Urinary System Flashcards
Most Common cause of UTI
E.Coli, 2nd is Staphy. saprophyticus
What’s important when assessing UTI?
CVA Tenderness
U/A results for lower UTI
Elevated nitrates, increased leukocyte esterase, urine sediments, hematuria, alkalotic urine. NO CASTS
How can urethritis and vaginitis be differentiated from UTI?
By absences of hematuria
Two 1st choice drugs for uncomplicated UTI
Bactim- 1 tab bid x 3 days (ex. sulfa/pregnancy)
Nitrofuritonin- 100 mg bid x 7 days (pregnancy)
Treatment for Complicated UTI
Ciprofloxacin 250 mg BID x 3 days (no pregnancy)
Drugs for UTI during pregnancy
Ampicillin/Clavulanate: 500 mg PO QuadD x 7 days
Cephalexin: 500 mg PO Quad d x 7 days
Get U/A at end to confirm eradication for all!
Diagnosis of upper UTI
Chills, fever, CVA tenderness, WBC casts
Differential diagnosis for upper UTI
Nephrolithiasis, lower UTI
Treatment for Upper UTI, 1st Choice
Ciprofloxacin 500 mg BID x 7 days
Alternative Treatment for Upper UTI (x2)
Amoxicillin/ Clavonic acid x 14 days
TMP/SMZ BID x 14 days.
What else will pyelonephritis need to order?
If male, urinary tract anatomy imaging. If recurrent for females, the same.
What do you do for gross hematuria?
Refer to urologist
Defining hematuria
Gross or microscopic, or transient or persistent
Most common causes of hematuria?
Calculi, infection, cancer, obstruction, bleeding diathesis
When do you refer to a urologist for hematuria?
Gross or >50 RBC/hpf on single UA
S&S of interstitial cystitis or painful bladder syndrome?
Frequency, nocturia, urgency, urethral pain, lower abdominal pain, incomplete emptying,
Pathology of IC?
Believed that potassium or uric acid infiltrate the bladder wall because of a poor production of mucus that coats the wall
What different diseases are associated with IC?
IBS, SLE, fibromyalgia, migraines, sensitive skin, allergies
How is it diagnosed?
Diagnosis of exclusion, with potassium sensitivity test
Treatment for IC?
TENS unit, acupuncture, smoking cessation, exercise, stress reduction, bladder training, legal exercises, bladder diary, bland diet
Prostatitis incidence?
Most common male GU disease
25% will have prostatitis.
4 Types of prostatitis
I- Acute Bacterial
2- Chronic bacterial
3- Chronic Non-Bacterial- Chronic pelvic pain syndrome
4- Asymptomatic inflammatory prostatitis
S&S of prostatitis?
Abrupt, low back pain, suprapubic pain, dyschezia, fever, chills, nausea, malaise, arthralgia, meager, urinary frequency, weak stream, terminal dribbling
S&S of physical exam?
I- very tender, warm, swollen, boggy
II- not that tender, boggy
Chronic Non Bacterial- just tender
Treatment for Prostatitis?
Mild to moderate- Bactrim or cipro x 6 weeks
Severe- in patient care
Labs for prostatitis?
U/a, C&S
BPH S&S
Strain, heistance, weak stream, incomplete emptying, dribbling, nocturia
Treatment for BPH
Alpha adrenergic blocker- bedtime, 2-4 weeks for response
Finasteride
Etiology of Epididymitis?
G&C, e. coli, staph aureus, lifting and straining
Physical exam for epididymitis?
Testicular pain with vas deferent modularity
Edema of scrotum and epidiymus
Positive Prehn’s sign
Hydrocele, prostate may be tender
Treatment of epididymitis?
Treat like gonorrhea or chlamydia
If it’s an enteric organism, treat with levaquin 500 mg PO x 10 days
If there’s no improvement after 3 days, reevaluate
Etiology of Testicular torsion?
Occurs during sleep, trauma, sex, with L testicle mor often being affected
Most in males 10-20
S&S of testicular torsion
Abdominal pain, scrotal edema and erythema
NO FEVERS
Absent cremasteric reflex and Prehn’s sign
Treatment of testicular torsion?
Emergency, surgical intervention
Four etiologies of erectile dysfunction?
Neurologic, vascular, hormonal (hypogonadism and hyperprolacinemia), and psychological
What type of bacteria makes the urine alcolotic in UTI?
Proteus Mirabilis
What lab result on UA is not likely in pyeloneprhitis?
Proteinuria
How are most bladder cancers treated?
Transurethral resection as well as intrathecal chemotherapy.
