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GU > Lecture 8: Catheterization/UA/Hematuria > Flashcards

Lecture 8: Catheterization/UA/Hematuria Flashcards

1
Q

What are the 2 main purposes of urinary catheterization?

A
  1. Draining the urinary bladder
  2. Collecting the urine for measurement or analysis.
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2
Q

What are the 4 common impediments to urine flow?

A
  1. Acute urinary retention
  2. Bladder outlet obstruction
  3. Severe hematuria with clots
  4. During and after surgery of the GU tract or adjacent structures.
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3
Q

When is urinary catheterization indicated?

A
  1. Impeded urine flow
  2. Diagnostic evaluation
  3. Treatment of GU condition
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4
Q

What are the absolute and relative CIs to urinary catheters?

A

Absolute:

  • Pelvic trauma
  • Blood at urethral meatus or gross hematuria in context of trauma.

Relative:

  • Urethral stricture, recent GU surgery, artifical urinary sphincter
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5
Q

What are the complications associated with using an urinary catheter?

A
  • Infection
  • Mechanical damage
  • Bladder damage
  • Urethral damage
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6
Q

When is an external urinary catheter not very useful?

A
  • When we need accurate urine measurement.
  • When we need to get past a urinary obstruction.
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7
Q

What are the pros of using a suprapubic urinary catheter?

A
  • Bypassing urethra, so no urethral trauma.
  • Increased satisfaction vs indwelling catheter
  • Less infection
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8
Q

How long should we be using a foley for?

A

Up to 3 weeks only!!

Consider urostomy or suprapubic for longer.

High UTI risk!!!
Also uncomfortable af

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9
Q

How does a foley work?

A

Double lumen.

  • Lumen 1 is for the actual catheter part.
  • Lumen 2 is to inflate a balloon with saline to keep it in the bladder.
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10
Q

What makes urine orangey? Brown?

A
  • Orangey: Phenazopyridine or rifampin.
  • Brown: Rhubarb
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11
Q

What makes urine super yellow?

A

Vit B

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12
Q

What does an UTI typically smell like?

A

Foul or fishy odor

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13
Q

What diet makes urine acidic? Alkaline?

A
  • Acidic: protein and cranberries
  • Alkaline: vegetarians, citrus fruit, low-carb

Citric acid is metabolized into alkaline byproducts.

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14
Q

What can cause a false negative for heme in an urine dipstick?

A

Excessive Vit C

Urine dipstick is not confirmatory for hematuria without microscopy.

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15
Q

What does leukocyte esterase imply in a urine dipstick?

A

SUGGESTIVE of UTI

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16
Q

What kind of bacteria makes nitrites?

A

G-

E. coli is prob the most common.

Absence of nitrites doesnt mean no UTI.

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17
Q

What makes urobilinogen and bilirubin?

A
  • Urobilinogen: metabolized biliburin by gut bacteria
  • Bilirubin: Unconjugated
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18
Q

What is the most likely substance to cause a false negative on urine dipstick?

A

Vit C/ascorbic acid

19
Q

What does presence of detectable glucose on an urine dipstick?

A

DM

Unless on SGLT2 inhibitor.

20
Q

What usually causes ketones in urine?

A
  • Fasting
  • Exercise
  • Pregnancy

Generally just suggests ketosis.

21
Q

What is a urine dipstick sensitive for?

A

Albumin only

If they spill out other protein, it can’t catch.

Not as accurate as a urine microalbumin.

22
Q

What is urine SG generally used to estimate?

A

Urine osmolality

23
Q

What is considered positive for RBCs on a urine microscopy?

A
  • 5+ RBCs per HPF
  • 3+ RBCs on multiple HPFs
24
Q

What causes dysmorphic RBCs?

A

Glomerular disease

They’ve been forced through weird holes in the tubules.

Suggestive of nephrotic or nephritic synrome

25
Q

What causes RBC casts?

A

GN or vasculitis

26
Q

What is an abnormal WBC count on urine microscopy?

A

> 5 WBCs per HPF

Implies injury to urinary tract

27
Q

What do WBC casts imply?

A

Inflammation of the kidney

Casts in general suggest poor urine flow.

28
Q

What kind of urine samples containing bacteria are significant?

A

Catheterized or suprapubic tap.
If theres any bacteria at all = significant.

These should be sterile.

29
Q

How much bacteria needs to be present for an UTI?

A

> 100,000 colony count

MUST BE ROOM TEMP URINE

One organism = UTI
multiple = contamination

30
Q

What is the MC yeast in urine microscopy?

A

C. albicans

31
Q

What conditions are suggested by increased shedding of tubular epithelial cells?

A
  • Nephrotic syndrome
  • Tubular degeneration

They are very round

32
Q

What are lipid filled cells in lipiduria called?

A
  • Oval fat bodies
  • Maltese crosses
  • Grape clusters
33
Q

Presence of what kind of epithelial cells suggests cancer in an urine microscopy?

A

Transitional epithelial cells

If in high numbers.

34
Q

What are granular casts suggestive of?

A

ATN

35
Q

What are waxy casts suggestive of?

A

CKD

36
Q

Presence of what findings on a urine dipstick suggest infection?

A
  • WBCs
  • Leukocyte esterase
  • Nitrites
37
Q

Presence of what findings on a urine dipstick suggest renal pathology and followups with imaging/nephro consult?

A
  • Proteinuria
  • RBC casts
38
Q

If we suspect hematuria, what labs are appropriate for evaluation?

A
  • Serum BUN/Cr
  • CBC
  • Coags
39
Q

What is the imaging modality of choice for upper tract origins of hematuria?

A

CT Urography

MRI is 2nd

40
Q

What is a CT abd/pelvis good for in terms of hematuria imaging?

A
  • Checks for neoplasms
  • Checks for benign conditions
41
Q

What imaging modality is generally NOT recommended for hematuria analysis?

A

US

42
Q

What is cystoscopy good for in terms of hematuria analysis?

A

Lower urinary tract.

Best to do while patient is actively bleeding.

43
Q

What conditions should make us cautionary in performing a renal biopsy?

A

Avoid if on anticoags or has a coagulopathy

Last resort

44
Q

If imaging is negative for hematuria, what shoudl we do?

A
  • Reimage in like 3-6 months.
  • If recurrent: refer to nephro/uro

GU (14 decks)

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