Nocturia Flashcards
Differentiate glomerular versus non-glomerular hematuria
acanthocytes (dysmorphic urine RBC)
Red Cell Casts
New Proteinuria
Elevated Serum Creatinine
Non-glomerular: more likely to have visible BC
________- is one of first things to consider in workup of hematuria
urine culture
Most hematuria is found on _______ and can easily be diagnosed by ________
- routine urine exam
- ruling out infection
____________ is size and stage tumor in RCC
CT abdomen
In patients patients WITHOUT symptoms of dysuria, nocturia or incontinence, what is NOT recommended?
- PSA
- DRE
________________ increases a patient’s risk for prostate cancer
1st degree relative w prostate cancer
Dx and Tx of prostate cancer is ________
individualized
With is a surgical concern with Urinary Tract Stone Disease?
concommitant infection
What will pt with Urinary Tract Stone Disease
present on in PE
- Severe flank pain that radiates to groin
- Urinary frequency, hesitancy, hematuria
- N/V
What can we use on a pt with Urinary Tract Stone Disease to see stones on imaging?
CT
UD
There are 7 ________ causes of geriatric urinary incontinence (aka ____________)
- reversible
- transient urinary incontinence
What are the 7 reversible causes of transient urinary incontinence?
DIAPPERS
Delirium Infection Atrophic vaginitis Pharmaceuticals Psychosocial/Psychiatric Excess urine: diuresis, hyperglycemia Stool impaction
MCC of fever
infection
Other causes of fever
- AI disease
- CNS disease (head trauma, lesion)
- Cancer (esp lymphoma, leukemia, RCC, primary or metastic liver cancer
Nocturia
getting up to pee more than 2x/night, which often occurs in the setting of dysuria and/or UI
Dysuria
hard time peeing, occurring at more external locations like urethra, bladder and suprapubic area or as the urine exits the body
Urinary incontinence
can’t control the flow of urine
Leaking of urine when coughing, sneezing or standing
stress incontinence
urgency and inability to hold pee
caused by?
urge incontinence
_____ incontinence has variable presentation
overflow incontinence
What is the MCC of established geriatric incontinence (2/3 of cases?
Detrusor overactivity (urge incontinence)
What are the causes of:
- Stress incontinence
- Urge incontinence
- Overflow incontinence
- Stress incontinence is d/t urethral incontinence (urethral obstruction, prostate enlargement, stricture, bladder neck contraction)
- Urge incontinence is d/t detrusor overactivity
- Overflow incontinence is d/t detrusor underactivity
What is the LCC of incontinence?
Detrusor overactivity
Dysuria DDx
o Cystitis o Uretheritis (gon or chlamydia) o Pyelonephritis o Vaginitis o Epididymis o Balantis o Prsastitis o URetheral syndrome o Genital herpes o Reactive arthritis (reiters syndrome)
How can we diagnose detrusor overactivity (=> urge incontinece) vs uretheral incompetence (=> stress incontinence?
Standing full bladder stress test: ask the patient to stand while coughing
- immediate release of urine => urethral incompetence
- few second delay release of urine => detrusor overactivity (uninhibited bladder contraction)
What distinguishes detrusor overactivity from underactivity and urethral incontinence?
Destrusor underactivity has a high postvoid residual (generally over 450 mL)
lab tests for incontinence
- review meds
- UA, urine culture for infection
- Tests for hyperglycemia, hypercalcemia, DI
lab tests for incontinence
US to see if postvoidal residual
In regard to prostate cancer, the decision is always based on
risk vs benefit
______ is a pathologic process that contributes to the development of lower urinary tract symptoms (LUTS)
BPH
LUTS are subdivided into what symptoms
Obstructive symptoms (urinary hesistancy, straining, weak stream, terminal dribbling, prolong voinding, incomplete emptying)
irritative symptmos (increase in freq, urgency, nocturia, incontinence, small boided bolumes)
diagnostic symptoms score of BPH (AUA sx scale) = tells us sx severity and prostate cancer risk
0-7: mild
8-19: moderate
20-35: severe
In patients with symptoms, ___________ can identify those with normal flow rates who are unlikely to benefit from treatme
