Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

URINARY > Presentation of Diseases of the Kidney and Urinary tract > Flashcards

Presentation of Diseases of the Kidney and Urinary tract Flashcards

1
Q

what comprises the upper urinary tract

A
  1. kidneys - parenchyma, pelvi-calyceal system

2. ureters - PUJ, ureter, VUJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what comprises the lower urinary tract

A
  1. bladder
  2. bladder outflow tract
    - bladder neck (intrinsic urethral sphincter)
    - prostate
    - external urethral sphincter/pelvic floor
    - urethra
    - urethral meatus
    - foreskin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 7 different types of renal/kidney diseases

A
  1. infection
  2. inflammation
  3. iatrogenic
  4. neoplasia
  5. trauma
  6. vascular
  7. hereditary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

for each of the 7 types of kidney disease, give an example

A
  1. infection -pyelonephritis
  2. inflammation - glomerulonephritis, tubulointerstitial nephritis
  3. iatrogenic - nephrotoxicity, PCNL
  4. neoplasia - renal tumours, collecting system tumours
  5. trauma - blunt trauma
  6. vascular - atherosclerosis, hypertension, diabetes
  7. hereditary - polycystic kidney disease, nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how can renal disease present

A

pain, pyrexia, haematuria, proteinuria, pyuria, mass on palpation, renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the definition of proteinuria

A

urinary protein excretion of >150mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how many types of haematuria are there

A

2 - microscopic and macroscopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the definition of microscopic haematuria

A

≥3 red blood cells per high power field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define oliguria

A

urine output <0.5ml/kg/hour

ie abnormally low urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define anuria

A

Absolute anuria - No urine output

Relative anuria - <100ml/24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define polyuria

A

urine output >3L/24 hours (i.e. abnormally large urine output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

define nocturia

A

Waking up at night ≥1 occasion to micturate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

define nocturnal polyuria

A

Nocturnal urine output >1/3 of total urine output in 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

for acute kidney injury (AKI) what are the definitions in terms of staging

A

use RIFLE staging criteria

R - risk
I - injury
F - failure
L - loss
E - end stage kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

explain the R stage from RIFLE

A

Risk - at risk of acute kidney injury when:
increase in serum creatinine level (1.5x)
OR
decrease in GFR by 25%
OR
UO <0.5mL/kg/h for 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

explain the I stage from RIFLE

A 
Injury - kidneys injured when:
increase in serum creatinine level (2.0x)
OR
decease in GFR by 50%
OR
UO <0.5 mL/kg/h for 12 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

explain the F stage from RIFLE

A

Failure - kidneys go into failure when:
increase in serum creatinine level (3.0x)
OR
decrease in GFR by 75%
OR
serum creatinine level >355μmol/L with acute increase of >44μmol/L
OR
UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

explain the L stage from RIFLE

A

Loss - Persistent ARF or complete loss of kidney function >4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

explain the E stage from RIFLE

A

End stage kidney disease - complete loss of kidney function >3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the functions of the kidney

A
  1. body fluid homeostasis (fluid overload - peripheral oedema, congestive cardiac failure, pulmonary oedema)
  2. electrolyte homeostasis (Na+, K+, Cl-, etc)
  3. acid base homeostasis (excrete H+, generate HCO3-)
  4. regulation of vascular tone (regulate BP)
  5. excretory functions (physiological waste esp urea, drugs)
  6. endocrine functions (erythropoeitin, VIt D metabolism, renin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how can chronic renal failure present

A

Asymptomatic (found on blood and urine testing)

  • tiredness
  • anemia
  • oedema
  • high blood pressure
  • bone pain due to renal bone disease
  • Pruritus (in advanced renal failure)
  • Nausea/vomiting (in advanced renal failure)
  • Dyspnoea (in advanced renal failure)
  • Pericarditis (in advanced renal failure)
  • Neuropathy (in advanced renal failure)
  • Coma (untreated advanced renal failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the 5 types of ureteric diseases

