Renal Medicine 3 Flashcards
what is included in urinary tract disease
• Urinary tract infection • Urinary tract obstruction ○ Renal stones ○ Tumours ○ Prostatic hypertrophy • Urinary tract malignancy
who is urinary tract infection more common in
more common in women than men
what are the usual micro-organism causing UTIs
• Usually E.coli (85%)
○ Staph, fungi, virus & TB possible
§ An immunosuppressed individual is more likely to have other organisms getting in
Urine bacteriostatic to perineal organisms
what is cystitis
bladder inflammation
what are predisposing factors to UTIs
○ Poor bladder emptying
○ Low urinary flow rate
is there bacteria in urine normally
no
urine is sterile
detecting any bacteria implies infection
is it normal to find cells in the urine
no
white cells in the urine is indicative of UTI
blood (red cells) and proteins should also not be found in the urine
which section of the urine is the most sterile
• Collect MID-stream urine sample (MSSU)
○ Middle section of urine is the most sterile
○ Start of urine is washing out bacteria trying to ascend
○ End of urine there is a risk of organisms trying to get in again
what does urine sampling show and include
- Shows how contamination changes with flow
- Usually the mid stream is the least contaminated
- Random sampling more likely to catch contamination
what is supra-pubic urine sampling
- Needle into abdomen and penetrates the bladder to take a sample out
- Can have a catheter at the bottom of the abdomen
○ Less inconvenient having it in your stomach
○ Less likely to get infected
○ Patients are still free to pee
○ Better long term
what can infected urine cause
○ Cystitis
§ Can spread upwards to the kidney - more likely when you have problems with urine flow
§ Muscle of bladder can contract incorrectly
□ When it contracts it should close off access to the ureters so the urine cannot go back to the kidney
□ When this isn’t working then the urine can be squeezed back up to the kidney and any micro-organism in it can reach the kidney
○ Renal infection
○ Prostate infection
§ Urine passing through the prostate gland
Antibiotics into the prostate area can be difficult
does urethritis always come with cystitis
no
urethritis can happen in isolation
does not spread into the bladder usually
gonococcal - tends to be more localised
what is urine reflux
- Bladder contracts (during voiding) and instead of forcing urine out of the urethra as normal it also forces urine back into the kidneys
- UTI can be passed up into the kidneys and can a renal infection
- Can be an inherited problem
○ Some people are born this way - Can be a developed problems
Usually need surgery to get the ureter to properly close off during voiding when the bladder contract
what are the symptoms of an UTI
• Dysuria = Pain on peeing
• Urinary frequency
○ Need to pee more quickly = lots of voiding
○ Takes less filling before it needs to empty
○ Doesn’t pass as much urine each time you pee as the bladder isn’t full
• Cloudy urine (should be clear)
○ Infected urine contains cells and proteins which creates the cloudy appearance
• Offensive smelling urine
• Supra-pubic pain
○ The bladder sits relatively close to the pubic bone
○ Causes pain in abdomen
• Symptoms vary for patients
how is a UTI diangosed
○ MSSU only (less contamination)
○ Microscopy, culture and sensitivity § Look for cells in the urine § Try to culture the organism □ Most of time will be E.coli From this the lab will try and see what drugs the organism will be sensitive to
how is a UTI treated
• Increase fluid intake
• Frequent micturition
○ Pee more
• Occasionally antibiotics are required
○ Trimethoprim, amoxycillin
§ Don’t need to have an antibiotic for a UTI unless things have gone too far and the infection has spread systemically and the patient has a fever etc
§ If you think you have a UTI starting then just increase fluid intake to try and wash out the infection by peeing more often
what causes urinary tract obstructions
• Renal calculi / stones
• Prostatic disease
○ Hypertrophy
○ Prostatic malignancy
• Urinary tract strictures
• External compression
○ Squishing the urinary tracts
where do kidney stones have the worst effect
ureter
causes ureter muscle to spasm as it tries to pass the stone
once it reaches the bladder it can usually pass fairly painlessly
describe kidney stones
§ Stones form in the pelvis of the kidneys
□ Can be sharp and pointy and different sizes
® Big stones usually remain in the kidney
® Small stones can usually pass with little problem
® It is the middle stones that cause the worst pain as they are small enough to move but still big enough to get caught
where can the prostate gland be found
Prostate gland sits just underneath the bladder and urine has to pass through this to get out of the body
prostate gland grows throughout life
what is prostatitis
○ Inflammation of the prostate
○ Causes sudden narrowing of the urinary passage
○ Can happen within days or hours
- causes discomfort when patient tries to pee and urine flow is more difficult
- usually bladder struggles to maintain the pressure needed to force urine out of the body so results in incomplete emptying of the bladder = risk of a UTI
what is benign prostatic hypertrophy
○ Hyperplasia of the prostate
§ Not linked to prostatic cancer
○ Happens over a longer period - usually over years
○ Can completely block urinary outflow
More people have this
gland gets bigger and causes the urethra to narrow
not due to inflammation
tends to affect the full gland
what is prostatic cancer
○ Adenocarcinoma
○ Not linked to benign prostatic hypertrophy
○ Happens in one area with the prostate and as it gets bigger it can stop the urinary outflow
how can you deal with the effects of prostatitis
make the urethra bigger
