Urinary tract Flashcards

Question

acute pyelonephritis management and tx

Answer 1

-May be managed as outpatient -Hospitalize if: -Intractable vomiting -Evidence of shock -Severe dehydration -Initiate treatment in the hospital for pregnant females -Treatment should last atleast10 days -Follow-up 3-5 days after treatment completion -Obtain urine culture prior to treating -However, do not wait for culture report prior to treating… -You can modify the treatment later if needed

Answer 2

-Quinolones -Levofloxacin 250mg IV/PO daily x 10 days -Norfloxacin 400mg PO daily x 10 days -Ciprofloxacin 500mg PO BID x 10 days -Cefuroxime 750mg IV TID x 10 days -If unable to tolerate PO -May be changed to a PO med when able -TMP/SMX 160/800mg PO daily x 14 days -Only after sensitivity known (high rate of resistance)

Answer 3

-Initiate treatment with IV or IM in hospital -IV hydration may be required -Cefuroxime 0.75 – 1.5gm IV TID -Ceftriaxone 1mg IM daily may be used -When afebrile, patient may take oral meds to complete 10 days tx -Ensure eradication of organism with repeat Urine culture 5 days post tx

Answer 4

-High levels of resistance seen -Use urine culture and sensitivity -Local hospitals may report an antibiogram -Treat using narrow spectrum antibiotics -Pseudomonas, enterococci, staphylcocci, and candida species are more common than in the outside population… -E. coli is seen in 50% (however tend to be resistant strains)

Answer 5

-Prostatic hyperplasia should be evaluated -Options include: -Digital rectal exam -Ultrasound- prostate and residual bladder volume measured -PSA -Obtain urine culture (and blood culture if considering prostatitis) prior to treatment -If febrile, quinolones are the drug of choice -> This class attains the best concentration in prostate

Answer 6

-Antibiotic options -Quinolones -Ciprofloxacin or norfloxacin -Treatment of choice if not contraindicated -TMP/SMX (Check sensitivities prior due to resistance) -Duration of treatment -Acute infection: 2-4 weeks -Chronic infection: 4-6 weeks

Answer 7

-70% of cases have sterile urine -Culture urine and treat initially -If there is pyuria “without bacteria”- Test for Chlamydia

Answer 8

-Complication that affects patients that have: -Indwelling urinary catheter (long term) -ICU patient treated with broad spectrum Abx -Comorbidity of DM or immune suppression -Tx- Remove catheter (resolves 1/3 of cases) -Fluconazole 200-400mg/day for 14 days -Flucytosine and Amphotericin B (if resistant) -Untreated may lead to sepsis

Answer 9

-Frequent bladder emptying -Post coital voiding -Every 3-4 hours during day -Good hygiene -Manage constipation -Think of the overall picture with your patient

Answer 10

-Symptoms -Fever -Painful Voiding Symptoms and enlargement of epididymis -very painful to touch -Causes -Sexually transmitted: -Chlamydia -Gonorrhea -Non-sexual caused: -Associated with prostatitis and gram negative organisms -Treatment -Bed rest -Scrotal elevation -Treat the underlying pathogen

Answer 11

-MC benign tumor -over 80 years of age -> >90% chance -Symptoms are based on progression of disease -Endocrine relation with genetic and race connections likely -Hyperplastic process Nodular growth pattern -Treatment likely works with or against the components affected -Alpha-blocker- smooth muscle component -5-alpha-reductase inhibitors- epithelium component

Answer 12

-Findings may include: -Distension of urinary bladder -Enlarged palpable prostate -Hydronephrosis -enlarged, boggy prostate -no nodules or odd feeling -IF THERE IS PROSTATE CANCER- enlarged, nodular, firm prostate -IF THERE IS PROSTATISTIS- hot, enlarged, tender

Answer 13

-Stress -Pelvic floor is unable to prevent passage of urine -Occurs with coughing, sneezing, laughing -Urge -Involuntary loss of urine with sudden sensation to urinate -Overflow -Constant ‘dribbling’ of urine at all times or for a time period after urinating -Structural -Typically related to fistulas in women

Answer 14

-Delirium -Infection -Atrophic urethritis/vaginitis -Pharmaceuticals -Psychological disorders (depression) -Excessive urine output -Restricted mobility -Stool impaction

Answer 15

-Definition: the inability to achieve or maintain an erection sufficient for satisfactory sexual performance -May be a marker of cardiovascular disease -Risk factors include: -Age -CV disease -Smoking -DM -Pelvic surgery/radiation -Drugs/Alcohol

Answer 16

-Medications -Phosphodiesterase Type 5 Inhibitors -> Sildenafil, Tadalafil, Vardenafil (oral); Alprostadil (Injected) -Testosterone replacement- sex drive not ED -Evaluate for current medications as a side effect causing ED -surgical -non-surgical- vacuum therapy

Answer 17

-History -Prior fertility -STD history -Steroid/testosterone use -Surgeries -Injuries -Physical activity -Birth history (if known) -Physical -Secondary sexual characteristics present -Gynecomastia -Eunuchoid habitus -Male genital exam: -Urethral meatus position -Testicular size -Epididymis -Pampiniform plexus -Vas deferens -etiology: -Abnormal Sperm production Abnormal Sperm function Obstruction of ductal outflow tract -semen analysis: -count -motility -morphology -serologic testing: -horomones- testosterone, FSH -genetic testing