A
  1. infection
  2. iatrogenic/trauma
  3. neoplasia
  4. hereditary
  5. obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

for each of the 5 types of ureteric disease, give an example

A
  1. infection - ureteritis
  2. iatrogenic/trauma - inadvertently cut or tied during hysterectomy or colon resection
  3. neoplasia - TCC of ureter, TCC of bladder obstructing VUJ, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy
  4. hereditary - PUJ obstruction, VUJ reflux
  5. obstruction
    - intra-luminal (stone, blood clot)
    - intra-mural (scar tissue, TCC)
    - extra-luminal (pelvic mass, lymph nodes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how can ureteric disease present

A

pain (eg renal colic), pyrexia, haematuria, palpable mass (ie hydronephrosis), renal failure (only if bilateral obstruction or single functioning kidney)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the 7 types of bladder disease

A
  1. infection
  2. inflammation
  3. iatrogenic/trauma
  4. neoplasia
  5. idiopathic
  6. degenerative
  7. neurological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

for each of the 7 types of bladder disease, give an example

A
  1. infection - cystitis
  2. inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula
  3. iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)
  4. neoplasia - TCC of bladder, squamous cell carcinoma of bladder
  5. idiopathic - overactive bladder syndrome
  6. degenerative - chronic urinary retention
  7. neurological - neurogenic bladder dysfunction
27
Q

how can bladder diseases present

A

pain (suprapubic), pyrexia, haematuria, LUTS (storage and voiding symptoms), recurrent UTI, chronic urinary retention, urinary leak from vagina, pneumaturia

28
Q

the bladder is called an “unreliable witness” due to LUTS having multiple causes - name these causes

A
  1. bladder pathology
  2. bladder outflow obstruction
  3. pelvic floor dysfunction
  4. neurological causes
  5. systemic disorders
29
Q

what are the three area responsible for control of micturition

A
  1. cortical centre (bladder sensation and conscious inhibition of micturition)
  2. pons (micturition centre)
  3. sacral segments (S2-S4) (micturition reflex)
30
Q

what comprises the micturition reflex

A
  • relaxation of internal urethral sphincter (autonomic-sympathetic)
  • relaxation of external urethral sphincter (somatic)
  • contraction of detrusor muscle (autonomic-parasympathetic)
31
Q

what are the two phases of the micturition cycle

A
  1. storage (filling) phase

2. voiding phase

32
Q

what are the 5 types of bladder outflow tract diseases

A
  1. infection/inflammation
  2. iatrogenic/trauma
  3. neoplasia
  4. idiopathic
  5. obstruction
33
Q

for each of the 5 types of bladder outflow tract diseases, give an example

A
  1. Infection/Inflammation - prostatitis, balanitis
  2. Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture
  3. Neoplasia - prostate cancer, penile cancer
  4. Idiopathic - chronic pelvic pain syndrome
  5. Obstruction
    - primary bladder neck obstruction
    - benign prostatic enlargement (BPE) causing obstruction
    - urethral stricture
    - meatal stenosis
    - phimosis
34
Q

how do bladder outflow tract diseases present

A

Pain (suprapubic or perineal), Pyrexia, Haematuria, LUTS (voiding, overflow incontinence), Recurrent UTIs, Acute urinary retention, Chronic urinary retention

35
Q

what is the definition of acute urinary retention

A

painful inability to void with a palpable and percussible bladder

36
Q

what are the residuals for acute urinary retention

A

vary from 500ml to 1 litre (but usually <1 litre)

37
Q

what are the main causes of acute urinary retention

A

main cause is BPO BUT can also occur independently of BPO (eg. UTI, urethral stricture, alcohol excess, post-operative causes, acute surgical or medical problems)

38
Q

for patients with BPO, what usually triggers acute urinary retention

A

usually triggered by an unrelated event (eg. constipation, alcohol excess, post-operative causes, urological procedure)

39
Q

what is the immediate treatment for acute urinary retention

A

catheterisation (either urethral or suprapubic)

BUT
Treat underlying trigger if present

40
Q

what is the definition of chronic urinary retention

A

painless, palpable and percussible bladder after voiding

41
Q

what are the residuals for patients with chronic urinary retention

A

patient often able to void BUT residuals range from 400ml to >2 litres depending on stage of condition (i.e. wide spectrum)

42
Q

what is the main etiological factor for chronic urinary retention

A

detrusor underactivity:

