Presentation of urinary Disorders

Question 1

Divide the urinary tract into upper and lower [2]

Answer 1

Upper Urinary Tract = Kidneys –> Vesicouretic junction

Lower Urinary Tract = Bladder –> Urethral meatus/foreskin

Question 2

Define proteinuria?

Answer 2

> 150mg/day or urinary protein

Question 3

Define pyuria?

Answer 3

White cells in the urine

Question 4

Define oliguria, anuria, polyuria, nocturia and nocturnal polyuria?

Answer 4

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

Question 5

How does Chronic renal Failure present? [11]

Answer 5

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

Question 6

Categories of Ureteric obstruction? [3]

Answer 6

Intra-luminal - Stones or blood clots
Intra-mural - Scar tissue or TCC (Transitional Cell Carcinoma)
Extra-luminal - Pelvic mass or lymph nodes

Question 7

Disorders of what neurological regions can cause bladder dysfunction? [3]

Answer 7

1) Cortical centres - Conscious micturition control
2) Pons - Micturition Centre
3) Sacral Segments S2-4 - Micturition reflex

Question 8

Types of pain in urinary disease? [3]

Answer 8

Renal colic - in obstructions
Suprapubic pain - bladder or urethral disorders
Perineal pain - Bladder outflow tract disorders

Question 9

What is pneumaturia? Cause? [2]

Answer 9

Gas or air in the urine

Most often due to a colo-vesical fistula from colonic diverticulosis

Question 10

What are the groups of Lower Urinary Tract Symptoms? [2]

Answer 10

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)

Question 11

Types of incontinence [6]

Answer 11

Stress
Urge
Mixed
Overflow (Urinary retention reaches such a high pressure that you become incontinent)
Neurogenic
Dribbling

Question 12

What are the main differences between acute and chronic urinary retention?

Answer 12

Acute is a painful inability to void with palpable/percussible bladder
Chronic is painless and the bladder is still palpable/percussible after voiding

Question 13

Whats the main cause of acute urinary retention? [2]

Answer 13

Benign Prostatic Obstruction

Often with an underlying trigger such as excess alcohol, constipation or post-operatively

Question 14

Whats the treatment for acute urinary retention? [2]

Answer 14

Catheterisation

Treat underlying trigger/cause

Question 15

Complications/presentation of Urinary Retention? [6]

Answer 15

Voiding LUTS
UTIs
Post-decompressive Haematuria
Electrolyte distubances or persistant renal dysfunction (chronic)
Pathological Diuresis

Question 16

What is pathological diuresis? [1]

What are accompanying signs of this? [3]

Answer 16

Postobstructive diuresis is a polyuric response initiated by the kidneys after the relief of a substantial bladder outlet obstruction.
UO >200ml/hr
Postural Hypotension
Weight Loss
Electrolyte abnormalities

Question 17

What is required to diagnose a UTI? [7]

Answer 17

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

Question 18

List some major urinary emergencies? [9]

Answer 18

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

Question 19

What is paraphimosis? [2]

Answer 19

Retracted foreskin that cant be returned to normal position

can lead to gangrene -> amputation

Question 20

What is priapism?

Answer 20

A prolonged often painful erection