urine flow studies
_____________ can identify those with high postvoid residuals who may need intervention
bladder US
_____________studies detect primary bladder dysfunction
pressure-flow (urodynamic) studies
________ is recommended if hematuria is documented and to assess the urinary outflow tract before surgery
cytoscopy
___________ is advised for patients with hematuria, a history of calculi, or prior urinary tract problems.
imaging of upper tracts
Symptoms of benign prostatic hyperplasia most often come from
- blocked uretha
2. Overworked bladder
_________ is the most common reason men seek treatment for BPH, and therefore the goal of therapy for BPH.
sympmatic relief ((alpha-adrenergic ANT)
surgery is a 2nd line threapy
__________I as combination therapy seeks to provide symptomatic relief while preventing progression of BPH
alpha-adrenergic receptor antagonist and a 5ARI
First, avoid PSA in _______
Second, do not treat __________
3rd; refer _______ to urologist
men with little-no gain
2nd: those who do not need tx; screen detected prostatte cancer does not need immediate treatment and can be managed w surviellence
3rd: refer men who do not need tx to
before performing PSA, do what?
determine pts risk for BPH and prostate cancer.
DRE is likely not considered unless pt is high risk; even then does not impact decision making
R
refer men with PSA of _______ to urology if symotom score is moderate -severe
4-7 ng/ml
DDx for cystitis
o Pyelonephritis o Urethritis o Vaginitis o Prostatitis o Asymptomatic bacteriuria (ASB)
, ____ occurs in the absence of symptoms attributable to the bacteria in the urinary tract and usually does not require treatment, while _____ has more typically been assumed to imply symptomatic disease that needs ABX therapy.
ASB
UTI
I often diagnose ASB in elderly patients or those with ________s. Often, they do not need therapy, such as antibiotics!
chronic indwelling catheters
patient does not have local or systemic symptoms referable to the urinary tract
usually bacteriuria detected incidentally
ASB
The typical symptoms of cystitis are
dysuria, urinary frequency, and urgency
. _____ is the main feature distinguishing cystitis from pyelonephritis.
fever
prostatitis is almost always _______ in nature and will often compaoin of pain where
bacterial
between scrotum and anus (perineal)
a symptomatic episode of cystitis or pyelonephritis in a pt with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy.
complicated UTI
symptoms of LHF
- breathless (dyspnea)
- Orthopnea
- PND
- hemoptysis
- high RR and HR
6/ rales
7 base of lungs are dull to percussion bc of congestion of luid in lungs
volume overload is a typical process that is commonly treated with ______ and other medications to_________, _______ afterload and _____ preload
diuretics
increase contractility
increase afterload
decrease preload
why can HF lead to nocturia?
HF causes decrease renal perfusion during day when standing up; when laying down it goes back to normal => diuresis
essential of dx of kidney stone dz
- severe flank pain
- N/V
- Id on non-constrast CT or US
Epidemo of kdinewy stones
male
30-40a
hot summer months
struvite calci are most likely due to
urease producing organisms (proteus, pseudomas, providencia)
• Laboratory Tests for kidney stones
UA; will see gross/microscopic hematuria in 90% of pts
urinary pH
Persistent urinary pH < 5.5 is suggestive of…
uric acid or cystine stones
Persistent urinary pH ≥ 7.2 is suggestive of a
struvite infection stone
Urinary pH between 5.5 and 6.8 typically indicates
calcium-based stones
what iwll detect most stones
plain film of abdomen (KUB; kidney, ureter, bladder)
b. Prevention of kidney stones
- increase fluid intake to pee out 1.5-2 l
- drink during meals, 2 hours after, before bed and at night
- decrease Na+ intake
- decrease animal protein
when to refer for kidney stones
- urinary obstrauction
- kidney stone + flank pain
- abnormal kidney
- concomiitant pyelonephritisi or recurrent infection
when to admit for kidney stones
- N/V to manage sx
2. Obstruction stone with sign of infection (CONSULT UROLOGY ASAPROONY)
when to admit for kidney stones
- N/V to manage sx
2. Obstruction stone with sign of infection (CONSULT UROLOGY ASAPROONY)
acute bacterial prostatits mcc
e.coli and pseudomas
Prostatitis, Acute Bacterial
• Essentials of Diagnosis
o Fever o Irritative voiding symptoms o Perineal or suprapubic pain o Exquisite tenderness on rectal examination o Positive urine culture
acute bacterial prostatits
CBC:
UA:
Urine culure
CBC: leukocytosis and left shift
UA: pyuria, bacteruria, hematuria
culture: +
why can diabetic pts experience nocturia
DB => hyperglycemia => high glucose => osmotic diuresis => nocturia
why can diuretics cause nocturia
HF pts are congested; diuretics restribute volume => lying down changes venous pressure and increases VR => kidneys filter more fluid at night
