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Urinary > Session 9 Urinary > Flashcards

Session 9 Urinary Flashcards

1
Q

Features of urinary tract obstruction

A

Can occur at any level

Unilateral or bilateral, complete or incomplete, gradual or acute onset

Increases risk of UTI, reflux and stone formation

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2
Q

Causes of urinary tract obstruction

A
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3
Q

Causes of urinary retention

A

Calculi
Pregnancy
Benign prostatic hypertrophy BPH
Recent surgery
Drugs
Urethral strictures

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4
Q

Why does pregnancy cause urinary retention

A

High levels of progesterone relax muscle fibres in the renal pelvis and ureters and cause a dysfunctional obstruction

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5
Q

Other causes of urinary retention

A

Pelviureteric junction obstruction
Pelvic masses
Constipation
Inflammation
Tumours
Neurogenic disorders

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6
Q

Neurogenic disorders that impact urinary retention result from

A

Congenital abnormalities affecting the spinal cord

External pressure on the cord or lumbar nerve roots

Trauma to the spinal cord

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7
Q

What are Calculi

A

Kidney stones

Hard deposits made of minerals and salts that form inside kidneys

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8
Q

Acute vs chronic urinary retention

A

Acute- painful inability to void, residual volume 300-1500ml

Chronic- painless, may still be voiding, residual volume 300-4000ml

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9
Q

Management of acute urinary retention

A

Catheterise and record residual urinary volume

History

Examination (abdomen, external genitalia, DRE)

Investigations: Urine dip, Us and Es

Treat any obvious cause e.g. constipation,
BPH- alpha blocker, may trial without catheter after 1-2 weeks

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10
Q

Management of chronic urinary retention

A

Catheterise and record residual volume

History

Exam

urine dip, Us and Es

Plan for long term catheterisation or intermittent self-catheterisation. Wouldn’t attempt TWOC

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11
Q

Types of chronic urinary retention

A

High pressure: abnormal U and Es, hydronephrosis, repeat episodes = permanent renal scarring and CKD

Low pressure: Normal renal function, no hydronephrosis

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12
Q

what is post-obstructive diuresis

A

Following resolution of urinary retention through catheter, kidneys can often over-diurese

Leads to worsening AKI. Monitor urine output for 24hrs post catheterisation

Patients with high urine volumes should be supported with IV fluids

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13
Q

What is Diuresis

A

Losing large amounts of water

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14
Q

What is hydronephrosis

A

Dilation of the renal pelvis and calyces due to obstruction at any point in the urinary tract causing increased pressure and blockage

Unilateral - upper urinary tract obstruction

Bilateral- lower urinary tract obstruction

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15
Q

Consequences of hydronephrosis

A

Progressive atrophy of the kidney develops, the back pressure from the obstruction is transmitted to the distal parts of the nephron

GFR declines, if bilateral, renal failure

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16
Q

Hydronephrosis and Hydroureter anatomy

A
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17
Q

Obstruction at the pelviureteric junction causes

A

Hydronephrosis

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18
Q

Obstruction at the ureter causes

A

Hydroureter, eventually leading to hydronephrosis

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19
Q

Obstruction of the bladder neck/urethra causes

A

Bladder distension, hypertrophy, eventually hydroureter and hence hydronephrosis

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20
Q

Features of acute ureteric obstruction

A

Results in renal colic

Usually caused by calculus- can be due to blood clots or sloughed papilla

Usually unilateral

Leads to acute renal failure if bilateral (presents as Anuria or oliguria)

Pyonephrosis can develop- infected, obstructed system

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21
Q

Why does GFR decline in hydronephrosis

A

So much fluid in Bowman’s capsule = pressure bigger than capillaries

Fluid pushed from nephron back into capillaries

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22
Q

What is a sloughed papilla

A

Filling defect in collecting system and ureter

Renal pyramid falls down and blocks urine

23
Q

What is Pyonephrosis

A

Infected, obstructed kidney

Urological emergency

Failure to promptly decompress may lead to death from sepsis and permanent loss of renal function

24
Q

Diagnosis of upper urinary tract obstruction

A

CT or USS- show structure not function

Diuretic Renography (MAG3) is a functional test

25
Q

How do you drain upper urinary tact

A

Nephrostomy
JJ stent

26
Q

Features of Urolithiasis (urinary Calculi)

A

10% of population, more common in men and Caucasians

Dehydration = predisposing factor

High recurrence rate 60-80%

27
Q

Kidney stones form

A

Anywhere in urinary tract.

