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Genitourinary > MDT's Part 1 > Flashcards

MDT's Part 1 Flashcards

1
Q

What is hematuria?

A

Presence of blood in urine

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2
Q

Gross vs microscopic hematuria?

A
  • Gross: visible to naked eye
  • Microscopic: only detectable my microscopy
  • Both require further evaluation
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3
Q

Gross hematuria from the lower tract (bladder/urethra) is most commonly found from what?

A

Urothelial carcinoma of the bladder

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4
Q

What is microscopic hematuria most commonly from?

A

Benign prostatic hyperplasia

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5
Q

In gross hematuria, what is the presence of blood at the beginning of the urinary stream called and what area of the urinary tract is the source?

A
  • Initial hematuria

- Anterior (penile) urethral source

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6
Q

In gross hematuria, what is the presence of blood at the end of the urinary stream called and what area of the urinary tract is the source?

A
  • Terminal hematuria

- Bladder neck or prostatic urethral source

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7
Q

In gross hematuria, what is the presence of blood throughout the urinary stream called and what area of the urinary tract is the source?

A
  • Total hematuria

- Bladder or upper tract source

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8
Q

When would hematuria indicate Ureteral stone?

A

Hematuria associated with renal colic

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9
Q

Irritating voiding symptoms in a young woman with hematuria may suggest?

A

Acute bacterial infection and associated cystitis

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10
Q

In UA for hematuria, what does proteinuria and casts suggest?

A

Renal origin

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11
Q

Imaging/Referral for hematuria?

A
  • CT scan without contrast of Upper tract
  • Cystoscopy
  • Urology (anatomic abnormality, urolithiasis, recurrent cystitis)
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12
Q

General considerations for Urinary Tract Infection?

A
  • Coliform bacteria most common (E. coli)
  • Ascending infection most common route
  • Hematogenous spread to urinary tract is uncommon
  • Lymphatic spread is rare
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13
Q

What is acute cystitis?

A
  • Infection of the bladder
  • Most commonly due to coliform bacteria (E. coli)
  • Uncomplicated cystitis in men is rare and implies pathologic process
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14
Q

S/S of acute cystitis?

A
  • Irritating voiding symptoms
  • Suprapubic discomfort (tenderness with palpation)
  • Women experience hematuria and Sx’s appear post sex
  • Usually afebrile
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15
Q

Imagining for acute cystitis?

A
  • Abdominal ultrasonography or cystoscopy

- CT scan is warranted if pyelonephritis are suspected

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16
Q

Treatment of acute cystitis?

A
  • Women:
  • Cipro
  • Nitrofurantoin (Macrobid)
  • Bactrim
  • Men:
  • Depends on underlying etiology
  • Urinary analgesics
  • Pyridium (Phenazopyridine)
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17
Q

Prevention of cystitis in women who have 3 or more episodes in one year?

A
  • Thorough urologic evaluation
  • Prophylactic antibiotic therapy
  • Bactrim
  • Nitrofurantoin
  • Cephalexin
  • Single dose at bedtime or after intercourse
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18
Q

What is pyelonephritis?

A
  • Infectious inflammatory disease involving kidney parenchyma and renal pelvis
  • Gram-negative bacteria most common causative agent
  • E. coli
  • Proteus
  • Pseudomonas
  • Infection usually spreads from lower urinary tract (except S. aureus)
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19
Q

S/s of Pyelonephritis?

A
  • Fever
  • Flank pain
  • Irritative voiding Sx’s
  • Shaking chills
  • Nausea/vomiting
  • Diarrhea
  • Tachycardia
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20
Q

Differential Dx for pyelonephritis?

A
  • Acute cystitis
  • Acute Intra-abdominal disease
  • Males:
  • Epididymitis
  • Acute prostatitis
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21
Q

Imaging for pyelonephritis?

A

Renal ultrasound

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22
Q

Inpatient treatment for pyelonephritis?

A
  • Ampicillin IV and gentamicin continued for 24 hours after fever resolved
  • Then oral antibiotics to 14 day course of antibiotics
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23
Q

Outpatient treatment for pyelonephritis?

A
  • Ciprofloxacin
  • Levofloxacin
  • Phenazopyridine
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24
Q

Complications of pyelonephritis?

A
  • Sepsis and shock
  • Abscess formation from inadequate therapy
  • Catheter drainage might be necessary
25
Q

MEDEVAC to Urology or infectious disease for pyelonephritis when?

A
  • Evidence of complicating factors
  • Severe infections
  • Evidence of sepsis
  • Need for parental antibiotics
  • Absence of clinical improvement in 48 with oral antibiotics
26
Q

What is acute prostatitis?

A

Inflammation and infection of prostate gland usually caused by gram-negative rods (E. coli and Pseudomonas)

27
Q

Most likely routes of infection for prostatitis?

A
  • Ascent up the urethra

- Reflux of infected urine

28
Q

S/s of prostatitis?

A
  • Perineal, suprapubic, or sacral pain
  • Fever, high
  • Irritative voiding symptoms
  • Obstructive symptoms that may lead to urinary retention
  • Warm and tender prostate
29
Q

Lab findings prostatitis?

A
  • Leukocytosis and a left shift on UA
  • Pyuria, Bacteriuria, and hematuria on UA
  • Urine cultures demonstrate offending pathogen
30
Q

Rad for prostatitis?

A

No

31
Q

Inpatient treatment of prostatitis?

A

Ampicillin and gentamicin until 24-48 hours resolution of fever
- oral antibiotics for 4-6 weeks

32
Q

Outpatient treatment of prostatitis?

