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Y2 Renal > Urinary tract conditions > Flashcards

Urinary tract conditions Flashcards

1
Q

What is cystitis

A

Inflammation of the bladder

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2
Q

What are the causative pathogens of UTI

A

E. coli
Proteus
Pseudomonas aeruginosa
Enterococcus faecalis

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3
Q

What is the most common causative pathogen of UTI

A

E. coli

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4
Q

What is the most common causative pathogen of UTI in an immunosuppressed patient / patients with catheters

A

Pseudomonas aeruginosa

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5
Q

What is the most common causative pathogen of UTI acquired in hospitals

A

Enterococcus faecalis

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6
Q

Risk factors of UTI in adults

A

Female
Catheterised patients

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7
Q

Why are females more susceptible to UTI

A

Shorter, wider urethra
Urethra close to anus

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8
Q

What are the risk factors of UTI in children

A

Girls
Incomplete bladder emptying
Poor hygiene
Vesicoureteric reflux

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9
Q

What can cause incomplete bladder emptying in children

A

Infrequent peeing
Obstruction due to constipation
Neuropathic bladder

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10
Q

What is vesicoureteral reflux

A

Condition in which urine flows backward from the bladder to the ureters

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11
Q

What are the 2 routes of spread of infection for UTI

A

Ascending
Haematogenous

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12
Q

Describe the ascending route of UTI infection

A

Bacteria from bowel -> perineal skin -> enter the lower urethra -> spread into the bladder -> ureter -> kidneys

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13
Q

Describe the haematogenous route of UTI infection

A

Bacteraemia / septicaemia affecting the kidneys

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14
Q

What is considered as uncomplicated UTI

A

Anatomy of the urinary tract is normal, renal imaging is normal
No underlying condition causing the infection

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15
Q

What is considered as complicated UTI

A

Occurs in urinary tracts with stones
Recurrent infection + stone can cause kidney damage

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16
Q

Symptoms of UTI in adults

A

Dysuria (pain when urinating)
Urinary frequency
Urinary urgency
cloudy / offensive smelling urine
Haematuria
Lower abdominal pain

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17
Q

What symptoms may suggest lower UTI spreading to upper urinary tract

A

Loin pain
Fever

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18
Q

Investigations for UTI

A

Midstream specimen of urine (MSU)
Urine dipstick if indicated
Urine culture if indicated

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19
Q

When is urine dipstick indicated

A

Women <65
who do not have risk factors for complicated UTI

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20
Q

When is urine culture indicated

A

Women >65
Recurrent UTI (2 episodes in 6 months)
Pregnant women
Men
Visible / non-visible haematuria

