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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
Most common microorganism causing UTI
Escherichia coli (80%)
26
UTI predisposing factors
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
UTI in children
Oral antibiotic for 3 days | Trimethoprim, nitrofurantoin
28
UTI in pregnant women
Pyelonephritis in pregnancy can lead to preterm labour or loss of pregnancy
29
UTI in pregnant women- contraindicated antibiotics
Trimethoprim- teratogenic | Nitrofurantoin can cause haemolysis in 3rd trimester
30
UTI in pregnant women- antibiotics
Penicillins | Cephalosporins
31
UTI in non-pregnant sexually active women
Trimethoprim/sulfamethoxazole for 3 days Trimethoprim alone for 3 days Nitrofurantoin for 5 days
32
UTI in young men
Rarely occurs in men <50 Further investigation should be done into underlying urinary tract abnormality Fluoroquinolone antibiotic for 7-14 days
33
UTI in elderly people
UTI risk increases with age More likely to have asymptomatic UTI Treatment not always indicated Antibiotics used= ciprofloxacin or trimethoprim/sulfamethoxazole
34
UTI in people with abnormal urinary tracts
Bacterial therapy >14 days
35
Recurrent UTI lifestyle advice
Change contraception to avoid products with spermicides Drink cranberry juice Drink more fluid and urinate after intercourse Vaginal oestrogen creams for postmenopausal women
36
UTI- when to consider antibiotics
Preventative antibiotic treatment may be recommended if you repeatedly develop bladder infections + have not responded to other preventive measures
37
Preventive antibiotic regimes- Continuous
Low dose of antibiotic 1 x day or 3 x week for several months to several years
38
Preventive antibiotic regimes- following intercourse
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
Preventive antibiotic regimes- self treatment
Plan to begin antibiotics at 1st sign of bladder infection
40
UTI- Urine dipstick
Nitrates +ve Leucocytes +ve Haematuria +ve
41
UTI- Urine MCS
Presence of RBCs, WBCs and bacteria Identification of infecting organism Identification of therapy organism is sensitive to
42
Isolated UTI
At least 6 months between infections
43
Recurrent UTI
>2 infections in 6 months or 3 within 12 months Re-infection- diff organism Persistence- same organism
44
Unresolved UTI
Inadequate therapy | May be due to bacterial resistance
45
Lower UTI is called
Cystitis
46
Cystitis presentation
``` Frequent small vol. voids Urgency Suprapubic discomfort Dysuria Haematuria ```
47
Cystitis investigations
Dipstick of midstream urine- presence of leucocytes and nitrites Urine MC+S if dipstick negative
48
Cystitis management
Uncomplicated- short dose Abx, trimethoprim Complicated- 7-10 days, Abx augmentin + more Ix Male- 2 wk quinolone Abx e.g. ciprofloxacin
49
Upper UTI is called
Pyelonephritis
50
Pyelonephritis Presentation
Flank/loin pain Nausea + vom Fever + rigors LUTS
51
Pyelonephritis investigations
Dipstick MSU | Urine MC+S- 80% E coli
52
Pyelonephritis management
Not systemically well- consider outpatient, 10 day oral Abx | Systemically unwell- admit for IV Abx
53
Pyelonephritis complications
Perinephric abscess RFs- diabetes, obstructing calculus Microbiology- S aureus, E coli, Proteus Tx- draining, ABx

Met 3b (21 decks)

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