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Repro. Med 2 > Urinary Tract > Flashcards

Urinary Tract Flashcards

1
Q

___ is pain/burning w/ urination

A

Dysuria

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2
Q

___ is blood in the urine

A

Hematuria

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3
Q

___ is the sudden, strong urge to pass urine

A

Urgency

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4
Q

__ is the complaint of voiding too often

A

Frequency

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5
Q

__ is a UTI that is a recurrent infxn, generally w/ different organisms or the same organism, but different susceptibilities

A

Recurrent UTI

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6
Q

___ is a UTI where an organism never clears, frequently identical susceptibility profile

A

Persistent UTI

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7
Q

___ is a UTI that generally reflects inadequate tx (duration, drug choice)

A

Unresolved UTI

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8
Q

___ is a UTI in the context of features that increase risk of therapy failure

A

Complicated UTI

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9
Q

___ is a UTI in healthy/normal individual

A

Acute uncomplicated UTI (“acute cystitis”)

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10
Q

___ is bacteria in the urine, w/o significant host response/sx

A

Asymptomatic bacteriuria

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11
Q

What are some common infectious agents that can cause a UTI? Which organism is most common?

A

E. coli (80%)

Staph, Klebsiella, Proteus

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12
Q

What % of women report having had a UTI in the past?

A

50-60% of women

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13
Q

What are local S/s of a UTI? Systemic sx?

A 
Dysuria
SP pressure
Frequency 
Urgency 
Cloudy/malodorous urine

Systemic: fever, malaise, flank pain

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14
Q

What is included in the w/u for a UTI?

A

Check for CVAT (costovertebral angle tenderness)
UA (cx)
(+/-) genital exam

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15
Q

What is included in the gross exam of a UTI?

A

Color (food, infxn, meds, blood)

Clarity/turbidity (infxn, post-prandial, phosphaturia)

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16
Q

What is included in the dipstick analysis? (many things!)

A 
Specific gravity
pH
Blood 
Protein
Glucose 
Ketones
Nitrite
Leukocytes
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17
Q

What is the range of normal pH for urine?

A

5.0-8.0

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18
Q

What is the nml range of blood in the urine?

What can cause a false positive?

What should you consider if you see dysmorphic RBCs?

A

0-3

Menses, highly concentrated urine, exercise

Glomerular dz

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19
Q

What is the normal range for protein in the urine?

A

0-4

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20
Q

T/F Some glucose in the urine is a normal finding

A

F: any amount of glucose in the urine is an abnormal finding

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21
Q

What can ketones in the urine signify?

A

Hunger or DM

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22
Q

What may cause a (+) nitrite result in a urine dipstick?

A

INFXN

90% specificity!

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23
Q

What is the normal range for leukocytes in the urine?

What does a (+) leukocyte finding indicate?

A

0-3+

Often (+) w/ infxn or contamination

24
Q

T/F Epithelial cells (squamous cells) are an abnormal finding in the urine, especially in women

A

F: squamous/epithelial cells are commonly found in the urine of a female

25
Q

___ are protein coagulum found in renal tubule that traps lumenal contents

A

Casts

26
Q

What do RBC casts signify?

What do WBC signify?

A

RBC: Glomerular bleeding
WBC: Pyelonephritis, glomerulonephritis

27
Q

What are urine crystals associated w/?

A

Stones!

28
Q

Who needs a Urine cx?

A

All men

Women (if recent abx tx, early recurrence, DM, pregnant, surgical or anatomic complexity, sx >7 days)

29
Q

What are some risk factors for UTI? Explain each. (x3)

A

Anatomy
- female, incomplete emptying (neurogenic bladder, DM), obstruction (BPH, stricture), phimosis, stones

Behavior
- sexual activity, spermicide use, wiping, baths

Environment

  • introduction of contaminated FB
  • colonization of chronic FB
  • overgrowth due to alternation in normal flora
30
Q

What are some tx options for UTI?

A 
TMP/SMX (cheap)
TMP (pts on warfarin, multiple allergies) 
Quinolones
Nitrofurantoin (longer duration of use) 
Cephalexin (PCN sensitive) 
Amoxicillin
31
Q

What are some non-antimicrobial strategies for tx of a UTI? What is the approximate efficacy of each?

A

Cranberry or lingonberry juice (20-30% effective)
Vaginal estrogens (30% effective)
Probiotics

32
Q

Catheters are a problem due inevitable colonization of the bag or tubing, w/ subsequent extraluminal migration ___ % or intraluminal migration ___ % into the bladder

A

66%

33%

33
Q

In an open system, __% of pts are bacteruric by 4 days

A

95%

34
Q

Closed systems have an infection rate as low as __% per day of catheterization, but as high as __% at 7 days

A

5%

55%

35
Q

___ is the combination of bacteria + matrix which results in obstruction or encrustation of catheter

The bacteria are usually ____

A

Biofilm

Urease-positive

36
Q

___ is an infection of the renal parenchyma and collecting system

A

Pyelonephritis, (“upper UTI”)

37
Q

What are common infectious organisms that can cause pyelonephritis? Which one is the most common?

