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Hospital Based Medicine And Surgery > L14: Voiding Problems > Flashcards

L14: Voiding Problems Flashcards

1
Q

What can urinary symptoms be divided into

A

Voiding (obstructive)
Storage
Post micturition

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2
Q

What are the voiding (obstructive) symptoms

A 
Hesitancy 
Poor or intermittent stream
Straining
Incomplete emptying 
Terminal dribbling
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3
Q

What are the storage urinary symptoms

A

Urgency
Frequency
Nocturia
Urinary incontinence

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4
Q

What are the post micturition symptoms

A

Post micturition dribbling

Sensation of incomplete emptying

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5
Q

What is urinary incontinence

A

Involuntary leakage of urine

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6
Q

What are the type of incontinence

A 
Stress incontinence
Urge incontinence
Mixed incontinence
Overflow incontinence 
Continuous incontincene
Neurogenic incontinence
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7
Q

What is stress incontinence

A

When the pressure of the bladder exceeds the urethral pressure and can be caused by coughing, straining, laughing, lifting

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8
Q

What is the cause of stress incontinence

A

Weak pelvic floor muscle

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9
Q

What are the risk factors for stress incontinence

A

Post partum
Continuation due to strainign
Pelvic surgery
Post menopausal

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10
Q

What is urge incontinence

A

A sudden desire to urinate and is an overactive bladder caused by the destructor muscle over activity. It leads to an inhibited bladder contraction that causes a rise in the intra vesical pressure and leakage of urine

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11
Q

What are the causes of urge incontinence

A 
Neurogenic- previous stroke
Infection
Malignancy
Idiopathic 
Medication; cholensterase inhibitors
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12
Q

What is overflow incontinence

A

Due to progressive stretching of the bladder wall that causes damage to the efferent fibres of the sacral reflex and loss of bladder sensation

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13
Q

What are the causes of overflow incontinence

A

Prostatic hyperplasia
Spinal cord injury
Congenital defects

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14
Q

What investigation can be carried out in incontinence

A 
Post void bladder scan in overflow incontinence 
Vaginal spectrum 
MRI
Dipstick for haematuria or infection
Cystoscopy
Intra vesicular urogram
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15
Q

What is the treatment for stress incontinence

A

Pelvic floor muscle training
Duloxetine
Surgery

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16
Q

What is the treatment for urge incontinence

A 
Oxybutynin 
Tolterodine
Mirabegron 
Bladder training 
Surgery
17
Q

What is the treatment for overflow incontinence

A

Treat BPH

18
Q

What are the 3 natural points where renal stones are likely to get trapped

A 
Pelvic ureteric junction
Pelvic brim (where the ureter enters the pelvis and crosses the iliac vein(
Vesico-ureteric junction (ureter passes the vas deferens)
19
Q

What are the risk factors for kidney stones

A 
Dehydration
Previous calculus
Hypercalcaemia
Hyperuricaemia
Inherited condition
Structural abnormalities of the urinary tract
20
Q

What can a renal stone be made of

A

Calcium
Struvite
Uric acid
Cysteine

21
Q

Which type of stone is the most common

A

Calcium renal stones

22
Q

Which renal stone is related to chronic uti

A

Struvite

23
Q

What is the presentation of kidney stones

A

Sudden onset of loin to groin pain

24
Q

Describe the SOCRATES of a ureteric colic pain

A 
S-loin
O-sudden
C-throb/cramp
R- groin
A: haematuria, dysuria, frequency 
T: comes in waves 
E: movement 
S: 10/10
25
Q

What is the gold standard investigation for renal stone

A

Ct of the urinary tract

26
Q

What is the management of renal stones

A

Fluid
Majority will pass stone without invtervention
Analgesia for pain
Septic- antibiotics
If obstruction: nephrostomy or ureteric stent insertion

27
Q

What is the management if the stone is less than 10mm and there is no obstruction

A

Conservative

28
Q

What is the management of a renal stone that is more than 10mm with no obstruction

A

Uretescopy and laser fragmentation to break up the stone

29
Q

What is the chemical composition of a stone

A 
Calcium oxalate- majority 
Calcium phosphate
Uric acid 
Cystine 
Magnesium ammonium phosphate
30
Q

Why do the majority of stone form due

A

Metabolic causes

31
Q

What is the metabolic cause of calcium

A

Hyperparathyroidism
Dietary excess
Absorptive hypercalciuria: increases calcium absorption form the gut
Renal leak hypercalciuria- leak of calcium from the kidney
Excess vitamin d and calcium supplements
Renal tubular acidosis
Prolonged immobilisation
Sarcoidosis

32
Q

What are the other metabolic causes due to oxalate

A

Hereditary hypoeroxaluria
Dietary excess
Intestinal disease: Crohn’s and ulcerative colitis

33
Q

What is hereditary hypoeroxaluria

A

A condition where there is a problem with an enzyme in the liver which has to break down oxalate, a lack of the enzyme leads to hyperoxaluria leading to a stone formation

34
Q

How does intestinal disease such as Crohn’s and ulcerative colitis cause hypoeroxaluria

A

Fatty acids in the gut bind with dietary calcium which prevents the excessive oxalative absorption by the gut into the circulation. In Crohn’s disease and ulcerative colitis, fatty acids is not Brocken down so the gut absorbs oxalate unbound to calcium

35
Q

What are the metabolic causes of uric acid

A

Dietary excess of animal protein
Gout related
High cell turnover

36
Q

What is the medical management of renal stones

A 
Increase fluid uptake and for urine output of 2.5-3 litres
Reduce meat intake 
Avoid oxalate rich foods
Reduce milk and milk products
Avoid added salt
37
Q

What is the pharmacological management of renal stones

A

Allopurinol- in uric acid and uricosuric oxalate stone
Pottassium citrate: in uric acid and cystine stones
Penicillamine: for cystine stone
Thiazide diuretics: in renal hypercalciuria
Calcium carbonate in malabsorption

38
Q

What are the differential diagnosis in renal stones

A 
Gallstone colic
Appendicitis
Ovarian torsion
Leaking aneurysm
Shingles
Pnuemonia/pleural effusion

Hospital Based Medicine And Surgery (30 decks)

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