Presentation of urinary Disorders Flashcards
Divide the urinary tract into upper and lower
Upper Urinary Tract = Kidneys –> Vesicouretic junction
Lower Urinary Tract = Bladder –> Urethral meatus/foreskin
Define proteinuria?
> 150mg/day or urinary protein
Define pyuria?
Pus in the urine
Any infection or inflammatory disorder could cause it
Define oliguria, anuria, polyuria, nocturia and nocturnal polyuria?
Oliguria <0.5ml/Kg/hr
Anuria = Absolure (no urine) or Relative (<100ml/24hrs)
Polyuria = >3L/24hrs
Nocturia = Waking >1 time a night to pee
Nocturnal polyuria = Nocturnal UO is >1/3rd of total ouput
Define acute kidney injury (AKI)?
Aka Acute Kidney Failure (ARF)
An abrupt loss of kidney function that develops within 7 days
How do we stage AKI?
RIFLE. A progressive set of criteria to monitor the severity of Kidney Injury
What does the R in rifle mean?
RIFLE - AKI staging
R = Risk:
1) 1.5 serum creatinine
2) OR 25% loss of GFR
3) <0.5ml/Kg/hr UO for 6 hours
What does the I in RIFLE mean?
I - Injury
1) 2x serum creatinine
2) Or 50% loss of GFR
3) <0.5ml/Kg/Hr UO for 12 hours
What does the F in RIFLE mean?
Failure
1) 3x serum creatinine
2) Or 75% loss in GFR
3) Or UO <0.3ml/Kg/hr for 24 hours
4) Or Anuria for 12 hours
What does the L in RIFLE mean?
Loss
1) Persistent AKI
2) Or complete loss of function >4 wks
What does the E mean?
End Stage Disease
Completely loss of kidney function >3 months
How does Chronic renal Failure present?
1) Fluid issues (Peripheral oedema, pulmonary oedema, dyspnoea & CHF)
2) Anaemia (produces erythropoeitin)
3) Hypertension (Renin)
4) Bone pain
5) Pruritis, N&V
6) Pericarditis
7) Neuropathy
8) tiredness
9) Coma
10) Electrolyte inbalances
11) Acid base inbalance
Categories of Ureteric obstruction?
Intra-luminal - Stones or blood clots
Intra-mural - Scar tissue or TCC (Transitional Cell Carcinoma)
Extra-luminal - Pelvic mass or lymph nodes
Disorders of what neurological regions can cause bladder dysfunction?
1) Cortical centres - Conscious micturition control
2) Pons - Micturition Centre
3) Sacral Segments S2-4 - Micturition reflex
Types of pain in urinary diseae?
Renal colic - in obstructions
Suprapubic pain - bladder or urethral disorders
Perineal pain - Bladder outflow tract disorders
What is pneumaturia?
Gas or air in the urine
Most often due to a colo-vesical fistula from colonic diverticulosis
What are the groups of Lower Urinary Tract Symptoms?
Storage LUTS: (basically can’t hold urine in)
Frequency, nocturia, urgency, urge incontinence
Voiding LUTS: (Problems voiding bladder)
Poor Flow, intermittent, dribbling, hesitency, incomplete emptying, overflow incontinence
Most often down to Bladder Outflow Obstruction (BOO)
Types of incontinence?
Stress Urge Mixed Overflow (Urinary retention reaches such a high pressure that you become incontinent) Neurogenic Dribbling
What are the main differences between acute and chronic urinary retention?
Acute is a painful inability to void with palpable/percussible bladder
Chronic is painless and the bladder is still palpable/percussible after voiding
Whats the main cause of acute urinary retention?
Benign Prostatic Obstruction
Often with an underlying trigger such as excess alcohol, constipation or post-operatively
Whats the treatment for acute urinary retention?
Catheterisation
Treat underlying trigger/cause
Whats the main cause of Chronic Urinary Retention?
Mainly down to detrusor inactivity:
1) Primary bladder failure
2) Secondary to longstanding BOO (either Benign prostatic enlargement {BPE} or urethral stricture)
How do you treat Chronic Urinary Retention?
Catheterise
IV fluids
Long Term Catheter
Or Clean Intermittent Self Catheterisation (CISC)
Or Transurethral Resection of Prostate (TURP) if down to Benign prostatic enlargement
Complications/presentation of Urinary Retention?
Voiding LUTS UTIs Post-decompressive Haematuria Electrolyte distubances or persistant renal dysfunction (chronic) Pathological Diuresis
What is pathological diuresis?
UO >200ml/hr
Postural Hypotension
Weight Loss
Electrolyte abnormalities
Its a possible complication of urinary retention
What is required to diagnose a UTI?
Microbiological evidence = 10^4 cfu/ml bacterial account from a MSSU
+ atleast 1 of fever, loin/flank pain, suprapubic pain, urinary frequency, urinary urgency or dysuria
Types of UTI?
complicated
- Due to some co-morbidy e.g. immunosuppression, an abnormal renal tract e.g. tumour or stone or a foreign body e.g. catheter
Uncomplicated
- Mainly sexually active young women
List some major urinary emergencies?
1) Acute Kidney Injury
2) Sepsis from UTI
3) Renal Colic
4) Hemorrhagic shock from severe haematuria
5) Urinary Retention
6) Metastatic complications e.g. hypercalcaemia or spinal cord compression
7) Testicular Torsion
8) Paraphimosis
9) Priapism
What is paraphimosis?
Retracted foreskin that cant be returned to normal position
can lead to gangrene -> amputation
What is priapism?
A prolonged often painful erection
