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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
___ are protein coagulum found in renal tubule that traps lumenal contents
Casts
26
What do RBC casts signify? | What do WBC signify?
RBC: Glomerular bleeding WBC: Pyelonephritis, glomerulonephritis
27
What are urine crystals associated w/?
Stones!
28
Who needs a Urine cx?
All men | Women (if recent abx tx, early recurrence, DM, pregnant, surgical or anatomic complexity, sx >7 days)
29
What are some risk factors for UTI? Explain each. (x3)
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
What are some tx options for UTI?
``` TMP/SMX (cheap) TMP (pts on warfarin, multiple allergies) Quinolones Nitrofurantoin (longer duration of use) Cephalexin (PCN sensitive) Amoxicillin ```
31
What are some non-antimicrobial strategies for tx of a UTI? What is the approximate efficacy of each?
Cranberry or lingonberry juice (20-30% effective) Vaginal estrogens (30% effective) Probiotics
32
Catheters are a problem due inevitable colonization of the bag or tubing, w/ subsequent extraluminal migration ___ % or intraluminal migration ___ % into the bladder
66% 33%
33
In an open system, __% of pts are bacteruric by 4 days
95%
34
Closed systems have an infection rate as low as __% per day of catheterization, but as high as __% at 7 days
5% 55%
35
___ is the combination of bacteria + matrix which results in obstruction or encrustation of catheter The bacteria are usually ____
Biofilm Urease-positive
36
___ is an infection of the renal parenchyma and collecting system
Pyelonephritis, ("upper UTI")
37
What are common infectious organisms that can cause pyelonephritis? Which one is the most common?
Most common = E. coli | Proteus, Pseudomonas, Klebsiella
38
What is more common in pyelonephritis: Ascending spread or Descending spread?
Ascending
39
What are some predisposing factors for pyelonephritis? (x7)
``` Prolonged catheter Renal calculi Obstruction DM Immunosupressive Congenital anomalies Pregnancy (PROD ICP) ```
40
What are clinical S/s of pyelonephritis?
Fever, chills, malaise, N/V Flank pain, CVAT on affected side Dysuria, urgency, frequency
41
What is included in the w/u for pyelonephritis?
``` UA+ Cx Blood Cx CBC Chem-8 Renal sonography (excludes obstruction) ```
42
What is the tx for pyelonephritis?
IV abx, hydration, blood glucose monitoring obstruction: decompress via percutaneous tube or urethral stent **providers should have a low threshold for hospitalization!
43
___ is a calculi w/in the urinary tract, anywhere from renal calyces to the urinary bladder
Urinary lithiasis
44
What are etiologies of urinary lithiasis? | Which etiologies are most common?
``` 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
What are predisposing factors for urinary lithiasis?
Environmental factors (chronic FB, factory worker) Functional abnormalities (high-pressure neurogenic bladder) Anatomic abnormalities (horseshoe kidney, congenital UPJ obstruction, stenosed infundibulum)
46
__% of men and __% of women will have at least 1 symptomatic stone by 70 y/o
12% | 5%
47
What are the S/s of urinary lithiasis?
Pain (that waxes and wanes) hematuria, N/V, UTI sxs, fever
48
What kind of pain might a pt experience if a stone is located in the following locations: ``` Kidney? Proximal ureter? Distal ureter? UVJ? Bladder? ```
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
What is included in the w/u for urinary lithiasis? A pH level <5.5 suggests ____ A pH level >8 suggests ____
``` 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
Where are 3 "tight spots" in the urethra?
``` Ureteropelvic junction (UPJ) Iliac vessels/pelvic brim Ureteropelvic junction (UVJ) ```
51
What is the likelihood of stone passage in relation to stone size?
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
What is the tx for urinary lithiasis?
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
What are some indications for surgery for a urinary lithiasis?
``` 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
What subsequent eval and tx may be required for urinary lithiasis?
Stone composition | Recurrent stone formers need metabolic work-up
55
What are general recommendations for pts w/ urinary lithiasis?
Increase hydration | Decrease dietary sodium/oxalate/animal protein
56
How do you tx the following pts post-metabolic w/u from urinary lithasis? Hypercalciuria? Hypocitraturia? Hyperoxaluria? Uric acid stone?
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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