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Renal :') > Hematuria, dysuria, and nocturia > Flashcards

Hematuria, dysuria, and nocturia Flashcards

1
Q

what makes a uti uncomplicated?

A

if it is in a non-pregnant outpatient woman without any anatomic abnormalities or urinary instrumentation

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2
Q

what are some examples of factors that are associated with complicated UTIs?

A

pregnancy, urinary retention/obstruction, renal failure, renal transplant, and males

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3
Q

how is a recurrent UTI defined?

A

2 or more infection in 6 months or 3 or more infections in one year

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4
Q

what is asymptomatic bacteriuria?

A

bacteriuria present on urine culture but no clinical UTI symptoms present in the patient

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5
Q

what is catheter-associated UTI (CA-UTI)?

A

uti associated with placement of urinary catheter or within 48 hours of removal

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6
Q

what are the gram negative organisms associated with UTIs?

A

E. coli, Klebsiella pneumonia, proteus mirabilis, pseudomonas aeruginosa

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7
Q

what are the gram positive organisms associated with UTIs?

A

enterococcus species, staphylococcus saprophyticus, and group B streptococcus

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8
Q

what is the classic presentation of UTIs?

A

irritative voiding symptoms, suprapubic abdominal pain, gross/microscopic hematuria

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9
Q

what are the irritative voiding symptoms?

A

dysuria, urinary frequency, urinary urgency

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10
Q

what is the classic presentation of pyelonephritis?

A

patients will have the irritative voiding symptoms as well as: fever/chills/rigors, flank pain, CVA tenderness, fatigue, nausea/vomiting, and anorexia; AMS is a common presentation in older adults

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11
Q

what are 5 complications associated with UTIs?

A

sepsis/septic shock, acute kidney injury, perinephric abscess, emphysematous pyelonephritis, and papillary necrosis

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12
Q

how does interstitial cystitis present?

A

with irritative voiding symptoms but there is no evidence of infection

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13
Q

What things can urine dipstick detect?

A

leukocyte estrase, nitrites, blood, and color

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14
Q

what does presence of LE or nitrites typically mean?

A

there is a sensitivity of 75% and specificity of 82% for UTI

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15
Q

what does urinalysis with microscopy detect?

A

hematuria, pyuria, WBC casts, bacteria present

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16
Q

what do urine cultures with sensitivities show?

A

true UTIs have more than 10^5 CFU (colony-forming units/ml)

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17
Q

when might you use imaging to diagnose a UTI?

A

it is typically reserved for patients with acute complicated UTIs and/or possible pyelonephritis

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18
Q

what imaging modality do you use for UTIs?

A

CT abdomen/pelvis with and without IV contrast

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19
Q

what do CT scans in the setting of UTIs evaluate for?

A

calculi, obstruction, pyelonephritis findings

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20
Q

what are the pyelonephritis findings that can be seen on CT scans?

A

perinephric abscesses, perinephric stranding, areas of decreased contrast enhancement, and emphysematous pyelonephritis

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21
Q

What are the 4 different types of prostatitis?

A

acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, asymptomatic prostatitis

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22
Q

how is chronic bacterial prostatitis defined?

A

chronic infection of prostate gland (greater than 3 months)

23
Q

what is chronic pelvic pain syndrome?

A

chronic pelvic pain with no detectable infection of prostate gland

24
Q

who is most likely to get prostatitis?

A

young and middle-aged men

25
Q

what are the risk factors for prostatitis?

A

functional or anatomical anomalies (urethral stricture), urinary tract instrumentation, UTIs, diabetes, smoking, HIV

26
Q

what gram negative bacilli are most likely to causes prostatitis?

A

e. coli, klebsiella pneumonia, proteus mirabilis, pseudomonas aeruginosa

27
Q

what gram positive cocci are most likely to cause prostatitis?

A

enterococcus species and normal skin flora

28
Q

what is the clinical presentation of acute bacterial prostatitis?