  1. primary - ie primary bladder failure
  2. secondary - ie due to longstanding BOO, such as BPO or urethral stricture
43
Q

how does chronic urinary retention present

A 
LUTS 
or 
complications (e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure) 
or 
incidental finding
44
Q

what happens at the severe end of the spectrum when bladder capacity is reached and bladder pressure is in excess of 25cm water (i.e. high pressure chronic)

A

overflow incontinence and renal failure

45
Q

what patients with chronic urinary retention do not need treatment

A

asymptomatic patients with low residuals

46
Q

what is the immediate treatment of chronic urinary retention

A

catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)

47
Q

what are complications of chronic urinary retention

A

UTI, post-decompression haematuria, pathological diuresis, electrolyte abnormalities (hyponatraemia, hyperkalaemia, metabolic acidosis), persistent renal dysfunction due to acute tubular necrosis

48
Q

what are the two types of diuresis that can occur in HIGH pressure chronic urinary retention

A
  • Physiological (usually <200ml/hour)

- Pathological (usually >200ml/hour)

49
Q

what is subsequent treatment for chronic urinary obstruction

A

either long term urethral or suprapubic catheter, CISC or TURP if due to benign prostatic obstruction (BPO)

50
Q

what is the definition of a UTI

A

an infection affecting the urinary tract (including kidneys, bladder, prostate, testis and epididymis)

51
Q

what are the two things that are required for a diagnosis of a UTI

A

microbiological evidence AND symptoms/signs

52
Q

what microbial evidence is needed for a UTI diagnosis

A

Bacterial count of 104 cfu/ml from MSSU specimen with no more than two species of micro-organisms

53
Q

what symptoms/signs are needed for a UTI diagnosis

A

At least one of the following:

  • Fever >38ºC
  • loin/flank pain or tenderness
  • suprapubic pain or tenderness
  • urinary frequency
  • urinary urgency
  • dysuria
54
Q

what are the two types of UTI

A

uncomplicated - young sexually active females only with clear relation to sexual activity

complicated** - everyone else

**complicated UTIs ALWAYS need to be investigated

55
Q

what factors need to be considered for differentiating between complicated and uncomplicated UTI

A
  • Age
  • Sexual activity (females)
  • Gender
  • Co-morbidities (e.g. immunosuppression, renal failure, medications)
  • Abnormal renal tract (e.g. stones, renal outflow obstruction, BOO, horseshoe kidney, VU reflux, renal scarring, bladder tumour)
  • Foreign body (e.g. catheter, ureteric stent)
  • Type of organisms (E. coli, Staph. saprophyticus, Klebsiella, Proteus, Pseudomonas, Staph aureus)
56
Q

UTIs have different names depending on the organ affected - name the following:
bladder, prostate, kidney, testis

A

bladder - cystitis
prostate - prostatitis
kidney - pyelonephritis
testis - orchitis

57
Q

what are complications of UTI

A
  • infective: sepsis (esp. pyelonephritis), perinephric abscess
  • renal failure (scarring)
  • bladder malignancy (squamous cell carcinoma)
  • acute urinary retention
  • frank haematuria
  • bladder or renal stones
58
Q

what investigations are used for upper and lower UTI

A

MSSU/CSU

59
Q

what investigations are used for lower tract UTI

A

flow studies, residual bladder scan, cystoscopy

60
Q

what investigations are used for upper tract UTI

A

USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan

61
Q

what is the treatment for UTI

A
  • Appropriate antibiotic therapy (type? duration? route?)

- Treat complications and cause

62
Q

list soe emergencies related to urinary tract disease

A

Acute renal failure

Sepsis due to UTI +/- upper or lower urinary tract obstruction

Renal colic

Severe haematuria causing haemorrhagic shock

Metastatic disease causing metabolic derangements (eg. hypercalcaemia from bony metastases), spinal cord compression from vertebral metastases, etc.

Acute urinary retention

Chronic high-pressure urinary retention

Iatrogenic injury/Trauma to upper or lower urinary tracts, penis and testis

Testicular torsion

Paraphimosis

Priapism

63
Q

what are the organisms associated with UTIs

A 
E. coli
Staph. saprophyticus Klebsiella
Proteus
Pseudomonas
Staph aureus)

URINARY (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions