Renal Outflow Flashcards
what are the 2 types of renal outflow disease
urinary tract infection
obstruction
3 urinary tract disease
urinary tract infection
urinary tract obstruction
urinary tract malignancy
3 things that can cause urinary tract obstruction
renal stones
tumours
prostatic hypertrophy
what causes a UTI
Ascending infection from skin organisms
- Irritate colonise and destroy superficial layer of epithelium —–Red, hot, swollen
- Increase permeability of cells
- Outflow of inflammatory fluid
Girls more than boys
- Distance from outside world is shorter
mainly affecting bladder
- can affect anything from kidney down in urinary tract
what is urine
filtrate of plasma
Should have no cells or no protein
- Get them sign of infection
- —Kidney disease
- —Inflammatory or neoplastic changes in the bladder
Urine is sterile
- Most of the time shouldn’t contract as no poisons or bacteria should be present
what organisms cause UTIs
E. coli (85%)
- Staph, fungi, virus & TB possible (if in body can spread to bladder)
Urine bacteriostatic to perineal organisms
- Not washed of by urine flow or killed by urine action
immunosuppressed individual are more prone
what is cystitis
bladder inflammation
- lining of the bladder wall
how can cystitis be easily managed
by watching urine flow
- Pass urine regularly
- Wash urine out
what are 2 predisposing factors for cystitis
poor bladder emptying
Low urinary flow rates
what is a possible issue of taking a urine sample from first part of urine
Skin contamination possible
- Contains organisms washed out that have been trying to climb in
Middle section is sterile
what are signs of bacterial infection in urine
detecting any bacteria, white cells or blood
- 30% may be asymptomatic
what type of urine sample is the best to collect
mid-stream urine sample (MSSU)
what type of urine collection is needed to assess kidney function
24hr urine collection
MSSU
mid-stream urine sample
- sterile
out of:
- random void collection;
- clean catch collection (or bladder catheter);
- suprapubic sterile aspiration
which is least likely to have a contaminated urine sample
suprapubic sterile aspiration
how to collect a suprapubic sterile aspiration
Bladder needs to be rather full
Penetrate the bladder
Catheter in through tummy - rather than urethra
- Less inconvenient, less likely to be infected
- And can still pee if necessary
what are 3 illnesses which infected urine can cause
cystitis
renal infection
prostate infection
how can you contract a renal infection from infected urine
Spread upwards to kidney
- More likely in certain circumstances
Muscle contracts in the bladder close of the ureter
- Meaning cannot be squashed back up to kidney
- —Urine reflux
- As well as voiding out get reflux up ureter
- Get renal infection
- Can happen from birth
- —-May need surgical repositioning of ureter so when bladder contracts can work properly
- Inherited problem but can also develop
But if infection in bladder, not working well, then can pass up to kidney (infection too)
Renal infection is consequence of UTI
how can urethritis occur in isolation
STI link
- gonococcal
without cystitis/UTI prior
discharge is unpleasant
5 UTI symptoms
Dysuria
Urinary frequency
- Less filling before wants to empty
- Lots of voiding before full
Cloudy urine
- Should be clear and varying in colours
- But cloudy due to cells and proteins
Offensive smelling urine
Supra-pubic pain
2 methods of diagnosis of a UTI
MSSU only (less contamination)
Microscopy, Culture & Sensitivity
- White cells and RBC in urine are cultured for
3 methods of UTI treatment
first step wash organism out, continuously
- build up body defences
frequent micturition (urination)
occasionally antibiotics required (on occasion, if systemic signs and symptoms)
- trimethoprim, amoxycillin
- most of the time E.Coli cause
sensitive to similar antibiotics
4 causes of urinary tract obstruction
renal calculi
prostatic disease
urinary tract strictures
external compression
what is another name for renal calculi
renal stones
where are renal calculi formed
Form in kidney
- Pass down through ureter into the bladder
Pain when stone in ureter
how do renal calculi/stones cause pain
Pain when stone in ureter
Expect fluid so peristaltic wave
- Pointy sharp - contract harder to force down
- Won’t shift
- Digging into surface of ureter
Wait until stone in bladder and passed out
- Stones are often formed in pelvis of kidney and sit there - don’t always move
2 classes of prostatic disease
hypertrophy
prostatic malignancy
where is the prostate
sits underneath the bladder
- urine has to pass through the prostate to leave
how long is the growth period of the prostate
grows throughout life
- Gets bigger and bigger with time
Bigger on outside smaller on inside
- Ureter gets squashed so much hard to pass urine through
benign prostatic hypertrophy occurs in
males
prostatitis
inflammation of the prostate
- sudden narrowing of the urinary passage (overnight)
