Urinary Tract Disorder

Question 1

How can urinary stones be imaged?

Answer 1

Plain x-ray KUB - show calcification

Question 2

What are the symptoms of urological stones?

Answer 2

Pain (colic), haematuria, infection

Question 3

What are kidney stone composed off?

Answer 3

75% are calcium oxalate - visible on X-ray
10% struvite
10% urate (radiolucent)

Question 4

How are stones managed?

Answer 4

Increase fluid load
Dietary modification - less animal protein, sodium, sugar
Treat infection
Alkanise urine –> urate
Bendroflumethiazide - reduces calcium oxalate stones

Large stones (>8mm) - Extracoporeal Shock wave Lithotripsy (ESWL)

Question 5

How do Lower and Upper UTIs present?

Answer 5

Lower UTIs - urinary frequency and urgency accompanied by dysuria. Possible frank haematuria and systemic illness.

upper UTI (pyelonephritis) - LUTS + unilateral loin pain. Pyrexia and systemically unwell.

Question 6

How are UTIs diagnosed?

Answer 6

Urine dipstick - nitrite (a bacterial breakdown product), leucocytes, blood and protein suggests an infection

Urine M,C & S

Question 7

What is the treatment of simple UTIs?

Answer 7

3-day course of trimethoprim, cephalexin or nitrofurantoin

Question 8

What is the treatment of pyelonephritis and pyrexia?

Answer 8

24-48 hrs IV gentamicin or temicillin, followed by 10-day course of PO antibiotics

Question 9

What is recurrent UTIs.

Answer 9

More than 3 episodes per year. Can be treated with long-term low does prophylactic antibiotics.

Question 10

What investigations are carried out in complicated UTIs?

Answer 10

outpatient cystoscopy and either an ultrasound or a CT scan of the upper urinary tracts

Question 11

A 35 year old lady with a previous history of ureteric stone disease presents with a 2 day history of severe loin pain. Her temperature is 39°C, pulse 130 and blood pressure 80/50. Her urine contains nitrite and leucocytes on dipstick. After fluid resuscitation and intravenous antibiotics what should you do next?

Answer 11

An urgent ultrasound scan to exclude pyonephrosis

Question 12

How is pyonephrosis managed?

Answer 12

Nephrostomy tube

Question 13

Which antibiotic can be used to treat a UTI during pregnancy?

Answer 13

nitrofurantoin

Question 14

What is the gold standard investigation for suspected urolithiasis?

Answer 14

CT KUB

Question 15

What is used for analgesia to treat renal colic pain?

Answer 15

Diclofenac