinence: Risk factors (5)
-Diabetes, MS, obesity
-BPH, Multi-parity
Urinary Incontinence: Types
-Stress
-Urge
-Overflow
-Functional
-Mixed
Urinary Incontinence: Stress
-Caused by coughing, sneezing, laughing, exercising, or lifting something heavy
Urinary Incontinence: Urge
-Sudden, intense urge followed by involuntary loss
-Causes: Infection or Conditions (DM or neurologic)
Urinary Incontinence: Overflow
Dribbling as bladder doesn’t empty completely
Urinary Incontinence: Overflow
Dribbling as bladder doesn’t empty completely
Urinary Incontinence: Functional
-Physical or mental impairment impedes getting to the toilet on time
Incontinence: Causes
-Obstruction such as BPH
-DM
-Pelvic floor weakness
-Infection
-Stones
-Tumor
Enuresis
Involuntary loss of urine
-Involuntary voiding of urine > 2x/month during the day or night
Enuresis is more common in:
Male Children (3:1)
Enuresis: Primary classification
Children: Never were dry/were not potty trained
Enuresis: Secondary Classification
-Begins after 6 months of dryness
Enuresis: Secondary Classification (Causes)
-ADD
-Stress
-Anxiety
-Pinworm
-Food Allergies
Retrograde flow of urine from bladder into ureters or kidneys
Vesicoureteral Reflux
Vesicoureteral Reflux: Epidemiology
More common in infants and young children
Vesicoureteral Reflux: MC Causes
Congenital defect at ureterovesical junction
Vesicoureteral Reflux: Symptoms
-Dysuria, urgency, frequent urination, hematuria, abdominal pain
Bladder Injury: Signs/Symptoms
-Suprapubic pain, urinary retention, hematuria (90%), muscle rigiditiy over lower abdomen
Most common renal cancer (90-95%)
Renal Cell Carcinoma
Renal Cell Carcinoma affects people between:
50-70 yoa
Renal Cell Carcinoma: Symptoms
-Appear late when the tumor is large & metastatic
-Hematuria, flank pain, palpable mass, fever
Most common type of bladder, ureter, urethra cancer
Transitional Cell Carcinoma
Transitional Cell Carcinoma: Causes
Certain drugs, radiation, mutation, cigarette smoke
Wilms’ Tumor/Neuroblastoma manifests in _____
Children <5 yoa
Wilms’ Tumor/Neuroblastoma: Cause
Possible genetic abnormalities
Wilms’ Tumor: Symptoms
Painless, palpable abdominal mass
Wilms’ Tumor: Prognosis
Good, but may recur within 2 years
UTI vs. Interstitial Cystitis
UTI: Hematuria may be present, WBC in urine
Interstitial Cystitis: Normal labs, Dx by exclusion
Abdominal and Posterior Flank Area: Exam Findings
-Bruit: Renal artery stenosis
-Murphy’s Kidney Punch: Pyelonephrtitis
-Palpable Kidneys: Masses potentially
Abdominal and Posterior Flank Area: Exam Findings
-Bruit: Renal artery stenosis
-Murphy’s Kidney Punch: Pyelonephrtitis
-Palpable Kidneys: Masses potentially