A

Most common = E. coli

Proteus, Pseudomonas, Klebsiella

38
Q

What is more common in pyelonephritis: Ascending spread or Descending spread?

A

Ascending

39
Q

What are some predisposing factors for pyelonephritis? (x7)

A 
Prolonged catheter
Renal calculi
Obstruction
DM
Immunosupressive
Congenital anomalies 
Pregnancy 
(PROD ICP)
40
Q

What are clinical S/s of pyelonephritis?

A

Fever, chills, malaise, N/V
Flank pain, CVAT on affected side
Dysuria, urgency, frequency

41
Q

What is included in the w/u for pyelonephritis?

A 
UA+ Cx
Blood Cx
CBC
Chem-8
Renal sonography (excludes obstruction)
42
Q

What is the tx for pyelonephritis?

A

IV abx, hydration, blood glucose monitoring
obstruction: decompress via percutaneous tube or urethral stent

**providers should have a low threshold for hospitalization!

43
Q

___ is a calculi w/in the urinary tract, anywhere from renal calyces to the urinary bladder

A

Urinary lithiasis

44
Q

What are etiologies of urinary lithiasis?

Which etiologies are most common?

A 
Ca++ stones (80%)
Uric acid stones (5-10%)
Struvite stones 
Cystine stones (1-5%) 
Mucinex stones/HIV drug stones
** infection stones (15-20%) 
**see study guide for details
45
Q

What are predisposing factors for urinary lithiasis?

A

Environmental factors (chronic FB, factory worker)

Functional abnormalities (high-pressure neurogenic bladder)

Anatomic abnormalities (horseshoe kidney, congenital UPJ obstruction, stenosed infundibulum)

46
Q

__% of men and __% of women will have at least 1 symptomatic stone by 70 y/o

A

12%

5%

47
Q

What are the S/s of urinary lithiasis?

A

Pain (that waxes and wanes)

hematuria, N/V, UTI sxs, fever

48
Q

What kind of pain might a pt experience if a stone is located in the following locations:

Kidney?
Proximal ureter?
Distal ureter?
UVJ?
Bladder?
A

Kidney – often asymptomatic
Proximal ureter – flank pain (sharp, intermittent, severe)
Distal ureter – groin/inguinal pain, can radiate to ipsilateral testicle/labium
UVJ – urinary hesitancy, urgency
Bladder – frequently asymptomatic

49
Q

What is included in the w/u for urinary lithiasis?

A pH level <5.5 suggests ____
A pH level >8 suggests ____

A 
Workup:
UA + Cx 
Chem -8 (renal fxn)
imaging
- US (if prenant) 
- KUB (90% stones are radiopaque)
- IVP/IVU (intravenous pyelogram) 
- CT (w/o contrast) 
<5.5 = uric acid stone
>8 = infection
50
Q

Where are 3 “tight spots” in the urethra?

A 
Ureteropelvic junction (UPJ)
Iliac vessels/pelvic brim
Ureteropelvic junction (UVJ)
51
Q

What is the likelihood of stone passage in relation to stone size?

A

90% stone in distal ureter and <4mm will pass
50% 4-5.9mm will pass w/o surgery
20% >6mm will pass w/o surgery

52
Q

What is the tx for urinary lithiasis?

A

Medical expulsive therapy with α-blocker (Flomax)
- Flomax is not FDA-approved for stones but widely used to facilitate passage of mid- to distal ureteral stone

Strain all urine in anticipation of stone passage

Pain control w/ narcotics, NSAIDs

Urology referral for illness, renal failure, unyielding pain/N/V

53
Q

What are some indications for surgery for a urinary lithiasis?

A 
Ureteral stone too large to pass
Persistent/severe pain
Recurrent UTI
High risk non-compliance with expectant management
Staghorn calculi

**see study guide for specific procedures

54
Q

What subsequent eval and tx may be required for urinary lithiasis?

A

Stone composition

Recurrent stone formers need metabolic work-up

55
Q

What are general recommendations for pts w/ urinary lithiasis?

A

Increase hydration

Decrease dietary sodium/oxalate/animal protein

56
Q

How do you tx the following pts post-metabolic w/u from urinary lithasis?

Hypercalciuria?
Hypocitraturia?
Hyperoxaluria?
Uric acid stone?

A

Hypercalciuria: loop diuretics (HCTZ)
Hypocitraturia: citrate supplementation (Avoid excess Vit-C)
Hyperoxaluria: calcium supplementation!
Uric acid stone: urinary alkalinization for low urine pH, allopurinol

Repro. Med 2 (12 decks)

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