URINARY SYSTEM Flashcards
** UTI
Lower called?
Upper called?
Main organism?
RF?
CF?
IVX?
TX
non-pregnancy
pregnanct
Lower UTI: Urethritis, cystitis and prostatitis
Upper UTI: Pyleonephritis
E.COLI Main organism
RF: abnormality of renal tract, incomplete bladder emptying, Female, Sex, menopause
CF: Increased Frequency, pain on weeing, blood in wee, urgency, foul smelling, loin/abdo tenderness, confusion and fevers
IVX: Dipstick, MSU, FBC. U+E, CRP, blood cultures, USS or cystoscopy
Tx: Fluids and wee often
Non-pregnant women: Trimethoprim or Nitrofurantoin
Pregnant: Get expert help
Men: Take seriously and refer if upper UTI/ recurrent
Consider PSA in men
** Acute Cystitis
CF
IVX
Management
- Inflammation or infection of bladder
RF: Female, DM. pregnancy
CF: frequency, dysuria, urgenecy, suprapubic pain
IVX: Urine dipstick, MSU
Management: 3-5 day trimethoprim
Analgesia and hydration
** Acute Pyelonephritis
Causative organism
RF
CF
Ivx
Tx
which antibiotic?
- Infection within renal pelvis often ascending
Cause: E.coli, klebsiella
RF: Vesicoureteric reflux, catheters or stents, pregnancy
CF: High fever, Rigors, Vomiting, Loin pain and tenderness, Malaise +/- LUTI syx
IVX: urinalysis, MSU, inflammation markers, FBC, USS
Management: Rest, fluid, analgesia
Start epirical abx awaiting cultures –> Ciprofloxacin
** Prostatic acute urinary obstruction
Drug treatment
- Benign Prostatic Hypertrophy
RF: ageing and afro-caribbean
CF: Nocturia, frequency, post-micturation dribbling, poor stream, hesitancy, urgency, incomplete emptying
IVX: MSU, bloods, USS, rule out cancer with PSA, PR
Management: Avoid caffeine and alcohol, relax
Transurethreal resection or incision of prostate
Drugs: Tamsulosin a blocker or Finasteride 5 alpha reductase (decreases testosterone)
** Severe Hyperkalaemia
Severe level?
Cause:
CF
Ivx
Management:
Mild = >5.5, Severe >6.5 - over 7 URGENT
Cause: Decreased excretion e.g AKI, CKD, ACE inhibitors, NSAIDS,
CF: SOB, fatigue, weakness, bradycardia, arrhythmias
Ivx: FBC, ECG tall tented t waves, ABG, Urine output
Management:
- 10 ml 10% Calcium Gluconate
- 10 units Insulin Act Rapid with 50ml 50% Glucose
- 10mg Neb Salbutamol back to back
Chronic Kidney Disease
EGFR under..
when go to nephrologist?
Signs?
DAMN?
Treatment
- Damage over 3 months
EGFR <60ml/L
Cause: increased BP, DM, glomerulonephritis, renovascular disease, infective, obstructive, renal stones
CF: N+V, Weight loss, fatigue, lethargy, insomnia, muscle cramps, nocturia, sexual dysfunction
Sings: increased pigmentation, HTN, restless leg, peripheral oedema
IVX: blood, U+E, Ca, ERR, FBC, MSU, renal USS, renal biopsy
Management: Refer to nephrologist if GFR< 30 or sustained decrease in eGFR –> DIALYSIS or transplant
Review meds: DAMN for acute AKI Diuretics Antibiotics and Ace inhibitors + ARB Methotrexate + metformin careful in CKD Nsaids
Lower BP target
- Statin and aspirin to all CKD !!!!!
- Folic acid and B vitamins, restrict dietary phosphate
- Bisphosphonates
- Prepare for dialysis
Acute Kidney Injury
Rise in…
CF:
Signs
Ivx
Rise in serum creatinine >26 in 48 hours or 1.5X baseline in 1 week or urine output <0.5ml/kg for 6 consecutive hours
Pre-renal, intrinsic and post renal
CF: Oligouria, N+V, Dehydration, confusion
signs: HTN, large painless bladder, dehydration with postural HTN, Pallor, rash, Signs of vasculitis
IVX: Bloods, U+E, CK, ABG, Blood cultures, hepatitis, urine dip, CXR? pulmonary oedema, ECG. renal ultrasound
Management: identify and correct pre and post renal factors
consider transfer to HDU
Pulse BP UO hourly, match input loss, correct fluid depletion, Rx if sepsis
Incontinence
3 diff types
med for tx of stress incontiencence??
Stress: involuntary leakage on exertion
Functional: poor mobility
Urge: Sudden compelling desire to wee / involuntary detrusor contraction
RF: pregnancy, vaginal delivery, stroke, enlarged prostate
IVX: digital assessment, DRE for prostate, urine dip and bladder scam / urodynamic stress
2 week if microscopic haematuria aged >50
Manage:
Urge: reduce caffiene
Stress: pelvic floor muscles, Duloxetine
Nephrotic syndrome
CF
treatment
- PROTEINURIA and Hypoalbuminaemia due to damaged basement membrane
Cause: Primary golmerular diseases e.g minimal change + secondary eg infection HIB
CF: Facial swelling and peripheral oedema, DVT or MI, frothy urine, tired, breathless due to pleural effusion
IVX: Urine Dip, MSU, Quantify Proteinuria
FBC and coag, renal function tests, LFT
tx: NA and fluid restriction
HIGH DOSE DIURETICS and STEROIDS!!!
Detrusor Instability
SYX
Drug treatment?
- Overactive bladder- associated with detrusor muscle over activity
CF: urgency, freq, nocturia, urge incontience
Ivx: Urine dip, MSU, urodynamic studies
Reduce caffiene, lower MI
Drugs = Oxybutynin to relax urinary smooth muscles
Bladder Cancer
90% are?
Refer when?
- 90% transitional cell carcinoma
RF: smoking, rubber industires, shcistsomiasis
CF: painless haematuria, recurrent UTI
IVX: urine microscopy
REFER over 45s + haematuria
Management: Intravesical chemo, cystectomy
Prostatic Cancer
RF?
Tx drug:
Most adenocarcinomas arising in the peripheral zone
RF: age, afro-caribbean, FHx, Testosterone
CF: asymptomatic, noctura, hesitancy, obstruction, impotence
IVX: PSA, transrectal USS and biopsy urinalysis, bone X ray
Grading = Gleason
TX: Goserelin and prostacetectomy
Hydronephrosis
- Dilatation of the renal pelvis
Caused: by obstruction eg calculus or blood clot or tumour inside, within wall or from outside
CF: pain in back or ribs
Treatment: Analgesia, Nephrostomy to drain urine
Renal Carcinoma
most common in kids?
Traid of?
in kids = wilms tumour
CF: Triad of Haematuria, Loin pain and abdo / loin mass
- anorexia, malaise, ankle swelling
IVX: Bp increased due to renin secretion, blood FBC and urine cytology, MRI
Adult Polycystic disease
age of detection?
drug management
- Dont get symptoms until 30-60 years old
- Inherited
SYX: high bp, back pain, headache, blood in urine
Management: Tolvaptan slows growth of cysts
“tolvaps” the cysts
