Lower Urinary Tract Obstruction Facts Flashcards
lower urinary tract obstructions are related to
alterations of urine storage in the bladder or emptying of urine through the bladder outlet
types of incontinence
urge (mostly older aldults) - abrupt and strong desire to void (urgency)
stress (mostly women < 60 yr old and men who have prostate surgery) - coughing, sneezing, etc.
overflow - overdistention of bladder
mixed (older women) - stress and urge combo
functional - dementia or immobility
common causes of obstruction
urethral stricture, prostatic enlargement in men, pelvic prolapse (bladder and uterus) in women, tumor compression
symptoms of obstruction
frequent daytime voiding (more than every 2 hours)
nocturia (more than once a night for 65+ yrs old and twice a night for older)
poor force of stream
intermittency of urinary stream
bothersome urinary urgency, often combined with hesitency
feelings of incomplete bladder emptying
overactive bladder syndrome more common in
women and people over 65
how many healthcare visits per yr for UTIs
10 million
____% of women will have a lower UTI in their life
50
factors that protect against UTI
most bacteria washed out during micturition (urination)
low pH and high osmolality of urea
presence of Tamm-Horsfall protein or uromodulin
secretion from uroepithelium
longer urethra and prostatic secretions in men
____% of cases of septic shock are caused by urosepsis
30%
most common infecting microorganism is
second most common is
e. coli
staph saprophyticus
bladder infection most common in
women
risk factors for bladder infection
sexual activity, pregnancy
vesicouretreral reflux
instrumentation, poor hygiene
neurogenic bladder
obstruction
diabetes
common symptoms of bladder infection
can be asymptomatic - 10%
dysuria
urinary frequency
urinary urgency
suprapubic pain
hematuria
treatment of bladder infection
1-3 days of antibiotics
bladder infection can develop into
pyelonephritis (greater risk)
most common route of infection for pyelonephritis
from bladder to kidneys
but can occur from blood stream
most common bacteria for infection for pyelonephritis
e. coli, proteus, pseudomonas
pathophysiology of pyelonephritis
infiltration of WBC with renal inflammation
renal edema
purulent urine
severe cases can have medullary or cortical abscess - necrosis
tubules primary affected
symptoms of pyelonephritis
fever, chills, flank or groin pain
glomerulus can be damaged by
immulnologic abnormalities (most common)
chemicals (drugs)
radiation
hypoxemia
vascular disorders
infection
unknown causes
type of urine sediment from nephrotic damage
protein, lipids
little blood
type of urine sediment from nephritic damage
blood with red cell casts
white cell casts
not high levels of protein
glomerular damage decreases capillary membrane surface area which causes
fluid to move to interstitial spaces
decreased GFR
symptoms of glomerulonephritis
hematuria with RBC casts
* often smoky brown-tinged
* indicates blood from glomerlulus
proteinuria exceeding 3-5g/day (albumin major protein here)
HTN
decreased GFR - Na and water retention
prognosis of progressive glomerulonephritis
acute may not progress if treated
renal symptoms develop after 10-20 years
nephrotic syndrome follows (loss of protein through glomerulus)
progression to end stage renal failure
ultimately require dialysis or transplantation
hallmark signs of nephrotic syndrome
excretion of 3.5g or more protein in urine per day
nephrotic syndrome usually seen in
glomerulonephritis
diabetes
systemic lupus erythematosus
malignancies
drugs
nephrotic syndrome more common in
children
nephrotic syndrome usually associated with
more serious prognosis
hallmark signs of nephritic syndrome
hematuria and RBC casts in urine
proteinuria seen but less severe than in nephrotic syndrome
nephritic syndrome usually seen in
infection
rapidly progressing glomerulonephritis
