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J Renal > Urinary tract conditions > Flashcards

Urinary tract conditions Flashcards

1
Q

most common cause of urethra obstruction

A

prostatic disease (hyperplasia or malignancy)

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2
Q

what physiological movement happens that causes colicky pain in urethra/ureter obstruction

A

peristalsis

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3
Q

why might there be loin pain in ureter/urethra obstruction

A

hydronephrosis (from back up of urine into kidneys) causing the renal capsule to be stretched

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4
Q

loin to groin pain

A

kidney stones causing obstruction

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5
Q

most common cause of ureter obstruction

A

kidney stones

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6
Q

what are kidney stones made from (4)

A

calcium oxalate usually
struvite
calcium phosphate
uric acid

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7
Q

staghorn calculi

what are they made of

where are they found

A

struvite kidney stones

in pelvicoureteric junction

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8
Q

presentation of kidney stones

whats this similar to

A

loin to groin pain
10/10 pain, nothing makes it better
sudden onset

AAA

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9
Q

where do kidney stones usually get stuck (3)

A

points of ureteric constriction;
pelviureteric junction
pelvic brim
vesicoureteric junction

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10
Q

first line investigation for kidney stones

A

KUB xray

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11
Q

diagnostic investigation if you suspect kidney stones but couldnt see them on xray (eg too small)

A

CT

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12
Q

anatomical where do the ureters lie that makes them easy to follow on xray

A

in from of the transverse processes of the spine

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13
Q

apart from imaging what other tests would you want to do in kidney stones (after youve diagnosed them) (2)

A

leukocytes and nitrites for infection

serum Ca and urate to look for cause

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14
Q

which kidney stones pass on their own

how long

A

<4mm

1 month

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15
Q

initial treatment for kidney stone

A

NSAID for pain
thiazide diuretics to increase Ca absorption
alpha blocker (tamsulosin) bc alpha receptors in ureter

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16
Q

when would you do a stent for kidney stones (2)

A

if still there after 1 month OR presentation with pyrexia/infection/nausea/vomiting/pain unrelieved by opiates

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17
Q

when might you do a percutaneous nephrostomy (with stoma bag) for kidney stones

A

if infected hydronephrosis

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18
Q

what type of UTI microbio is associated with kidney stones (2)

A

proteus

klebsiella

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19
Q

what type of cancer can you get in the ureters/urethra

where else can you get this type of cancer

A

transitional cell carcinoma

bladder

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20
Q

name of upper UTI

A

pyelonephritis

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21
Q

name of bladder UTI

A

cystitis

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22
Q

other causes of cystitis (inflammation) that aren’t bacterial UTIs

A 
urethral trauma (honeymoon cystitis) 
viral (eg chlamydia, gonorrhoea)
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23
Q

honeymoon cystitis

A

inflammation of bladder cause by urethral trauma

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24
Q

what is an uncomplicated UTI

A

in a female (usually young) with no catheter/sepsis/stones etc

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25
Q

are women or men more likely to get UTIs

why

A

women

shorter urethra

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26
Q

why are pregnant people screened for UTIs

A

bc they are more susceptible to getting one, and it might turn into pyelonephritis (= bad for baby?)

27
Q

what is the most common route of infection spread in UTI

what is an uncommon route

A

perineal skin/bowel to urethra/bladder

haematogenous

28
Q

definition of bacteriuria

doe sit mean there is a UTI

A

bacteria in urine

no, could just be bc of catheter

29
Q

most common UTI microbio

A

ecoli

bowel commensal

30
Q

UTI microbio from catheters

A

pseudomonas

31
Q

UTI microbio from renal stones

A

PROTEUS

klebsiella

32
Q

UTI microbio from hospital

A

enterococcus faecalis

33
Q

UTI microbio
urine smells foul (burnt chocolate)
swarming cultures

A

proteus

34
Q

UTI microbio in women of child bearing age

A

staph saprophyticus (coag neg staph)

35
Q

presentation of lower UTI (4)

