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Y2 RnU > Urinary Tract > Flashcards

Urinary Tract Flashcards

1
Q

What is the infection of the upper urinary tract

A

Pyelonephritis => May be just kidney or ureter

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2
Q

What is the infection of the lower urinary tract

A

Cystitis

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3
Q

Difference between complicated and uncomplicated UTIs

A

Complicated - patients have factors that compromise the urinary tract or host defence eg. urinary obstruction, retention due to neurological disease, immunosuppression, renal failure or transplantation, foreign bodies, pregnancy

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4
Q

Largest contributor to UTI

A

UPEC - uropathogenic e coli

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5
Q

How do bacteria go up the ureter and cause

A

Using (pyelonephritis) associated Pilli
Type I pilli

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6
Q

Clinical presentation of UTI in infants

A

In infants (<2yrs)- vomiting/fever and in elderly - less localised symptoms like confusion/falls

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7
Q

Symptoms of pyelonephritis

A
  • Loin pain/flank tenderness ⇒ kidneys inflamed
  • Fever/rigors
  • Sepsis ⇒ If it gets into bloodstream
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8
Q

Symptoms of cystitis

A
  • If only cystitis and no pyelonephritis, will have localized symptoms below
    • Dysuria
    • Frequency
    • Urgency
    • Suprapubic tenderness
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9
Q

causes of recurrent UTI

A
  • Antimicrobial exposure is a risk factor
  • Often MDR organisms
  • Genetic - familial tendencies, susceptibility of uroepithelial cells, vaginal mucus properties,
  • high grade VUR
  • voiding dysfunction
    frequent sexual intercourse and spermicides
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10
Q

treatment of recurrent infections

A

trial methenamine 1g every 12 hrs + OTC high dose vitamin C for 6 months

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11
Q

For continued recurrent infections despite treatment

A

Long-term prophylactic antibiotics trimethoprim 100mg. Nitrofurantoin etc. can be used as an alternatives

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12
Q

When should dipstick be used in UTI patients

A

only < 65 yo, in presence of clinical symptoms

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13
Q

What does the presence of indicate in dipstick tests wrt UTI

A

Nitrites - UTI is possible

Leukocytes- not necessarily UTI

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14
Q

What kind of urine sample should be used for urine culture

A
  • Mid stream urine
    • As first part will have periurethral contaminants, end part also has
    • Mid stream reflects urine in bladder more accurately
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15
Q

Significant bacteriuria => what does it mean??

A
  • Indicates that the number of bacteria in the voided urine exceeds the number expected from contamination from the anterior urethra
    • Enough to have really established an infection
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16
Q

Asymptomatic bacteriuria

A

Significant bacteriuria but without symptoms

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17
Q

When is bacteriuria considered UTI

A

When it is symptomatic and results support clinical diagnosis

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18
Q

What does presence of inflammation in urine suggest

A

More likely to be UTI ( given presence of bacteria)

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19
Q

Main treatment for cystitis

A

Trimethoprim, if at risk for resistance give Nitrofurantoin AND eGFR >30

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20
Q

Recommended treatment for Pyelonephritis patients without penicllin allergy

A

Gentamicin, add amoxicillin if enterococcus isolated in urine in past 12 months or source of infection is unclear or patient has signs of severe sepsis

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21
Q

Recommended treatment for Pyelonephritis patients with penicllin allergy

A

vancomycin instead of amoxicillin

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22
Q

how to diagnose CAUTI

A

not dipstick or urine culture, diagnose clinically instead by exclusion

Tmeperature > 38 in younger patients, no evidence of focus of infection elsewhere
suprapubic or flank pain, frank haematuria, delirium, rigor

