Renal Outflow Disease Flashcards
What are the different urinary tract diseases
UTI
urinary tract obstruction
urinary tract malignancy
What can be the causes of urinary tract obstruction
renal calculi
prostatic disease
urinary tract strictures
external compression
Why do UTIs happen
Infection has got in through the exit of the urethra
What do the ascending bacteria in a UTI do
They will irritate, colonies and destroy parts of the epithelium
They will attract invasion of inflammatory cells to get rid of the infection
There will be an increased blood flow
If there are white blood cells, red blood cells and proteins in the urine what are these indicating
kidney disease, inflammatory changes or neoplastic changes
Why is UTI commoner to women
due to anatomy
What is the most common bacteria to cause a UTI
E.Coli
What other organisms could cause a UTI
staph, fungi, virus and TB
What is the effect of urine on perineal organisms
bacteriastatic
doesn’t kill them but stops them from reproducing
What is cystitis
bladder inflammation
What are predisposing factors to a UTI
poor bladder emptying
low urinary flow rates
Does urine have bacteria in it
Urine should not
it is sterile
What does detecting any bacteria in urine imply
infection
What is skin contamination of urine
The first stream of urine to come out is often contaminated but the next bit of urine should be sterile
What is indicative of an infection as well regarding urine
white cells
blood
When should the urine sample be collected
mid stream
What is supra pubic sampling
Suprapubic aspiration and catheterization is a procedure to obtain uncontaminated urine from the urinary bladder
How is supra pubic sampling done
You can put a catheter through the bottom of the abdomen or go through the urethra
If urine is infected what can it cause
cystitis
renal infection
prostate infection
What can cause urethritis in isolation, without cystitis
Gonorrhea
What are the symptoms of a UTI
dysuria urinary frequency cloudy urine offensive smelling urine supra-pubic pain
How is a UTI diagnosed
MSSU only (less contamination)
What is done to the urine in the lab
microscopy, culture and sensitivity
look for cells, try and culture the organism from that and see which antibiotics work
How is a UTI treated
increased fluid intake
frequent micturition
occasionally antibiotics required
What antibiotics are used to treat a UTI
trimethoprim
amoxycillin
When do we give antibiotic
when we start to see systemic signs and symptoms
Where does the prostate sit
underneath the bladder
What is benign prostatic hypertrophy
gets bigger and so becomes smaller on the inside squeezing the urethra
How can prostate disease lead to urinary tract obstruction
hypertrophy
prostatic malignancy
What is prostatitis
inflammation of the prostate
What is benign prostatic hypertrophy
hyperplasia of the prostate
What is prostatic cancer
adenocarcinoma
What does prostatitis result in
inflammation of bladder, narrowing of tube and inflammation and discomfort around the prostate itself
What are symptoms of urine outflow obstruction
slow stream hesitancy frequency urgency nocturia incomplete voiding
What is the treatment for BPH
initially drug based
may require surgery - prostatectomy
What is the drug used for benign prostatic hypertrophy
alpha-adrenergic antagonist
What are the two types of prostatectomy
transurethral prostatectomy
open prostatectomy
What is transurethral prostatectomy
A transurethral resection of the prostate (TURP) is surgery to remove parts of the prostate gland through the penis
What is an open prostatectomy
Open prostatectomy is a traditional “open” surgical procedure, which means the surgeon accesses the prostate gland through a standard surgical incision
What are risks of prostatectomy
damage to sphincter of the bladder causing incompetence
When does prostatic malignancy usually start
> 45 YO
Is prostatic malignancy symptomatic
Not usually - normally not the cause of death
Why is PSA not used for screening
It is not always diagnostic
problems with specificity and sensitivity
What is PSA useful for
monitoring disease activity in those known to have disease
What is the treatment of prostatic malignancy
surgery
radiotherapy
hormone treatment
What surgery is done for prostatic malignancy
radical prostatectomy
What are issues with radical prostatectomy
can lead to incompetence problems
What can radiotherapy do
it can help slow it down
What is the hormone treatment for prostatic malignancy
anti-androgens and LHRH analogues
Why are anti androgens used for prostatic malignancy
testosterone will make the cancer grow so we block testosterone and use Luteinizing hormone-releasing hormone instead
What does Luteinizing hormone-releasing hormone do
Luteinizing hormone-releasing hormone (LHRH) analogs lower your body’s ability to make testosterone to very low levels
Where can you develop renal calculi
in the kidney
in the bladder
What are the different stone types for renal calculi
calcium and oxalate (radiopaque) uric acid (not radiopaque(
How do you treat renal calculi
lithotrypsy
How does lithotripsy work
uses shock waves (pulses of energy) to break up the stones