A

supra pubic pain
dysuria (pain/burning when passing urine)
nocturia
haematuria

36
Q

presentation of upper UTI (5)

A 
loin pain 
fever
rigors 
malaise 
dysuria (pain/burning when passing urine)
37
Q

GP investigation for UTI for a young women with ?cystitis

what are you looking for

when dont you don it

A

dipstick urine (urinalysis)

leukocytes and nitrites

hospital, elderly, catheterised

38
Q

more accurate alternative to dipstick urine (urinalysis)

when would you do it

why is it better

A

midstream urine (MSU) sample

hospital, catheterised patient, elderly

midstream is less contaminated than rest of stream

39
Q

when would you do a culture for UTI (2)

A

hospital

recurrent UTI

40
Q

what number of organisms on culture is diagnostic of UTI

A

> 10^5 organisms/ml

41
Q

if someone has >10^5 organisms/ml but asymptomatic what do you do

what is the exception to this

A

dont treat

pregnancy

42
Q

if a young male has a UTI what else do you want to do to find out cause

A

cystoscopy

43
Q

self management/prophylaxis of further UTIs

A 
drink lots 
pee often 
cranberry juice/supplements 
wipe back to front 
prophylaxis antibiotics if recurrent
44
Q

when would you admit someone with a UTI

A

vomiting
fever
old

signs of sepsis

45
Q

uncomplicated female lower UTI treatment

A

trimethoprim PO or nitronfurantoin PO 3 days

46
Q

uncatheterised male lower UTI treatment

A

trimethoprim PO or nitronfurantoin PO 7 days

referral to urologist for cystoscopy (to find out cause)

47
Q

which UTI antibiotic is teratogenic in the first trimester of pregnancy

what does it do

what is the alternative

A

trimethoprim

inhibits folic acid secretion

nitrofurantoin

48
Q

which UTI antibiotic only works in the bladder bc it only reaches its therapeutic window in urine (not effective for pyelonephritis)

A

nitrofurantoin

49
Q

complicated UTI in GP practice treatment

A

coamoxiclav PO or cotrimoxazole PO 14 days

‘Complicated uti in Community’ = Coamoxiclav or Cotrimoxazole

50
Q

which UTI antibiotic has c diff risk

A

coamoxiclav

51
Q

complicated UTI in hospital treatment

A

amoxicillin/cotrimoxazole IV AND gentamicin IV 3 days

‘A Colleague Gets uti in hospital’ = Amoxicillin/Cotrimoxazole and Gentamicin

52
Q

what is cotrimoxazole basically the same as

A

trimethoprim

53
Q

coliform UTI treatment

A

gentamicin IV

54
Q

coliform UTI treatment if kidney failure

A

azetreonam

55
Q

pseudomonas UTI treatment

A

ciprofloxacin (4c antibiotic)

56
Q

UTI treatment in pregnancy

when is it given

what is there a risk of

A

cephalexin PO

to anyone with bacteruria (<10^5 organisms/ml) even if asymptomatic

c diff - 4C antibiotic (type of cephalosporin)

57
Q

treatment of non infectious cystitis

A

carbonic anhydrase inhibitors (for dysuria)

alkanise urine

58
Q

complications of non infectious cystitis

A

pyelonephritis, ureteritis (from ascending infection)

59
Q

who get chronic pyelonephritis

how does it present

A

people with anatomical abnormalities

no previous UTI, polyuria (kidneys cant concentrate urine)

60
Q

where does tuberculose pyelonephritis originate

how does it spread

A

TB form lungs

haematogenous spread

61
Q

how does tuberculose pyelonephritis present

A

same as all other pyelonephritis;

fever 
malaise 
loin pain 
dysuria 
weight loss 
night sweats
62
Q

investigation results of tuberculose nephritis

A

no bugs!

white cells/pus in urine instead

63
Q

pathology appearance of tuberculose pyelonephrtitis

A

kidneys with caseating granulomatous inflammation (looks white and cheesy)

64
Q

painful haematuria

A

probs UTI

J Renal (12 decks)

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