23
Q

when should people be treated for asympt bacteriuria

A

only in the case of pregnant women

24
Q

what are the anterior and posterior urethra

A
  • Anterior urethra following penile and bulbourethra
  • Posterior urethra = prostatic urethra
25
How are signals sent within the bladder
Sent within the tight junctions
26
Role of urothelium in bladder
Barrier and afferent signalling
27
Role of lamina propria in bladder
Functional centre coordinating the urothelium and detrusor
28
Where are nerves and blood vessels found in the bladder
Lamina propria
29
What happens as bladder fills
sensors detect increase in wall stretch tension → afferent neurons to dorsal horn of sacral spinal cord→ sensory/real time data on bladder state relayed to brainstem and higher centres which control bladder function
30
What ions does the bladder urothelium allow to pass and is it passive or active . What layer does the urothelium have
Urea, Na, K, passive, GAG layer
31
What nucleus modulates volitional micturition and where is it located
Pontine Micturition Centre ( Barrington's nucleus ) Processing in Onuf’s nucleus in intermediolateral S2, S3, S4
32
How does muscle coordination allow voiding to occur
- Coordination of muscles allows urine to enter posterior urethra, voiding to occur - Detrusor contraction - Urethral relaxation
33
positive feedback loop of normal bladder function - what happens when detrusor contracts
Wall tension rises , results in afferent signals sent to PMC and efferent signals increasing detrusor contraction
34
What nerves are involved in the innervation of detrusor muscle and external sphincter and pelvic floor , what innervation and what actions involved in voiding
Detrusor - contraction - pelvic nerves ( PS motor and sensory) External sphincter and pelvic floors - Pudendal nerve (somatic sensory and motor)
35
How does complete spinal cord injury affect voiding
Results in loss of central inhibition, typically reflex voiding and bladder emptying
36
What are the two main causes of storage LUTS
Increased urinary production or decreased storage capacity
37
Causes of polyuria
DM/DI, excess fluid intake
38
Cause of decreased bladder capacity
Reduced compliance, reduced functional capacity, neurogenic bladder=> neurological disorders like MS - bladder empties at far earlier point than functional capacity, irritation from bladder stones or tumours causing urgency and frequency
39
Symptoms of storage LUTS
Urgency, frequency, nocturia,
40
Causes of reduced compliance of bladder
could be due to increased UO as a result of renal concentrating ability decreasing with age, or bladder outflow obstruction
41
what is urinary incontinence
involuntary loss of urine that is a social or hygienic problem and is objectively demonstratable
42
Two main types of incontinence and their difference
urge = involuntary loss of urine associated with strong desire to void stress = Involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction eg. with coughing, sneezing, laughing, straining, exerting
43
What is a urodynamic assessment used for? and how does it work
identify underlying cause of incontinence Pressure from bladder and rectum measured during filling and voiding and patient is asked to cough periodically . Transducers will measure pressure
44
what does a bladder scan show
post void residual volume
45
Urodynamic assessment in stress incontinence
Increased abdominal pressure with coughing related to increased urinary flow
46
Urodynamic assessment in unstable bladder=> what is the main problem here
peak rises in urinary flow towards end of filling phase, confirmed urinary incontinence associated with spontaneous detrusor pressure rises Main problem here is SPONTANEOUS RISE IN DETRUSOR PRESSURE
47
Urodynamic assessment in BOO
Large rise in detrusor pressure associated with low urinary flow
48
Causes of Voiding LUTS
Decreased force of micturition usually secondary to bladder outlet obstruction(BOO, urethral stricture) May also occur with underactive/hypocontractile bladder eg. Spinal cord injury
49
Symptoms of voiding LUTS
- Hesitancy → Delay in start of micturition - Poor flow - Intermittence → Involuntary start stop possibly due to prostatic enlargement - Terminal Dribbling → Release of small amount of urine after micturition - Due to release of urine retained in bulbar/prostatic urethra - Straining→ Use of abdominal muscles to void in patients with underactive or hypercontractile ( Valsalva only normally required at end of voiding)
50
where are the umbrella cells found and what are they
Urothelium. Apical cells
51
What excitatory neurotransmitter and inhibitory neurones are involved in voluntary micturition
Ach vs GABA and glycine
52
What chemical is involved in relaxation of bladder neck and external urethral sphincter
NO
53
Treatment for unstable bladder stress incontinence BOO
- antimuscarinic or botox therapy in the bladder, selective B-3 adrenoreceptor agonist, intradetrusor botox - Pelvic glood exercises, weighr loss, autologus rectus abdominis sling, artificial sphincter - A-blockers, 5 ARI, TURP laser prostatectomy

Y2 RnU (9 decks)

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