Hematuria, Dysuria and Nocturia Flashcards
Uncomplicated UTI
Acute cystitis or pyelonephritis in a non-pregnant, normal anatomy, no instrumentation patient.
Complicated UTI
Any male, pregnant woman, or individual with renal failure, renal transplant, anatomic problem, catheter, or immunocompromised.
Definition of recurrent UTI
> 2 infections in 6m
>3 infections in 1y
Catheter-associated UTI (CA-UTI)
UTI within 48h post catheterization
RF for UTI
Female Sexual Activity Barrier/spermicide use Catheters DM
Pathogenesis of UTI
Uropathogenic bacteria from the colon, perineum, or vagina infect the urethra and ascend
Most common bacterial cause of UTI
E. Coli
Cystitis clinical presentation
Dysuria Urinary Frequency Urgency FUPA pain Hematuria
Pyelonephritis clinical presentation
Fever Flank pain CVA tenderness Fatigue N/V
AMS in older patients!!
Complications from UTI’s
Sepsis AKI Abscess formation Emphysematous Pyelonephritis Papillary necrosis
A patient shows irritative voiding symptoms but no evidence of infection. Ddx?
Interstitial Cystitis
Labs to run for diagnosis of UTI
Urinalysis with microscopy
Urine Dipstick
2 findings on Urine dipstick indicative of UTI
Leukocyte Esterase
Nitrites
3 drugs used for UTI’s
Nitrofurantoin
TMP-SMX
Fosfomycin
Recommendations to prevent UTIs
consider alternative contraception methods other than barriers or spermicides
Urinate after intercourse
Wipe front to back
avoid tight underwear
2 classification of prostatitis we’re concerned with
Acute Bacterial Prostatitis Chronic Prostatitis (>3m)
Pathogenesis of prostatitis
bacteria in the urethra migrate to the prostate via ducts. E. Coli most common
Acute Bacterial Prostatitis clinical presentation
Acutely ill with fever, malaise, N/V, sepsis
Irritative voiding
Obstruction
FUPA pain
Chronic Prostatitis presentation
Subtle signs and symptoms with recurrent UTI’s
Obstructive symptoms
Pain with ejaculation and/or blood in semen
Exam to perform if prostatitis is suspected
DRE
Treatment of Prostatitis
Treat empirically based on gram stain.
Gram- most common: Fluoroquinolones/TMP-SMX
Number 1 risk factor for BPH
Age: 80% of men>70y
Pathogenesis of BPH
not well understood, but increased stromal and epithelial cells within prostate that leads to Lower Urinary Tract Symptoms (LUTS)
LUTS- Bladder outlet obstruction (BOO) and/or Detrusor Muscle overactivity
When do most BPH patients present?
Storage symptoms occur such as urgency, frequency, notcturia, and incontinence
What is a normal Post-void residual U/S?
<100 ml Urine
Treatment of BPH
- a-blockers: Tamsulosin
- 5a–reductase inh
- PDE-5 inh- give ‘em a hard on while you’re at it!
- Anticholinergic- decrease bladder contraction
Surgical treatment of BPH
Transurethral Resection of Prostate (TURP)
What is the composition of most kidney stones?
Calcium oxalate
RF for developing kidney stones
High Calcium diet
Low fluid intake
RTA type IV and I
Horseshoe kidney
Nephrolithiasis presentation
Severe flank pain that radiates to the groin
Hematuria
Passage of stone
Hydronephrosis
Diagnostic test for Nephrolithiasis
NON-CONTRAST CT abdomen and pelvis. contrast would cover up the stone
Treatment for struvite crystals
Surgery, can’t pass them
Cystine crystal characteristics
Hexagonal shaped and form in acidic urine
Struvite Crystals characteristics
Coffin lid shaped and form in alkaline urine
Treatment of Nephrolithiasis
Fluids Pain control Anti-nausea alpha blockers to dilate ureters Shockwave therapy Basket extraction
