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Met 3b > LUTS + UTI > Flashcards

LUTS + UTI Flashcards

1
Q

3 Glandular Zones of prostate

A

Peripheral
Central
Transitional

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2
Q

Peripheral Zone

A

Affected by prostate adenocarcinoma

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3
Q

Central zone

A

Surrounds ejaculatory ducts

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4
Q

Transitional zone

A

Surrounds proximal urethra

Affected by BPH

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5
Q

Storage symptoms (irritative) LUTS

A

Frequency
Urgency
Nocturia

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6
Q

Voiding symptoms (obstructive) LUTS

A 
Hesitancy
Weak/intermittent flow
Straining
Incomplete emptying
Terminal dribbling
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7
Q

Frequency

A

High frequency with normal 24hr volume suggests bladder capacity diminished

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8
Q

How much volume does male bladder hole

A

300-600mL

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9
Q

Polyuria

A

More urine than usual- up to 3L is normal

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10
Q

Nocturnal polyuria

A

Passing, at night, more than 35% of 24hr urine production

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11
Q

Urine dipstick

A

Can identify haematuria, glycosuria, proteinuria, pyuria + presence of urinary nitrates + leucocytes
UTI + diabetes

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12
Q

PSA levels raised by

A 
Age
BPH
Prostatitis
UTI
Urinary retention
Ejaculation
Vigorous exercise
DRE
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13
Q

PSA Normal levels

A 
50-59= <3ng/ml
60-69= <4ng/ml
70+= <5ng/ml
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14
Q

BPH

A

Raises PSA

If below <10ng/ml, unlikely to be cancer

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15
Q

Prostate cancer signs

A 
Prostate hard + irregular
Unexplained haematuria
Lower back pain
Bone pain
Weight loss
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16
Q

Phimosis

A

Constriction of foreskin

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17
Q

Overactive bladder associated conditions

A 
BPH
Dementia, diabetic neuropathy, Parkinson's, MS, stroke
LUTI
Bladder stone
Cancer
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18
Q

Overactive bladder treatment

A

Antimuscularinics (oxybutyinin, tolterodine, darifenacin)

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19
Q

Nocturnal polyuria drug causes

A

CCBs
Diuretics
SSRIs

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20
Q

Acute urinary retention treatment

A

Catheterisation
Alpha blocker
Intermittent or continual urethral catheretirasation

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21
Q

BPH treatment- alpha 1 antagonists

A

Tamsulosin, Alfuzosin

Relaxes bladder neck

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22
Q

BPH treatment- 5a reductase inhibitors

A

Finasteride

Inhibit testosterone–> DHT

23
Q

BPH treatment- antimuscarinics

A

Offer if others not working

Oxybutynin

24
Q

Common microorganisms for UTI

A 
Escherichia coli (80%)
Staphylococcus saprophyticus (4%)
Klebsiella pneumoniae (4%)
Proteus mirabilis (4%)
Other bacteria (9%)
25
Q

Most common microorganism causing UTI

A

Escherichia coli (80%)

26
Q

UTI predisposing factors

A

History of recurrent UTIs
Presence of indwelling catheterisation
Abnormalities of renal tract function/structure- impaired urethral peristalsis, neuropathic bladder, outflow obstruction, anatomical abnormality
Immunosuppression
Previous urinary tract instrumentation
Incomplete bladder emptying (e.g. BPH)
Female specific- pregnancy, spermicide coated condoms, sex
Male specific- not being circumcised, insertive anal sex
Lymphatic infection- IBD, retroperitoneal abscess

27
Q

UTI in children

A

Oral antibiotic for 3 days

Trimethoprim, nitrofurantoin

28
Q

UTI in pregnant women

A

Pyelonephritis in pregnancy can lead to preterm labour or loss of pregnancy

29
Q

UTI in pregnant women- contraindicated antibiotics

A

Trimethoprim- teratogenic

Nitrofurantoin can cause haemolysis in 3rd trimester

30
Q

UTI in pregnant women- antibiotics

A

Penicillins

Cephalosporins

31
Q

UTI in non-pregnant sexually active women

A

Trimethoprim/sulfamethoxazole for 3 days
Trimethoprim alone for 3 days
Nitrofurantoin for 5 days

32
Q

UTI in young men

A

Rarely occurs in men <50
Further investigation should be done into underlying urinary tract abnormality
Fluoroquinolone antibiotic for 7-14 days

33
Q

UTI in elderly people

A

UTI risk increases with age
More likely to have asymptomatic UTI
Treatment not always indicated
Antibiotics used= ciprofloxacin or trimethoprim/sulfamethoxazole

34
Q

UTI in people with abnormal urinary tracts

A

Bacterial therapy >14 days

35
Q

Recurrent UTI lifestyle advice

A

Change contraception to avoid products with spermicides
Drink cranberry juice
Drink more fluid and urinate after intercourse
Vaginal oestrogen creams for postmenopausal women

36
Q

UTI- when to consider antibiotics

A

Preventative antibiotic treatment may be recommended if you repeatedly develop bladder infections + have not responded to other preventive measures

37
Q

Preventive antibiotic regimes- Continuous

A

Low dose of antibiotic 1 x day or 3 x week for several months to several years

38
Q

Preventive antibiotic regimes- following intercourse

A

In women who develop UTIs after sex
Take single low dose after intercourse can help prevent bladder infections
–> overall less antibiotic use than continuous

39
Q

Preventive antibiotic regimes- self treatment

A

Plan to begin antibiotics at 1st sign of bladder infection

40
Q

UTI- Urine dipstick

A

Nitrates +ve
Leucocytes +ve
Haematuria +ve

41
Q

UTI- Urine MCS

A

Presence of RBCs, WBCs and bacteria
Identification of infecting organism
Identification of therapy organism is sensitive to

42
Q

Isolated UTI

A

At least 6 months between infections

43
Q

Recurrent UTI

A

> 2 infections in 6 months or 3 within 12 months
Re-infection- diff organism
Persistence- same organism

44
Q

Unresolved UTI

A

Inadequate therapy

May be due to bacterial resistance

45
Q

Lower UTI is called

A

Cystitis

46
Q

Cystitis presentation

A 
Frequent small vol. voids
Urgency
Suprapubic discomfort
Dysuria
Haematuria
47
Q

Cystitis investigations

A

Dipstick of midstream urine- presence of leucocytes and nitrites
Urine MC+S if dipstick negative

48
Q

Cystitis management

A

Uncomplicated- short dose Abx, trimethoprim
Complicated- 7-10 days, Abx augmentin + more Ix
Male- 2 wk quinolone Abx e.g. ciprofloxacin

49
Q

Upper UTI is called

A

Pyelonephritis

50
Q

Pyelonephritis Presentation

A

Flank/loin pain
Nausea + vom
Fever + rigors
LUTS

51
Q

Pyelonephritis investigations

A

Dipstick MSU

Urine MC+S- 80% E coli

52
Q

Pyelonephritis management

A

Not systemically well- consider outpatient, 10 day oral Abx

Systemically unwell- admit for IV Abx

53
Q

Pyelonephritis complications

A

Perinephric abscess
RFs- diabetes, obstructing calculus
Microbiology- S aureus, E coli, Proteus
Tx- draining, ABx

Met 3b (21 decks)

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