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21
Q

What urine dipstick result can suggest UTI

A

positive for nitrite or leukocyte and red blood cells

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22
Q

What are the symptoms of UTI in children

A

Abdominal pain
Dysuria
Haematuria
Urinary frequency

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23
Q

What symptoms of UTI may show in infants

A

Fever (less common in above 1 year old)
Poor feeding
Vomiting
Irritability

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24
Q

Investigations for UTI in children

A

Urine dipstick
Urine culture with appropriately collected urine

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25
How should urine culture be collected from a child
Clean catch If not possible -> urine collection pads Suprapubic aspiration is only used if the methods above do not work
26
What should not be used to collect urine sample from a child
Cotton wool balls / sanitary towels
27
Management of lower UTI in non-pregnant women
Trimethoprim or nitrofurantoin for 3 days Send culture if >65 / visible or non visible haematuria
28
Management of lower UTI in pregnant women
Send culture in all cases 1. Nitrofurantoin UNLESS close to TERM 2. Amoxicillin / cefalexin in THIRD term
29
Why isn't trimethoprim used in pregnant women for lower UTI
it is teratogenic in the first trimester
30
Management of lower UTI in men
Send culture in all cases Trimethoprim / nitrofurantoin for 7 days
31
Management of lower UTI in catheterised patients
Do not treat asymptomatic patients Antibiotics for 7 days if symptomatic Change catheter
32
Management of lower UTI in children
Refer immediately if <3 months old Oral trimethoprim / nitrofurantoin
33
What are the complications of lower UTI
Acute bacterial prostatitis Acute pyelonephritis
34
Symptoms of bacterial prostatitis
Symptoms of UTI + lower abdominal pain Penile pain Perineal pain Tender prostate on palpation
35
Investigations for bacterial prostatitis
MSU for culture
36
Management of bacterial prostatitis
Ciprofloxin for 28 days
37
Management of acute pyelonephritis
Cephalosporin (cefuroxime) / quinolone (ciprofloxacin/ofloxacin) for 10-14 days
38
What are the types of renal stones
Calcium oxalate and phosphate Magnesium ammonium phosphate Uric acid Cystine
39
Which type of renal stone is the most common
Calcium oxalate (calcium phosphate is less common)
40
What are the risk factors for renal stones
Males 20-50 Hypercalciuria Hypercalcaemia Hyperparathyroidism Dehydration Renal tubular acidosis
41
Uric acid renal stones can occur in patients with
gout
42
Causes of calcium oxalate stones
Mostly idiopathic hypercalciuria Hyperparathyroidism High intake of dietary oxalate - rhubarbs, cabbages Increase in oxalate due to malabsorption in small intestine Drugs
43
What drugs may increase risk of calcium stones
Loop diuretics Steroids Acetazolamide
44
Magnesium ammonium phosphate renal stones often occur
After infection
45
Where are the common sites of obstruction due to renal stones
Uretopelvic junction Vesicoureteric junction (most commonly obstructed) These are natural constrictions of the ureter
46
Where is the vesicoureteric junction
Where the ureter joins the bladder
47
Symptoms of renal stones
Severe sharp, localised, intermittent loin to groin pain Nausea and vomiting Haematuria (negative haematuria DOES NOT exclude renal stone) Sepsis
48
Investigations for renal stones
Non-contrast CT KUB Urinalysis Serum creatinine, U+E - check renal function ultrasound KUB may be helpful in some
49
When is ultrasound KUB used
In pregnant women / children with suspected renal stones But less effective than CT KUB
50
Why isn't Xray really used for renal stones
Because not all stones are visible - uric acid and cystine stones are radiolucent
51
Management of renal stones
If <5mm - watchful waiting + NSAID +/- antiemetics If >10mm - surgery Urgent renal decompression + IV antibiotics if signs of obstruction and infection (may be sepsis)
52
What are the options for treating big renal stones
1. Shock wave lithotripsy 2. Percutaneous ureterolithotomy
53
If a patient with large renal stone is obese, what surgical method should be used
Percutaneous ureterolithotomy
54
Which analgesia is preferred for renal stones
NSAID - IM diclofenac for rapid relief
55
What are the methods to reduce risk of another calcium stone
High fluid intake Low salt diet Thiazide diuretics - increases distal tubular calcium resorption
56
Risk factors of urinary incontinence
Increasing age Females Previous vaginal delivery Pregnancy FH Smoking - causes cough Obesity UTI
57
What are the types of urinary incontinence
Stress UI Urge UI / overactive bladder Mixed UI (urge + stress) Functional incontinence Outflow incontinence
58
What is stress UI
Small amounts of urinary leakage when intra-abdominal pressure is raised e.g. laughing, coughing, sneezing
59
What is urge UI
Urinary leakage due to detrusor overactivity / infection of the bladder (less common)
60
What is the detrusor muscle
Smooth muscle fibres that line the bladder wall
61
Classic symptom of urge UI
Urge to urinate quickly followed by uncontrollable leakage of urine
62
What is overflow incontinence
when you have the urge to urinate but can release only a small amount
63
What causes overflow incontinence
Bladder outlet obstruction - prostate enlargement / constipation Underactivity of detrusor muscle
64
What is functional incontinence
when comorbidities impair the patient's ability to get to a bathroom in time
65
What may cause functional incontinence
Sedating medications Alcohol Dementia
66
Investigations for urinary incontinence
Bladder diaries Examinations - vaginal, abdominal, rectal Urinalysis Urodynamic studies - Xray/US when bladder fills and empties
67
Why do you do vaginal examination for females with urinary incontinence
To check for prolapse of pelvic organs Check pelvic floor muscle strength
68
Why do you do rectal examination for patients with urinary incontinence
To check for prostate enlargement / constipation / rectal mass
69
Management of stress urinary incontinence
1. Pelvic floor muscle training for 3 months 2. Surgery 3. Duloxetine if decline surgery
70
Function of duloxetine in managing stress UI
Stimulates urethral sphincter
71
Management of urge UI
1. Bladder retraining for 6 weeks 2. Antimuscarinics - Oxybutynin / tolterodine 3. Beta agonist - Mirabegron
72
Function of oxybutynin / tolterodine (antimuscarinics) in managing UI
Inhibit contraction
73
Function of Mirabegron (beta agonist) in managing UI
Induce detrusor relaxation
74
When is mirabegron (beta agonist) used in managing UI
In frail elderly patients who should NOT use antimuscarinics because it is associated with causing confusion
75
Types of bladder malignancy
Urothelial carcinoma (transitional cell carcinoma) Squamous cell carcinoma Adenocarcinoma
76
Most common type of bladder cancer
Urothelial carcinoma
77
Risk factors for urothelial cancer
Smoking Increasing age Aromatic amines - used in dyes and rubber industries
78
What is the most common presentation of urothelial cancer
Papillary growth
79
Compare the prognosis of the different bladder cancers
Urothelial cancer - best prognosis Others have worse prognosis because most present as higher grade tumour
80
Symptoms of bladder cancer
Painless macroscopic haematuria
81
Investigations for bladder cancer
Refer urgently if present with painless haematuria CT urogram Flexible cystoscopy
82
Management of bladder cancer
If early - TURBT (transurethral resection of bladder tumour) If higher grade - intravesical chemotherapy If muscle invasive - cystectomy
83
What staging of bladder cancer is muscle invasive
T2 and above
84
What causes urinary retention in men
Benign prostatic hyperplasia Prostate cancer Urethral stricture
85
What causes urinary retention in females
Pelvic prolapse Pelvic mass
86
Management of urinary retention
Immediate catheterisation

Y2 Renal (12 decks)

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