PBL questions 2 Flashcards
causes of UTI
bacteria from stool entering urinary tract via urethra
pregnancy
blockage of the urinary tract - kidney stones
difficulty emptying bladder -enlarged prostate and constipation
urinary catheters
weakened immune system - diabetes, chemo, HIV
contraceptive diaphragm or condom coated in spermicide
symptoms of UTI - general
urinary frequency sudden urge to urinate dysuria pain/ burning on micturition smelly urine cloudy urine pain in lower abdomen malaise feeling unwell loin pain and fever - upper UTIs
symptoms of UTI in elderly
changes in behaviour
confusion
agitation
symptoms of UTI in children
appear generally unwell irritable not feeding properly pyrexic wetting the bed/ themselves deliberately retaining urine due to pain
diagnosis of UTIs
urinalysis - WBCs, RBCs, bacteria (nitrates), proteins, pH, glucose, bilirubin
urine culture
CT or MRI if frequent UTIs
cystoscopy if recurrent UTIs
treatment for UTIs
short course of antibiotics
different for different populations
plenty of fluids
pain relief - paracetamol
most commonly used antibiotic for an uncomplicated UTI
trimethoprim
nitrofurantoin
how do UTIs affect brain function in an acute setting?
elderly patients with serious infection can sometimes not exhibit characteristic signs such as fever due to the inability of the immune system to mount a response.
the bacteria in urine spread into blood stream
they can cross the BBB
causes confusion and cognitive difficulties - agitation and withdrawal
in people with a memory impairment or dementia a UTI can cause sudden and severe confusion - worsening their symptoms
what are the types of bladder incontinence?
stress
urge
overflow
total
stress incontinence
when urine leaks out at times when the bladder is under pressure - coughing/ laughing
urge incontinence
when urine leaks as you feel a sudden, intense urge to urinate or soon after
overflow incontinence
unable to fully empty the bladder, causing frequent leaking
total incontinence
when the bladder cannot store any urine at all, causing urine to be passed constantly and frequent leaking
causes of bladder incontinence
weakened or damaged pelvic floor muscles
weakened or damaged urethral sphincter muscles
overactivity of detrusor muscles
obstruction or blockage in bladder
spinal injury
fistula
what increases risk of bladder incontinence?
pregnancy vaginal birth obesity family history of incontinence increasing age
how is bladder incontinence diagnosed?
history taking bladder diary - physical examination dipstick test residual urine test - ultrasound scan cystoscopy urodynamic tests
what physical examinations are done in diagnosis of bladder incontinence
pelvic
vaginal
prostate
digital rectal
what is involved in a bladder diary?
3 days fluid intake type of fluids taken frequency of urination volume of urine how many episodes of incontinence number of times you experience urge
what is involved in urodynamic tests?
check function
measure pressure using a catheter
treatment for bladder incontinence
lifestyle changes pelvic floor exercises bladder training NHS continence services incontinence products Duloxetine antimuscarinics surgery urethral bulking agents artificial urinary sphincter botox injections sacral nerve stimulation posterior tibial nerve stimulation urinary diversion catheterisation augmentation cystoplasty
anticholinergic medications
class of drugs that block acetylcholine in CNS and PNS. Treat conditions associated with activation of the parasympathetic nervous system
side effects of anticholinergic medications
dry mouth blurred vision dry eyes constipation urinary retention dizziness due to drop in BP - postural hypotension cognitive problems - confusion heart rhythm disturbance these are common especially in the elderly
urinary retention
the inability to completely or partially empty the bladder
unable to start urination or fully empty the bladder
there are 2 types
what are the types of urinary retention?
obstructive
non-obstructive
obstructive urinary retention
there is an obstruction prevention urine flowing freely
non-obstructive urinary retention
weak. bladder muscles and nerve problems that interfere with brain-bladder impulses
causes of non-obstructive urinary retention
- stroke
- vaginal childbirth
- pelvic injury/ trauma
- impaired muscle or nerve function due to medication or anaesthesia
- accidents that injure the brain or spinal cord
causes of obstructive urinary retention
- cancer
- kidney/ bladder stones
- enlarged prostate in men
symptoms of urinary retention
- difficulty starting to urinate – dysuria
- difficulty fully emptying the bladder
- weak dribble or stream of urine
- loss of small amounts of urine during the day
- inability to feel when bladder is full
- increased abdominal pressure
- lack of urge to urinate
- strained efforts to push urine out of bladder
- frequent urination
- nocturia
how is urinary retention diagnosed?
medical history
physical examination of lower abdomen
rectal examination - check size of prostate
urine dipstick
ultrasound test - check volume in bladder
cystoscopy
CT scan
catheter used to record pressure in bladder
measuring urine flow rate
prostate-specific antigen blood test
electromyography
how to treat urinary retention?
antibiotics drugs to shrink the prostate cystoscopy laser therapy interventions to prevent the prostate obstructing the urethra surgery physical therapy bladder training
renal function tests
albumin to creatinine ratio serum creatinine creatinine clearance urine albumin urine microalbumin blood urea nitrogen
albumin to creatinine ratio
> 30mg
urine protein/creatinine
GFR
children and seniors have lower GFRs
serum creatinine
0.6-1.1mg/dL in women and 0.7-1.3mg/dL in men
high level may indicate kidney damage/ disease
creatinine clearance
88-128mL/min for women and 97-137mL/min for men
compares creatinine in blood and urine
urine albumin
0/8mg/dL is normal
rising levels show a kidney problem
urine microalbumin
<30mg is normal
30-300mg may mean early chronic kidney disease
>300mg means a later stage of CKD
blood urea nitrogen
7-20mg/dL normal for adults and children
if high may indicate kidney function is reduced
if low may indicate a protein deficiency
what are the different types of diuretic?
loop diuretics
potassium-sparing diuretics
thiazide diuretics
carbonic anhydrase inhibitors
loop diuretics
act on ascending limb of LoH
inhibit NKCC
increases water and electrolyte excretion
used for pulmonary oedema especially in left ventricular failure and chronic heart failure
potassium-sparing diuretics
causes retention of potassium
given with thiazide or loop diuretics as a more effective alternative to potassium supplements
used in conjunction with other drugs to treat hypertension and manage congestive heart failure
thiazide diuretics
promote diuresis by inhibiting the sodium/ chloride cotransporter in DCT
used to relieve oedema due to chronic heart failure and reduce BP in lower doses
carbonic anhydrase inhibitors
inhibit recycling of bicarbonate and reduce Na+ reabsorption
used for altitude sickness and glaucoma
why was Mr Kowlski’s BP medication stopped when he started antibiotics?
Trimethoprim, the antibiotic most commonly given to patients with UTIs is associated with sudden death in patients who take ACE inhibitors or ARBs due to trimethoprim-induced hyperkalaemia, especially in older patients, females, taking aspirin or have angiopathy.
Trimethoprim decreases urinary potassium excretion.
prevalence of UTIs
highest incidence in young women
incidence increases with age for both sexes
50% of women report having had a UTI some point in their life
lifetime risk in females = 60.4%
