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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
Q

How are signals sent within the bladder

A

Sent within the tight junctions

26
Q

Role of urothelium in bladder

A

Barrier and afferent signalling

27
Q

Role of lamina propria in bladder

A

Functional centre coordinating the urothelium and detrusor

28
Q

Where are nerves and blood vessels found in the bladder

A

Lamina propria

29
Q

What happens as bladder fills

A

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
Q

What ions does the bladder urothelium allow to pass and is it passive or active . What layer does the urothelium have

A

Urea, Na, K, passive, GAG layer

31
Q

What nucleus modulates volitional micturition and where is it located

A

Pontine Micturition Centre ( Barrington’s nucleus )
Processing in Onuf’s nucleus in intermediolateral S2, S3, S4

32
Q

How does muscle coordination allow voiding to occur

A
  • Coordination of muscles allows urine to enter posterior urethra, voiding to occur
    • Detrusor contraction
    • Urethral relaxation
33
Q

positive feedback loop of normal bladder function - what happens when detrusor contracts

A

Wall tension rises , results in afferent signals sent to PMC and efferent signals increasing detrusor contraction

34
Q

What nerves are involved in the innervation of detrusor muscle and external sphincter and pelvic floor , what innervation and what actions involved in voiding

A

Detrusor - contraction - pelvic nerves ( PS motor and sensory)
External sphincter and pelvic floors - Pudendal nerve (somatic sensory and motor)

35
Q

How does complete spinal cord injury affect voiding

A

Results in loss of central inhibition, typically reflex voiding and bladder emptying

36
Q

What are the two main causes of storage LUTS

A

Increased urinary production or decreased storage capacity

37
Q

Causes of polyuria

A

DM/DI, excess fluid intake

38
Q

Cause of decreased bladder capacity

A

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
Q

Symptoms of storage LUTS

A

Urgency, frequency, nocturia,

40
Q

Causes of reduced compliance of bladder

A

could be due to increased UO as a result of renal concentrating ability decreasing with age, or bladder outflow obstruction

41
Q

what is urinary incontinence

A

involuntary loss of urine that is a social or hygienic problem and is objectively demonstratable

42
Q

Two main types of incontinence and their difference

A

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
Q

What is a urodynamic assessment used for? and how does it work

A

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
Q

what does a bladder scan show

A

post void residual volume

45
Q

Urodynamic assessment in stress incontinence

A

Increased abdominal pressure with coughing related to increased urinary flow

46
Q

Urodynamic assessment in unstable bladder=> what is the main problem here

A

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
Q

Urodynamic assessment in BOO

A

Large rise in detrusor pressure associated with low urinary flow

48
Q

Causes of Voiding LUTS

A

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
Q

Symptoms of voiding LUTS

A
  • 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
Q

where are the umbrella cells found and what are they

A

Urothelium. Apical cells

51
Q

What excitatory neurotransmitter and inhibitory neurones are involved in voluntary micturition

A

Ach vs GABA and glycine

52
Q

What chemical is involved in relaxation of bladder neck and external urethral sphincter

A

NO

53
Q

Treatment for unstable bladder
stress incontinence
BOO

A
  • 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

RnU (9 decks)

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