A

acutely ill appearing, fevers, chills, malaise, n/v, signs of sepsis, irritative voiding symptoms, obstructive symptoms, suprapubic or perineal pain (“it hurts when I sit down”)

29
Q

what is the clinical presentation of chronic bacterial prostatitis?

A

subtle signs, symptoms of recurrent UTIs, obstructive symptoms, suprapubic or perianal pain, pain with ejaculation or blood in semen

30
Q

how do you make the diagnosis of acute prostatitis?

A

clinical diagnosis based on history and exam; digital rectal exam, urinalysis and culture

31
Q

what else should you consider testing for in patients with possible prostatitis?

A

consider testing for gonorrhea and chlamydia in high risk patients

32
Q

how do you make the diagnosis of chronic prostatitis?

A

digital rectal exam, urinalysis and culture, diagnostic standard is prostatic massage

33
Q

how might the digital rectal exam on a patient with acute prostatitis differ from a digital rectal exam done on a patient with chronic prostatitis?

A

the DRE on a patient with chronic prostatitis is often normal on exam

34
Q

how long should a patient with prostatitis be treated for?

A

duration of antibiotics is 4-6 weeks

35
Q

what are 5 complications associated with prostatitis?

A

bacteremia and sepsis, epididymitis, prostatic abscess, chronic prostatitis, chronic pelvic pain

36
Q

what are the risk factors for BPH?

A

age, metabolic syndrome, obesity, genetic susceptibility, excessive coffee or caffeine intake

37
Q

BPH results from what?

A

increased total number of stromal and glandular epithelial cells within the prostate

38
Q

what is LUTS and what does it result from?

A

lower urinary tract symptoms; results from both: bladder outlet obstruction (BOO) from BPH and detrusor muscle overactivity secondary to BOO

39
Q

what do you have when BPH becomes symptomatic?

A

it becomes LUTS

40
Q

what are the symptoms associated with LUTS?

A

storage symptoms (urinary frequency, urgency, nocturia, and urinary incontinence) and voiding symptoms

41
Q

which set of symptoms in LUTS is usually more bothersome for most men?

A

the storage symptoms

42
Q

how do you make the diagnosis of BPH?

A

typically a clinical diagnosis based on history and PE; DRE, UA, BMP, prostate specific antigen, or post-void residual US

43
Q

what might the findings of a DRE be in a patient with BPH?

A

typically reveals an enlarged but non-tender prostate

44
Q

how do you treat mild symptoms of BPH?

A

mild symptoms do not require treatment

45
Q

how do you treat more severe cases of BPH?

A

surgical treatment: Transurethral resection of prostate (TURP) or a simple prostatectomy

46
Q

what are the complications associated with BPH?

A

acute urinary retention, UTIs, bladder stones, formation of bladder diverticuli, acute or chronic kidney failure due to hydronephrosis

47
Q

what is the lay term for nephrolithiasis?

A

kidney stones

48
Q

what is the likelihood of forming a second stone?

A

it increases with time

49
Q

most kidney stones have a composition of what?

A

calcium oxalate (79.1%)

50
Q

kidney stones could be caused by acquired metabolic defects secondary to diseases such as what?

A

distal RTAs, primary or enteric hyperoxaluria, medullary sponge kidney, or horseshoe kidney

51
Q

when kidney stones cause symptoms it is usually because of what? what are the symptoms?

A

urinary obstruction; severe flank pain that radiates to the groin, hematuria, gravel passage or visualized stone passage, n/v

52
Q

what are the complications of nephrolithiasis?

A

hydronephrosis, AKI or CKD, recurrent urinary infections if stones become infected

53
Q

how do you make the diagnosis of nephrolithiasis?

A

non-contrast CT of abdomen and pelvis, KUB x-ray, renal and bladder US, urinalysis with microscopy, strain urine

54
Q

what is an example of a surgical treatment used for nephrolithiasis?

A

extracorporeal shock wave lithotripsy (ESWL)

Renal :') (16 decks)

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