process of prostate disease and effect on urination
Bladder outflow through prostate
- Make space inside tube bigger
Change in patency of the urethra
- Becomes permanent
- Discomfort when try and pee as inflammation of the bladder
Bladder becomes harder to force urine through
- Urine flow more difficult - last muscle to release urine, narrowing of tube
Cannot do full bladder
partially empty bladder
- More prone to infection
due to urine sitting for more in bladder
what is benign prostatic hypertrophy
Hyperplasia of the prostate
- Over 10-15 years
Can completely block urinary tract (full obstruction)
Change in gland (as supposed to inflammatory change)
Specific
- Whole gland gets bigger
Compresses urethra
- Can get bigger but not cause compression
- —Screen for prostate cancer
incidence of benign prostatic hypertrophy
Almost normal
- 80% of men over 80
100% if they live long enough – usually die of other cause first
2 treatment options for benign prostatic hypertrophy
Initially drug based
Surgery – prostatectomy
drug treatment for benign prostatic hypertrophy
ά-blocking drugs
shrink prostate down –> symptoms of obstruction fade
surgery treatment for benign prostatic hypertrophy
TURP –transurethral prostatectomy
- Slurping a tube through – like apple corer
- Cuts away prostate gland which is touching surface of urethra
Open prostatectomy
- Taking prostate gland out
Underneath other parts, can damage sphincters and reflexes -Difficult operation
damage to sphincter of bladder causes
incontinence
how can benign prostatic hypertrophy be treated by endoscopic surgery procedures
Heated up and coagulate blood vessels
- Chops of flecks
Enough capacity in tube to allow flow
6 symptoms of urinary outflow obstruction
Slow stream
Hesitancy
Frequency (smaller volumes as cannot fully empty)
Urgency
Nocturia
Incomplete voiding
what type of tumour is prostatic cancer
adenocarcinoma
happens in one focal area in prostate
- squash and stop urinary outflow
what age group are commonly affected by prostatic cancer
starts after 45
- 90% men >90yrs have this at autopsy
Fairly common tumour
- Most asymptomatic – not cause of death
- 10% men have symptomatic disease
2nd commonest male cancer in the USA
89% 5yr survival
63% 10yr survival
why is prostatic cancer not easily detected
Not a good screening process - unlike cervical
No association with viruses at the moment
May not present early as may not cause UTI
what is prostatic specific antigen
a blood test carried out when males turn 50 years old
- not always diagnostic
Problems with Specificity and sensitivity excludes using PSA for screening
- Normal person can have high result without having tumour
what does a high prostatic specific antigen (PSA) indicate
send for more tests as indication of tumour
- not diagnostic
what is a good use for prostatic specific antigen (PSA)
monitoring disease activity in those known to have the disease
- Once cancer is known and prostate cancer diagnosed
what is a better diagnosis tool for prostate cancer than prostatic specific antigen blood test
MRI scan around 50 is better for diagnosis
4 treatment options for prostate cancer
Surgery – radical prostatectomy
Radiotherapy
Hormone treatment
Widespread bone metastasis
- osteosclerosis (on radiograph – black is area of no bone however, bone is condensing/forming around prostate tumour
dense, white appearance on radiograph)
can spread to soft tissue (less likely than other tumours)
what is radical prostatectomy for prostate cancer treatment and what is a disadvantage of this
Get rid of the gland
Morbidity and mortality in some pt
- Can lead to chronic disease problem
how can radiotherapy help treat a prostate adenocarcinoma
help slow the progression
what are the hormone treatment options for prostate cancer
Anti-androgens & LHRH analogues
block hormone-dependent tumour growth
- testosterone – make cancerous tumour grow
- —-remove then slow down tumour progression
chemical castration – switch of maleness via hormones
tumour can develop resistance to hormone sensitivity so no longer work
what % of population develop renal calculi
5%
- in kidney or bladder (ureter= pain)
what are 2 different renal calculi stone types
calcium and oxalate (radiopaque – see on radiograph)
uric acid (not radiopaque)
how to deal with a renal calculi if an incidental finding on a radiograph
tell pt but do nothing if not causing bother
how to treat a renal calculi causing pain to pt
LITHOTRYPSY
what is lithotrypsy treatment of a renal calculi
Break into small parts to pass through with no trouble or harm
Ultrasound energy to kidney stone from outside the body
- Like US scaler, Many vibrations 25000/sec
- Energy from vibration pass onto object
Through skin to kidney
Soft tissues (kidney) Move with US wave
Stone cannot so will break
More than one generator from different angles converge on where stone is in Renal pelvis
- Less forces on one particular area