Answer 18

-PAINFUL -testicular torsion- ER -epididymitis -inguinal hernia -trauma -tumor -non-painful causes -varicocele -hydrocele -spermatocele -inguinal hernia -tumor

Answer 19

-varicocele -running athletes -bilateral varicocele - surgery to prevent infertility -unilateral- is fine -tortuous mass -veins that contain inadequate valves -hydrocele -transiluminates

Answer 20

-Genetic disorder -Fluid filled cysts cause: -Kidney enlargement that displaces normal structure -Reduced kidney function then occurs -1/3 of patients with polycystic kidney disease progress to end-stage renal disease and require renal replacement -“Simple” cysts in kidneys or liver does not equal PKD absolutely -autosomal recessive PKD is less common (10%)- born with it, high mortality, HTN -autosomal dominant PKD is MC (90%)- 20s, HTN

Answer 21

-DOMINANT -90% of PKD -Onset: age 30-40 -Cysts may start in childhood but progress to clinical significance in adulthood -HTN is commonly found in late 20s -Imaging will make dx -RECESSIVE -10% of PKD -Onset: during fetal development -HTN and UTIs in childhood -Growth failure -Liver failure -May need both liver and kidney transplantation -30% neonatal mortality rate

Answer 22

-Usually clinically silent – incidental finding -Patient may present with: HTN, hematuria, proteinuria, renal insufficiency -May lead to Chronic Renal Failure- Most common genetic cause of CRF

Answer 23

-Treatment options -Control of HTN- First line ACE-inhibitors or ARBs to decrease RAS system activity -Limit sodium in diet -Aggressive treatment of hypercholesterolemia -Renal replacement

Answer 24

-Solid crystal or concretion developed in kidneys -Classified by location or composition -Most will pass (usually without any symptoms) -Pain occurs when stones are not able to pass and cause obstruction or if spasm of ureter occurs

Answer 25

-Calcium oxalate and -Calcium phosphate- Starts with calcium phosphate concentrations that cause a ‘Randall’s Plaque’ that leads to calcium oxalate depositions and stone formation -Uric acid- Solubility pattern leads to deposition with persistently acidic urine -Struvite -Proteus mirabilis urease cleavage making urine alkaline leading to ‘staghorn calculus’ -Cystine- Genetically caused by abnormal recessive gene for cystine transport

Answer 26

-Urease producing organisms cleave urea to make NH4 and make urine alkaline, leading to phosphate deposition -The deposition then becomes a site for continued growth of bacteria

Answer 27

-Flank pain -Cramping, colic-like pain -Moderate to severe intensity -Nausea and Vomiting -Absence of fever -Labs: -+ blood (whole cells present) -+ protein -+/- WBCs/infection -CT: See the stones/obstruction -Ultrasound: Hydronephrosis if obstruction -Cystoscopy

Answer 28

-Non-contrast CT Abd/Pelvis -Gold standard -Finds the stone in 96% of cases -Positive predictive value is 100% -Negative predictive value is 97% -Ultrasound -1st imaging test in pregnant female but inferior to CT

Answer 29

-Dietary: -Increase fluid intake -Limit calcium intake -Increase citrate-rick drinks -Limit Vitamin C -Limit protein -Allopurinol (if uric acid) -Analgesia- Opiate based is often needed -Expulsion assistance- Alpha-blockers -Lithotripsy -Surgical options

Answer 30

-Condition in which the testis has not descended into the scrotum by 4 months old -Absent or undescended -Most common congenital abnormality of the GU tract in males -Can be bilateral (10%) or unilateral -Increased risk with premature births -30% versus 2-5% in normal births -Other risk factors: -Low birth weight -Prenatal exposure to hormonal disruptors

Answer 31

-If not corrected leads to increased risk for: -Testicular torsion -Testicular trauma -Infertility -Increased risk for malignancy

Answer 32

-Physical finding -Ultrasonography vs exploratory surgery -US less sensitive but used initially (r/o DSD)

Answer 33

-Management -If bilateral – assess for genetic/chromosomal abnormality and refer to a multidisciplinary team if DSD identified -If no hormonal/chromosomal abnormality- Refer to pediatric urologist for exploratory surgery and orchiopexy -Long term care -Monthly self testicular examination and evaluation clinically due to increased lifetime risk of testicular cancer

Answer 34

-Retrograde flow of urine from bladder to upper urinary tract -Increases risk for pyelonephritis -Primary VUR -Caused by incompetent closure of the ureterovesical junction -Usually related to a congenital short ureter -Secondary VUR -Caused by high pressure in bladder (neurologic or obstructive)

Answer 35

-Diagnostics -Start with US following initial UTI in children to assess for renal abnormalities -Voiding cystourethrogram -Treatment: -Antibiotic prophylaxis -If neuropathic cause, attempt treatment of cause or catheterization to decrease bladder pressure -Referral to urologist for surgical correction if continuing past 2-3 years old -Surgical procedure is reimplantation of ureters to normal position resulting in decreased reflux -Goals of Treatment: -Decrease infection rates -Limit injury to the kidneys