Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Renal & Urology > Urinary tract > Flashcards

Urinary tract Flashcards

1
Q

What are urinary tract calculi?

A

Presence of crystalline stones in the urinary system (kidneys, ureters, bladder etc). Almost all originate in the kidney.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is another name for kidney stone?

A

Nephrolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the types of urinary tract calculi? (x5)

A
  • Calcium oxalate
  • Calcium phosphate
  • Magnesium ammonium phosphate
  • Uric acid
  • Cystine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the aetiology of urinary tract calculi? (x9)

A
  • Dehydration: increases urinary salt concentration
  • UTI
  • Changes in urinary pH: can be idiopathic or drug related. Calcium oxalate, phosphate and magnesium ammonium phosphate arise in alkaline urine, cystine and uric acid stones in acidic
  • Hypercalciuria: idiopathic/drugs
  • Hypercalcaemia: malignancy, hyperparathyroidism, sarcoidosis, milk-alkali syndrome (too much calcium and absorbable alkali intake), high Vitamin D intake
  • Hyperoxaluria: high intake of high-oxalate-containing foods (in rhubarb, spinach, strawberries, tea, tomatoes, beans, chocolate, nuts) and Vitamin C, high colonic absorption in patients with small bowel disease/resection, genetic conditions of enzyme deficiency leading to increased oxalate production and excretion
  • Hyperuricaemia: tumour lysis syndrome, high cell turnover rates
  • Cystinuria: autosomal recessive defect of renal tubular transport of cystine and dibasic amino acids.
  • Anatomical abnormalities such as horseshoe kidneys (two kidneys bind together at bases)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of renal tract calculi?

A

Calculi may remain in the renal parenchyma or pass into ureter and bladder. During passage through the ureters, calculi may become lodged causing hydroureter and sometimes hydronephrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the diameter of a ureter?

A

6-8mm. Men are smaller than women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the epidemiology of urinary tract calculi: Type? Age? Gender?

A

Most common type is calcium oxalate. 20-50 years. Twice as common in men.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs and symptoms of urinary tract calculi? (x6)

A
  • Loin pain (kidney stones): renal colic radiating from loin to groin, scrotum, labium. Radiation to abdomen suggests upper ureteral/renal pelvis). Pain is cyclical and lasts 20-60 minutes
  • Dysuria and frequency
  • Strangury (in bladder stones; blockage of base of bladder leading to pain and desire to urinate)
  • Penile tip pain (bladder stones)
  • Urinary retention and bladder distension (urethral stones)
  • N&V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the investigations for urinary tract calculi? (x5)

A
  • BLOODS: U&Es, calcium, phosphate, albumin, PTH, vitamin D, urate, bicarbonate for information on aetiology
  • URINE: haematuria, sometimes pyuria (primary or secondary UTI)
  • NON-CONTRAST HELICAL CT: observe calcification, hydronephrosis. May also see perinephric stranding (oedema of kidney mesenchyma suggesting infection of system). Use USS in pregnant women or children
  • X-RAY (KUB – kidney-ureter-bladder): radio-opaque stones (note that urate stones are radio-lucent and cystine stones are semi-opaque)
  • STONE ANALYSIS: after extraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are urinary tract calculi managed? (x4)

A
  • Hydration and analgesics
  • Medical expulsive therapy only for distal ureteric stones less than 10mm
  • Empirical antibiotics if bacteriuria
  • If there are signs of obstruction, then urgent drainage with ureteric stent or percutaneous nephrostomy tube (called decompression) and remove stone after drainage has been performed for a few days or any infection has cleared (note that decompression does not mean stone removal). Drainage is done to prevent UTI and subsequent sepsis risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the indication for medical expulsive therapy?

A

Distal ureteric stones less than 10mm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is medical expulsive therapy?

A
  • In addition to analgesics, rehydration:
  • Alpha-blocker such as tamsulosin/alfuzosin to reduce ureteric spasm, leading to stone passage
  • May also consider using calcium channel antagonists such as nifedipine to reduce ureteric spasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the indication for urinary tract calculi removal?

A

Failed conservative/medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are urinary tract calculi removed? (x3)

A
  • LESS THAN 10mm: shock-wave lithotripsy (SWL)
  • BETWEEN 10-20mm (or patient under 16 with less than 10mm): ureteroscopy or SWL
  • Offer percutaneous nephrolithotomy (PCNL) following failed ureteroscopy/SWL. Over 20mm is rarely seen and are treated on a case-by-case basis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is SWL?

