Urinary Symptoms Flashcards
Dysuria:
- What is this?
- What 3 other symptoms may accompany this?
Pain/discomfort on urination
It is an ‘irritative ‘bladder symptom so:
- Urgency
- Frequency
- Nocturia
Dysuria:
Infectious causes:
- What is the main differential?
- What infections of their reproductive system could men get? - 2
- What infections of their reproductive system could women get?
Inflammatory causes:
- Atrophic vaginitis - what is it?
- Interstitial cystitis - what is another name for this?
- What inflammatory condition with arthritis may also cause it?
UTI (Cystitis)
Prostatitis
Balanitis - inflammation of the glans of the penis
Thinning, drying and inflammation of the vaginal walls that may occur when your body has less oestrogen.
Painful bladder syndrome
Reiter’s syndrome - urethritis
Dysuria:
Obstruction causes:
- What may obstruct the urethra or bladder?
- What may happen to the prostate?
What are some cancerous causes?
Stones
Benign prostatic hyperplasia
Prostate or bladder cancer
Urinary frequency:
Can be due to polyuria or frequent small amounts and is often accompanied by urinary urgency.
Causes of small frequent amounts:
- What is the main differential?
- What may be wrong with the bladder?
- Where may kidney stones be which will irritate the bladder most?
- Reduction in the size of the bladder may also cause it. What are some causes of this?
- How does a UMN lesion cause this?
UTI
Overactive bladder
Distal ureters where they irritate the bladder the most
Age Bladder cancer Prostate cancer Pregnancy Fibroids Faecal impaction
PUST AGAINST THE BLADDER SO COMPRESSES IT
They get a spastic bladder
Polyuria:
How many litres of urine production is deemed as polyuria in 24 hrs?
Causes:
- What endocrine disorder can cause this?
- What electrolyte at high levels could cause this?
- Why does heart failure cause NOCTURIA?
- What substances have diuretic side effects? - 2
> 3L in 24 hrs
DM
Hypercalcaemia - Thus, hypercalcemia may lead to polyuria by interfering with the absorption of sodium as well as inhibiting the action of vasopressin. One can’t help but compare its effect to that of a patient with diabetes insipidus taking a loop diuretic! No wonder these patient may suffer from polyuria!
Heart failure - Nighttime recumbency improves renal hemodynamics and sodium excretion, resulting in nocturia.
Alcohol
Coffee
Oliguria and anuria:
Under how many ml of urine production is deemed as oliguria in 24 hrs?
Causes:
- Think of 3 causes?
<400 ml/24hrs
<0.5 ml/kg/hr
AKI
Urinary obstruction
Urinary retention
Urinary RETENTION:
Causes:
- What may cause urinary retention? - 4 - think about what can cause compress the urinary system
- What inflammatory causes are there for men? - 2
- What inflammatory causes are there for women?
- What is a neurogenic causing a flaccid bladder?
- What drugs may cause this? - 4
Prostate enlargement Genitourinary prolapse Urinary tract stones Faecal impaction ---- Balanitis Prostatitis Vulvovaginitis ---- Cauda equina syndrome ---- Anticholinergics Opioids Epidural TCA's
Urinary RETENTION:
S+S:
- Where may they have tenderness?
- What could happen in the kidneys with urinary retention?
Investigations:
Urinalysis is always done!
- What bloods are done? - 3
- What imaging can be done?
What is the main management?
Suprapubic tenderness
FBC, U&E, glucose
Bladder scan for volume
Kidney scan for hydronephrosis
—-
Catheterise
Urinary obstruction:
What symptoms apart from retention does someone have with obstruction have? - 4
Causes:
Name 3 intraluminal causes?
List some intramural (in the wall) causes? - 5
Difficulty passing urine:
- Reduced flow
- Straining to void
- Hesitancy - difficulty in initiating micturition resulting in a delay in the onset of voiding after the individual is ready to pass urine
- Dribbling
Stones
Clots
Foreign body
Tumour Polyps Stricture Neurogenic bladder Congenital urethral valves
Urinary obstruction:
Causes:
Extramural:
- What prostatic diseases could cause this? - 2
- What gynae diseases could cause this?
- What GI problem may cause this?
BPH
Cancer
Prolapse ‘cystocele, rectocele’
Ovarian cyst
Fibroids
Uterine cancer
Faecal impaction
Neurogenic bladder:
What is the name of the muscle which remains relaxed to allow the bladder to store urine, and contracts during urination to release urine?
The sphincter is also used to control urine release.
Detrusor
Neurogenic bladder:
Peripheral:
- What symptoms does a flaccid bladder (or detrusor areflexia) do?
- Why is the bladder flaccid?
- What could cause this? - 6
- What vitamin deficiency could cause this?
Retention +/- overflow - DETRUSOR DOESN’T CONTRACT TO RELEASE URINE AS IT IS FLACCID
Because it is an LMN lesion
Diabetes Cauda equina Slipped disc HIV Alcohol
Vit B12 deficiency
Neurogenic bladder:
CNS:
- What will happen to the bladder or detrusor muscle if it is a UMN lesion?
- What does this lead to?
- Causes?
Spastic bladder (or detrusor hyperreflexia)
Urge incontinence
Stroke - may cause flaccidity and retention MS Cord lesion MND Parkinson's disease
Altered urine appearance:
What can cause cloudy urine?
What substance causes frothy urine?
What syndrome is this seen?
What is pneumatuira?
What can cause this? - 2
What can cause haematuria? - 3
UTI - due to pus
Protein
Nephrotic syndrome
Bubbles in urine
UTI Enterovesical fistula (diverticulitis, Crohn's)
Cancer
Inflammation
Stones
Prostatic Aetiology:
What 3 symptoms suggest a prostatic problem?
(1) Difficulty initiating voiding
- Voiding dysfunction is a broad term, used to describe the condition where there is poor coordination between the bladder muscle and the urethra.
(2) Poor stream - Think of BPH - it is blocking the urethra
(3) Dribbling
- After dribble happens because the bladder doesn’t empty completely while you urinate. Instead, the urine accumulates in the tube leading from your bladder.
- A common cause for after dribble is an enlarged prostate or weakened pelvic floor muscles.
ALL DUE TO URINARY OBSTRUCTION!