A
  • Cipro
  • Levofloxacin
  • Bactrim
  • Acetaminophen/NSAIDS
  • Stool softeners
33
Q

What to do if urinary retention develops with prostatitis?

A
  • Percutaneous Suprapubic tube is required

- Urethral catheterization is CONTRAINDICATED

34
Q

MEDEVAC for prostatitis?

A
  • Evidence of urinary retention
  • Signs of sepsis
  • Surgical drainage of bladder prostatic abscess
  • Evidence of chronic prostatitis
  • Absence of clinical improvement in 48 with oral antibiotics
35
Q

Chronic bacterial prostatitis?

A
  • May evolve from acute prostatitis
  • Many men have no Hx of acute infection
  • Gram negative rods are most common
  • Enterococcus only gram positive organism
  • Not to be managed by IDC alone
36
Q

S/Sx’s of chronic bacterial prostatitis?

A
  • Irritating voiding symptoms
  • Low back and perineal pain
  • Suprapubic discomfort
  • Hx UTI
  • PE unremarkable
  • Prostate may be:
  • Normal
  • Boggy
  • Indurate
37
Q

Tx of chronic bacterial prostatitis?

A
  • Bactrim
  • Cipro
  • Levofloxacin
  • Duration lasts 6-12 weeks
  • NSAIDS
  • Sitz baths
38
Q

What is Epididymitis?

A
  • Inflammation and/or infection of epididymitis
  • Can be divided into two categories:
  • Sexually transmitted forms
  • Non-sexually transmitted forms
  • Route of infection is probably urethra to ejaculatory duct
39
Q

Information on sexually transmitted epididymitis?

A
  • Typically occurs in men under 40 year
  • Associated with urethritis
  • Results from chlamydia or gonorrhea
40
Q

Information of non-sexually transmitted epididymitis?

A
  • Typically occur in older men
  • Associated with UTI and prostatitis
  • Caused by gram negative rods ( E. Coli, Klebsiella)
41
Q

S/Sx’s of epididymitis?

A
  • May follow acute physical strain, trauma, or sexual activity
  • Associated Sx’s of urethritis and cystitis
  • Pain develops in scrotum and may radiate along spermatic cord or to flank
  • Fever
  • Scrotal swelling
    • epididymis might be distinguishable from testes early on**
42
Q

Later S/Sx’s of epididymitits?

A
  • Epididymis and testes can appear as one mass
  • Prostate may be tender on rectal exam
  • Prehn sign
43
Q

What is Prehn sign?

A

Elevation of scrotum above pubic symphysis may relieve pain from epididymitis

44
Q

Imaging for epididymitis?

A

Scrotal U/S

45
Q

Tx for sexually transmitted epididymitis?

A
  • Ceftriaxone IM
    PLUS
  • Doxycycline
46
Q

Tx for non-sexually transmitted epididymitis?

A
  • Trimethoprim/sulfamethoxaz (Bactrim)
  • Ciprofloxacin
  • Levofloxacin
47
Q

Symptomatic relief for Epididymitis?

A
  • Bed rest
  • Scrotal support
  • Ice packs
  • NSAIDS
48
Q

Complications of epididymitis?

A
  • Delayed or inadequate Tx may result in:
  • Epididymo-orchitis
  • Decreased fertility
  • Abscess formation
49
Q

Follow up for epididymitis?

A

Refer to Urology if:

  • Persistent symptoms or infection despite antibiotic therapy
  • Signs of sepsis or abccess formation
50
Q

General considerations for renal calculi/urolithiasis/kidney stones?

A
  • Men are more frequently affected than woman (2.5:1 ratio)
  • Initial presentation predominantly between 3rd and 5th decade
  • There are five types urinary stones (calcium most common)
51
Q

What are some contributing factors to renal calculi/urolithiasis?

A
  • High humidity
  • Elevated temperatures
  • Sedentary lifestyle
  • HTN
  • Carotid calcification
  • Cardiovascular disease
  • High protein and salt diet with inadequate hydration
52
Q

What are some sign/symptoms of renal calculi/urolithiasis?

A
  • Sudden pain (may be episodic)
  • Pain localized to the flank
  • Pt constantly moving to find comfort
  • Pain may radiate anteriorly over abdomen
  • Stone size does not correlate to severity of symptoms
53
Q

How do obstructing urinary stones present?

A

Acute, unremitting and severe colic

54
Q

Urinalysis finding for urolithiasis/urinary stones?

A
  • Microscopic or gross hematuria (absence does not exclude)

- Urinary pH is a valuable clue

55
Q

Imaging for renal caculi/urinary stone?

A
  • Plain abdominal radiograph
  • Renal U/S
  • Spiral CT with Pt in prone position
56
Q

Tx for urinary stone?

A
  • Forced IV fluids or diuresis in counterproductive
  • Medical expulsive therapy (Alpha blockers, NSAIDS, corticorsteroids)
  • Surgical Tx
57
Q

Prevention of renal calculi?

A
  • Dietary modification:
  • Increased fluid intake
  • Restrict sodium intake
  • Spread animal protein throughout day
58
Q

Complications of urolithiasis?

A

Obstructing stone with an associated infection is a medical emergency
** MEDEVAC **

59
Q

Referral to urology for urolithiasis is warranted when?

A
  • Obstructing stone with associated infection
  • Stone fails to pass after 4 weeks
  • Fever
  • Intolerable pain
  • Persistent Nausea/vomiting

Genitourinary (6 decks)

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