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Renal system > PBL questions 2 > Flashcards

PBL questions 2 Flashcards

1
Q

causes of UTI

A

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

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2
Q

symptoms of UTI - general

A 
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
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3
Q

symptoms of UTI in elderly

A

changes in behaviour
confusion
agitation

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4
Q

symptoms of UTI in children

A 
appear generally unwell
irritable 
not feeding properly
pyrexic 
wetting the bed/ themselves 
deliberately retaining urine due to pain
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5
Q

diagnosis of UTIs

A

urinalysis - WBCs, RBCs, bacteria (nitrates), proteins, pH, glucose, bilirubin
urine culture
CT or MRI if frequent UTIs
cystoscopy if recurrent UTIs

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6
Q

treatment for UTIs

A

short course of antibiotics
different for different populations
plenty of fluids
pain relief - paracetamol

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7
Q

most commonly used antibiotic for an uncomplicated UTI

A

trimethoprim

nitrofurantoin

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8
Q

how do UTIs affect brain function in an acute setting?

A

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

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9
Q

what are the types of bladder incontinence?

A

stress
urge
overflow
total

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10
Q

stress incontinence

A

when urine leaks out at times when the bladder is under pressure - coughing/ laughing

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11
Q

urge incontinence

A

when urine leaks as you feel a sudden, intense urge to urinate or soon after

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12
Q

overflow incontinence

A

unable to fully empty the bladder, causing frequent leaking

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13
Q

total incontinence

A

when the bladder cannot store any urine at all, causing urine to be passed constantly and frequent leaking

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14
Q

causes of bladder incontinence

A

weakened or damaged pelvic floor muscles
weakened or damaged urethral sphincter muscles
overactivity of detrusor muscles
obstruction or blockage in bladder
spinal injury
fistula

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15
Q

what increases risk of bladder incontinence?

A 
pregnancy
vaginal birth
obesity
family history of incontinence
increasing age
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16
Q

how is bladder incontinence diagnosed?

A 
history taking 
bladder diary -
physical examination 
dipstick test
residual urine test - ultrasound scan
cystoscopy 
urodynamic tests
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17
Q

what physical examinations are done in diagnosis of bladder incontinence

A

pelvic
vaginal
prostate
digital rectal

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18
Q

what is involved in a bladder diary?

A 
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
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19
Q

what is involved in urodynamic tests?

A

check function

measure pressure using a catheter

20
Q

treatment for bladder incontinence

A 
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
21
Q

anticholinergic medications

A

class of drugs that block acetylcholine in CNS and PNS. Treat conditions associated with activation of the parasympathetic nervous system

22
Q

side effects of anticholinergic medications

A 
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
23
Q

urinary retention

A

the inability to completely or partially empty the bladder
unable to start urination or fully empty the bladder
there are 2 types

24
Q

what are the types of urinary retention?

A

obstructive

non-obstructive

25
Q

obstructive urinary retention

A

there is an obstruction prevention urine flowing freely

26
Q

non-obstructive urinary retention

A

weak. bladder muscles and nerve problems that interfere with brain-bladder impulses

27
Q

causes of non-obstructive urinary retention

A
  • stroke
  • vaginal childbirth
  • pelvic injury/ trauma
  • impaired muscle or nerve function due to medication or anaesthesia
  • accidents that injure the brain or spinal cord
28
Q

causes of obstructive urinary retention

A
  • cancer
  • kidney/ bladder stones
  • enlarged prostate in men
29
Q

symptoms of urinary retention

A
  • 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
30
Q

how is urinary retention diagnosed?

A

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

31
Q

how to treat urinary retention?

A 
antibiotics
drugs to shrink the prostate
cystoscopy
laser therapy 
interventions to prevent the prostate obstructing the urethra 
surgery 
physical therapy
bladder training
32
Q

renal function tests

A 
albumin to creatinine ratio 
serum creatinine
creatinine clearance
urine albumin
urine microalbumin
blood urea nitrogen
33
Q

albumin to creatinine ratio

A

> 30mg

urine protein/creatinine

34
Q

GFR

A

children and seniors have lower GFRs

35
Q

serum creatinine

A

0.6-1.1mg/dL in women and 0.7-1.3mg/dL in men

high level may indicate kidney damage/ disease

36
Q

creatinine clearance

A

88-128mL/min for women and 97-137mL/min for men

compares creatinine in blood and urine

37
Q

urine albumin

A

0/8mg/dL is normal

rising levels show a kidney problem

38
Q

urine microalbumin

A

<30mg is normal
30-300mg may mean early chronic kidney disease
>300mg means a later stage of CKD

39
Q

blood urea nitrogen

A

7-20mg/dL normal for adults and children
if high may indicate kidney function is reduced
if low may indicate a protein deficiency

40
Q

what are the different types of diuretic?

A

loop diuretics
potassium-sparing diuretics
thiazide diuretics
carbonic anhydrase inhibitors

41
Q

loop diuretics

A

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

42
Q

potassium-sparing diuretics

A

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

43
Q

thiazide diuretics

A

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

44
Q

carbonic anhydrase inhibitors

A

inhibit recycling of bicarbonate and reduce Na+ reabsorption
used for altitude sickness and glaucoma

45
Q

why was Mr Kowlski’s BP medication stopped when he started antibiotics?

A

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.

46
Q

prevalence of UTIs

A

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%

Renal system (17 decks)

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