3 common sites:
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction

28
Q

Diagnosis of kidney stones

A

CT scan of kidneys, ureter and bladder

29
Q

Compositions of urinary Calculi

A

5 types

  • Calcium Oxalate stones (most common)
  • Mixed calcium phosphate and calcium oxalate stones
  • Magnesium ammonium phosphate stones
  • Uric acid stones
  • Cystine stones
30
Q

What are calcium oxalate stones associated with

A

Hyeprcalcemia and primary hyperparathyroidism and hyperoxaluria

31
Q

What are mixed calcium phosphate and calcium oxalatate stones associated with

A

Alkaline urine

32
Q

What are magnesium ammonium phosphate stones associated with

A

Urea splitting bacteria

33
Q

What are uric acid stones associated with

A

Gout and myeloproliferative disorders

34
Q

What are cystine stones associated with

A

Patients with inherited cystinuria

35
Q

Clinical presentation of kidney stone

A

Depends on site

  • Dull continuous ache in loins
  • Renal colic
  • Strangury
  • Recurrent and untreatable UTIs, haematuria or renal failure
  • Aasymptomatic
36
Q

Why do ureteric stones cause classical renal colic

A

Increase in peristalsis in the ureters in response to the passage of a small stone

Radiated from loin to groin, patient appears sweaty, pale and restless with nausea and vomiting

37
Q

What is Strangury

A

The urge to pass something that will not pass

38
Q

Main stream treatment for urinary stones

A

Adequate analgesia and a high fluid intake
Urine is Sieved for analysis
Stones of 4-5mm or less usually pass spontaneously
Larger stones might require surgical intervention

39
Q

Other treatment options for kidney stones

A

Extracorporeal shock wave lithotripsy- show waves shock Calculi into small pieces which will then pass into urine

40
Q

Prevention of further stone formation is achieved with a

A

High fluid intake, correction of any underlying metabolic abnormality

41
Q

Disorders of the prostate

A
42
Q

Where is the prostate gland

A
43
Q

Main pathogens for prostatitis

A

E. coli, proteus and staphylococcus

STI = C trachomatis and Neisseria gonorrhoea

44
Q

Presentation of acute prostatitis

A

Inflammation can be focal or diffuse

Malaise, rigours and fever

Difficulty in passing urine, dysuria and perineal tenderness

Rectal examination reveals a soft, tender and enlarged prostate

45
Q

Why does chronic prostatitis occur

A

Inadequately treated infection

Some antibodies cannot penetrate the prostate effectively

History of recurrent prostatic and urinary tract infections

46
Q

Management of chronic prostatitis

A

Some patients asymptomatic- prevent with no preceding acute phase

Diagnosis confirmed by: histological examination showing neutrophils, plasma cells and lymphocytes

Positive culture from prostatic secretion

47
Q

What is chronic non-bacterial prostatitis

A

Most common type of prostatitis, results in enlargement of the prostate

Often no history of recurrent UTIs

Usually pathogen = C trachomatis (sexually active men affected)

Fibrosis as a result of chronic inflammation

48
Q

What does this show

A

Chronic non-bacterial prostatitis

Fibrosis as a result of chronic inflammation

49
Q

What is BPH

A

Non-neoplastic enlargement of the prostate gland, can lead to bladder outflow obstruction

Detectable in nearly all men over 60

Cause unknown but may be related to male sex hormones (testosterone)

50
Q

Presentation and examination for BPH

A

Enlarging prostate gland compresses on the prostatic urethra

Men present with obstructive lower urinary tract symptoms:
- Difficulty or hesitancy in starting to urinate
- A poor stream
- Dribbling post micturition
- Frequency and nocturia

Digital rectal examination for the prostate, which is firm, smooth and rubbery

51
Q

Untreated BPH presentation

A

Acute urinary retention + distended and tender bladder- desperate urge to pass urine

Or

Progressive bladder distension- chronic painless retention and overflow incontinence

Can lead to bilateral upper tract obstruction and renal impairment with the patient presenting in CKD

52
Q

Treatment for BPH

A

Alpha blockers, relax smooth muscle at bladder neck and within prostate

Finasteride (5a-reductase inhibitor)

Surgery- transurethral resection of the prostate TURP

53
Q

How does Finasteride work

A

Prevents the conversion of testosterone to the more potent androgen dihydrotestosterone

Urinary (20 decks)

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