A

Ultrasound used to break stones by both compressive and tensile forces. Fragments then pass out in the urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is ureteroscopy?

A

Place scope up urethra and into ureter/kidney. Once the stone is visualised, it can be fragmented using a laser and the fragments retrieved after.

17
Q

What is PCNL?

A

Percutaneous access via flank (usually IR) followed by sheath placement into the kidney and a nephroscope is used to remove the stone.

18
Q

What are the complications of urinary tract calculi? (x2)

A

Obstruction and hydronephrosis (hydrostatic dilation of renal pelvis leading to kidney damage), infection from urinary stasis

19
Q

What is a urinary tract infection?

A

Characterised by presence of at least 100,000 colony-forming units per millimetres of urine.

20
Q

What are the different types of UTI? (x4)

A

Cystitis (bladder), pyelonephritis (kidney), urethra (urethritis), and prostatitis (prostate)

21
Q

What is the aetiology of an UTI? (x4)

A

Most common route of infection is ascent of colonic organisms up urethra. As such, since cause often colonic, the most common organism is E. coli. Others, however, include Proteus mirabilis, Klebsiella and Enterococci

22
Q

What are the risk factors of UTI? (x2, x1 and x2)

A
  • Factors that increase susceptibility include urinary stasis. Factors that impair host defence system such as HIV also predisposes patients.
  • Female precipitating factors: alkalinisation of vaginal fluid (typically post-menopausal)
  • Male precipitating factors: structural/functional abnormalities that impair urine flow such as prostatic disorders and renal calculi. Homosexual intercourse from anal penetration also.
23
Q

How are UTIs categorised? (x2)

A
  • Acute or recurrent (at least 2 acute episodes in 6 months, or more than 3 in 12)
  • Uncomplicated and complicated (uncomplicated are acute cases in healthy women/men without functional or anatomical urinary tract abnormalities; complicated include infections in patients with impairments that reduce the efficacy antimicrobial therapy such as functional/anatomical urinary tract abnormalities, conditions that interfere with host defence, and resistant pathogens).
24
Q

What is the epidemiology of UTIs: Gender? (x3)

A

More common in women, rarely seen in men below the age of 50. Men tend to acquire complicated UTI.

25
Q

What are the signs and symptoms of an UTI? (x4)

A
  • CYSTITIS: frequency, urgency, dysuria (pain on micturition (urination)), haematuria, suprapubic pain, smelly urine, fever
  • PYELONEPHRITIS: fever, malaise, rigors, loin/flank pain
  • PROSTATITIS: fever, loin/perineal pain, irritative and obstructive symptoms
  • ELDERLY: malaise, nocturia, incontinence, confusion
26
Q

What are the investigations for UTI? (x5)

A
  • MSU: Dipstick test: for haematuria, proteinuria, leucocytes, nitrites (urinary bacteria reduce nitrates to nitrites)
  • MSU: Microscopy, culture and sensitivity: over 1,000 colonies/mL in the presence of UTI symptoms. However, can expect to see at least 100,000, particularly in men. Also note that 30% of women have no bacteriuria
  • RENAL USS or IV UROGRAM: in women with frequent UTIs, children and men to rule out obstruction (remember, men tend to have complicated UTIs where it is secondary to an issue like obstruction)
  • CT: in patients with impairment identified on USS
27
Q

How is cystitis medically managed? Course duration? Contraindicated?

A
  • Empirical antibiotics – nitrofurantoin in females and levofloxacin in males (as more likely to be complicated). Second-line include trimethoprim, pivmecillinam (females), ciprofloxacin (males), nitrofurantoin (males), and amoxicillin (males)
  • 7-day course in men due to increased complications risk; 3-day course in women
  • Watch-and-wait approach is given instead of antibiotics in women below 65 with 0/1 symptoms AND negative dipstick, in women over 65 with mild symptoms, and in men with 0 symptoms (unless before urological procedures)
  • Review antibiotics following culture and sensitivity
28
Q

How is cystitis managed when catheter in-situ?

A

Obtain a culture and consider changing the catheter. Do not treat unless patient is symptomatic. Nitrofurantoin and trimethoprim are first-line in lower UTI symptoms; cefalexin is first-line in upper UTI symptoms.

29
Q

How is pyelonephritis managed? (x3)

A

IV gentamicin, cefuroxime or ciprofloxacin

30
Q

What are the complications of an UTI? (x4)

A

Renal papillary necrosis, renal/perinephric abscess, pyonephrosis (infection of kidney characterised by pus in pelvic-calyceal system), gram-negative septicaemia.

Year 3 Renal & Urology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions