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CPRII- Renal Exam > Hematuria, Dysuria, Nocturia > Flashcards

Hematuria, Dysuria, Nocturia Flashcards

1
Q

Hematuria: Upper DDX

A 
Renal CA
Renal cysts
Stones
Glomerulonephritis
UTI
Pyelo
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2
Q

Hematuria: Lower DDX

A 
Bladder CA
Bladder stone
Hemorrhagic cystitis due to cyclophosphamide
BPH
Prostate CA
Urethritis
Urethral trauma
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3
Q

Difference between uncomplicated and complicated UTI

A

Uncomplicated: cystitis or pyelo in nonpreg female, no nanatomic issues or urinary instrumentation

Complicated: all others (pregnancy, exposure to abx, BPH, renal failure, males, catheter, immuno)

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4
Q

What do some references include in their definition of complicated UTI

A

Pyelo!

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5
Q

Pathogenesis of UTI’s

A

Uropathogenic bacteria colonizing GI Tract, Perineum, or Vagina inoculate urethra and ASCEND into the bladder. The bacteria can evade the innate and adaptive immune systems.

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6
Q

What is the most common UTI pathofen for both uncomplicated and complicated UTI

A

UPEC!!! (E. Coli, a gram neg bacilli)

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7
Q

UTI presentation

A
  • Irritative voiding sx (Dysuria, Frequency, Urgency)
  • Suprapubic tenderness
  • Hematura (gross or micro)
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8
Q

Pyelo presentation

A

-Irritative voiding sx
-Fever/chills/rigors
Unilateral flank pain
CVA tenderness
Fatigue
N/V, anorexia

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9
Q

Common presentation of UTI or pyelo in elderly?

A

AMS

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10
Q

UTI complications

A
  • Sepsis/shock due to bacteremia
  • AKI
  • Perinephric abscess (seen w/ pyelo)
  • Emphysematous pyelonephritis
  • Papillary necrosis
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11
Q

Dysuria DDx

A
  • Vaginitis
  • Urethritis
  • PID
  • Cystitis
  • Pyelo
  • Prostatitis
  • Epididymitis
  • Interstitial cystitis
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12
Q

What’s interstitial cystitis?

A

Irritative voiding sx but no evidence of infxn

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13
Q

UTI dipstick findings

A
  • Leukocyte esterase: a sign of pyuria (leukocytes in urine)
  • Nitrites: sign of bacteria in urine

PRESENCE OF EITHER HAS 75% SENS. AND 82% SPEC. FOR UTI’S

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14
Q

What does a WBC cast on UA w/ microscopy suggest

A

Pyelo or AIN

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15
Q

What will a urine culture w/ sensitivities show if there is a trace UTI

A

> 10^3 CFU (colony forming units/mL)

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16
Q

When should you image a pt w/ a UTI. What do you order?

A

If they are acute and complicated and/or if you’re concerned for pyelo. Order a CT Abd/Pelvis w/ and w/o contrast

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17
Q

Pyelo findings on CT?

A
  • Perinephric abscesses or stranding
  • Ares of decreased contrast enhancement
  • Emphysematous pyelonephritis
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18
Q

Uncomplicated UTI tx

A
  • Nitrofurantoin
  • Bactrim
  • Fosfomycin
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19
Q

If pt cannot take the recommended antimicrobials?

A

Take second line abx:

  • Fluoroquinolones OR
  • B-lactams (avoid ampicillin or amoxicillin alone)
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20
Q

Complicated UTI tx

A
  • Not hospitalized? Oral abx

- Hospitalized? IV abx: broad then narrow based on culture

21
Q

4 classifications of prostatitis

A
  • Acute Bacterial
  • Chronic Bacterial: >3 mo
  • Chronic pelvic pain syndrome: pain but no detectable infxn
  • Asx: infxn but asx
22
Q

How does bacteria move into the prostate?

A

Bacteria in the urethra will migrate via the prostatic ducts into the prostate gland

23
Q

Most common bacteria of prostatitis?

A

E. coli, a gram negative bacilli

24
Q

Acute bacterial prostatitis presentation

A
  • Acutely ill
  • Irritative voiding sx
  • Obstructive sx
  • Suprapubic or perineal pain
25
Q

Chronic bacterial prostatits presentation

A
  • Less acute illness
  • Sx of recurrent UTIs
  • Obstructive sx
  • Suprapubic or perineal pain
  • Pain w/ ejaculation or blood in semen
26
Q

Acute prostatits dx

A
  • Usually clinical
  • DRE: tenderness
  • UA and culture: +
  • Test for gonorrhea and chlamydia in high-risk pt’s
27
Q

CHronic prostatits dx

A
  • DRE
  • UA ad culture: usually not diagnostic
  • Dx standard is prostatic massage
28
Q

Abx for prostatitis

A

Fluoroquinalones ex. Cipro
Bactrim

Tx for 4-6 weeks!!!

29
Q

Prostatitis complications

A
  • Bacteremia and sepsis
  • EPididymitis
  • Prostatic abscess
  • Chronic prostatiits
  • Chronic pelvic pain
30
Q

BPH is due to what cellular processes?

A

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

31
Q

LUTS is due to what?

A

Both bladder outlet (BOO) obstruction from BPH and detrusor muscle overactivity secondary to BOO

32
Q

What are LUTS (lower urinary tract sx)

A
  • Storage sx: frequency, urgency, nocturia, incontinence

- Voiding sx: slow, dribbling, intermittiency

33
Q

How do BPH pt’s present?

A

Usually w/ storage sx

34
Q

How can you diagnose BPH?

A
  • Usuallu clinical (AUA sx index)
  • DRE (enlarged contender prostate)
  • UA
  • BMP to ensure normal Cr
  • PSA
  • Post void residual US
35
Q

MOA a-1 blockers for BPH tx

A

Block sympathetic adrenergic-receptor mediated contraction of prostatic smooth muscle cells and bladder neck. Results in 1-2 weeks.

36
Q

MOA 5-a reductase inhibitors for BPH tx

A

Decrease conversion of testosterone to dihydrotestosterone to shrink the prostate. Results in 6- 12 mo.

37
Q

MOA anticholinergic agents for BPH tx

A

Inhibits muscarinic receptors in detrusor to decrease contraction. Use in pt’s w/ an overactive bladder but a normal PVR.

38
Q

MOA PDE 5 inhibitors for BPH tx

A

Inhibits PDE 5 to increase cAMP and cGMP leading to smooth muscle relaxation; anti=proliferative effects. Used in pt’s w/ ED and LUTS

39
Q

Surgical tx of BPH

A
  • TURP (transurethral resection of prostate; most common)

- Simple prostatectomy

40
Q

BPH complications

A
  • Acute urinary retention
  • UTI’s
  • Bladder stones
  • Bladder diverticuli
  • Acute or chronic renal failure from hydronephrosis; usually involves both kidneys
41
Q

Nocturia DDX

A
  • Urinary incontinence
  • Diuretics
  • BPH
  • UTIs
  • Primary polydipsia
  • Polyuria
  • Sleep apnea
42
Q

What are most kidney stones made of?

A

Calcium oxolate. Next most common is mixed (calcium oxalate + calcium phsophate) then calcium phosphate

43
Q

What can help inhibit stone formation?

A

Citrate

44
Q

Sx of nephrolithiasis? What are they usually due to?

A

Usually from urinary obstruction.

  • Intermittent severe flank pain rad. to groin
  • Hematuria
  • Gravel passage
  • NV
45
Q

Complications of nephrolithiasis

A

-Hydronephrosis
-AKI or CKD
0Recurrent UTI if stone becomes infected

46
Q

Imaging for nephrolithiasis?

A

Non-con (the dye would obstruct the stone bc both show up white!) CT Abd/pelvis. AKA renal stone protocol.

If pregnant, do a renal and bladder US

47
Q

Which stones are radiopaque vs. radiolucent

A

Radiopaque: calcium oxalate.phosphate and struvite
Radioluscent: uric acid and cystine

48
Q

Medical therapy for nephrolithiasis

A
  • Fluids
  • Pain control
  • Antiemetics
  • Expulsive therapy to dilate ureter (alpha-blocker tamsulosin / ca channel blocker nifedipine)

CPRII- Renal Exam (6 decks)

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