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Spring 15 - GU, Nephro > Urinary Tract Issues > Flashcards

Urinary Tract Issues Flashcards

1
Q

What is another word for a lower UTI?

A
  • cystitis

- bladder infection

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2
Q

What are complicating factors of a lower UTI?

A
  • age > 65
  • DM
  • immunocompromised
  • male
  • pregnancy
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3
Q

How is pyelonephritis differentiated from lower UTI?

A

-lower UTI has no white cell casts and usually no fever

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4
Q

What are some risk factors for lower UTI?

A
  • female
  • pregnancy
  • instrumentation (eg catheter)
  • incontinence
  • sexual activity
  • DM
  • recent abx
  • poor hygiene
  • abnormal anatomy
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5
Q

What is the symptom triad for lower UTIs?

A
  • frequency
  • urgency
  • dysuria
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6
Q

Aside from frequency, urgency, dysuria - what are other possible sxs of lower UTI?

A
  • hematuria
  • abdominal pain
  • subrapubic tenderness
  • odor
  • nocturia
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7
Q

What findings are common on a UA in a lower UTI?

A
  • high specific gravity (dehydrated)
  • > 5 RBC per HPF (hematuria)
  • nitrates
  • leukocyte esterase
  • > 100,000 bacteria/mL (diagnostic)
  • > 10 WBC/mm3 (pyuria)
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8
Q

When should a urine culture be done in cases of complicated cystitis?

A

-before antibiotics +/- 1-2 wks after tx is finished

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9
Q

When should a urine culture be done in cases of cystitis in pregnant women?

A

-before antibiotics and 1-2 wks after tx is finished

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10
Q

When should a urine culture be done in cases of cystitis with clinical failure?

A

-after clinical failure and 2 wks after tx is finished

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11
Q

Non-pharm Tx for Lower UTI

A
  • cranberry juice and hydration
  • wipe front to back
  • post intercourse voiding
  • estrogen replacement
  • yogurt
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12
Q

Pharm Tx for Uncomplicated UTI

A

-TMP/SMX 1 DS po bid x3 days

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13
Q

Pharm Tx for Complicated UTI:

  1. Pregnancy
  2. At risk for STD
A
  1. ampicillin 7 days

2. doxycycline 7 days

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14
Q

Pharm Tx for Male UTI

A

TMP/SMX 10-14 days

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15
Q

Lower UTI Prophylaxis for Recurrence in Young Women

A
  • > 3 UTI per year

- 1 DS TMP/SMX po qday or po x1 post intercourse

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16
Q

What is another word for pyelonephritis?

A
  • upper UTI

- kidney infection

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17
Q

What is pyelonephritis?

A

-infection of renal parenchyma and renal pelvis

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18
Q

Complicating Factors of Pyelonephritis

A
  • pregnancy
  • immunosuppression
  • fever > 40C
  • age > 65
  • DM
  • persistent N/V
  • possible urosepsis
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19
Q

Signs and Sxs of Pyelonephritis

A
  • dysuria, frequency, urgency
  • flank pain, CVA tenderness
  • fever, rigors
  • HA
  • N/V, abdominal pain
20
Q

What are common UA findings in pyelonephritis?

A

-same as for lower UTI plus white cell casts

[-high specific gravity (dehydrated)

  • > 5 RBC per HPF (hematuria)
  • nitrates
  • leukocyte esterase
  • > 100,000 bacteria/mL (diagnostic)
  • > 10 WBC/mm3 (pyuria)]
21
Q

Risk Factors for Pyelonephritis

A
  • same as UTI: pregnancy, DM, immunosuppressed, instrumentation, catheter, tract abnormalities
  • renal calculi
  • neurologic deficit
  • prostatic enlargement
  • stress incontinence
  • hospital-acquired
22
Q

Tx of Pyelonephritis

A
  • supportive care
  • uncomplicated: cipro or TMP/SMX x14 days
  • complicated: hospitalize, IV quinolone, amp and gent
23
Q

What is another name for renal calculi?

A
  • kidney stones

- nephrolithiasis

24
Q

What are kidney stones typically made of?

A
  • 75% calcium oxalate

- some uric acid, some struvite

25
Q

How can kidney stones be differentiated from appendicitis and pancreatitis?

A
  • lay still in appy
  • hands and knees in pancreatitis
  • walking around with kidney stones
26
Q

What are the most likely areas of obstruction with kidney stones?

A
  • ureter-pelvic junction
  • pelvic brim
  • ureter-vesical junction
27
Q

How can kidney stones be avoided?

A
  • increase water intake
  • decrease salt and meat intake
  • avoid oxalate-rich foods
28
Q

Risk Factors for Kidney Stones

A
  • male
  • age 20-40
  • genetic predisposition
  • dehydration, warm climate, summer
  • diet rich in protein, obesity
  • diuretics
  • white > AA
29
Q

Signs and Sxs of Kidney Stones

A
  • “renal colic”: acute severe pain at rest originating in flank
  • hematuria
  • fever, tachycardia
  • pain may wax and wane
  • anxious, pacing
  • urgency, frequency
  • CVAn tenderness possible
30
Q

What is the test of choice for kidney stones and why?

A

-non-contrast CT: shows size of stone and can help predict probability of passage

31
Q

What will be found on urine dipstick in kidney stones?

A
  • blood
  • microscopic RBCs
  • crystals
32
Q

Treatment Options for Kidney Stones

A
  • none (pass on own)
  • control pain, give fluids, antiemetic
  • ESWL (lithotripsy)
  • cystoscopy to remove stone
  • stent placement
  • nephrostomy
33
Q

Who is more likely to have incontinence problems?

A

women 2x more likely than men

34
Q

Reversible Causes of UI

A
  • medication side effects
  • recent prostatectomy
  • excess fluid intake
  • atrophic vaginitis
  • fecal impaction
  • UTI
  • impaired mobility
  • glycosuria
35
Q

Urge Incontinence

A
  • most common type in elderly
  • bladder overactivity
  • strong desire to void followed by moderate to large loss of urine
36
Q

Sxs of Urge Incontinence

A
  • frequency
  • abrupt urgency
  • nocturia
37
Q

Tx of Urge Incontinence

A
  • oxybutynin (anticholinergic)
  • topical estrogen in women w/ urethritis
  • TCA: imipramine
38
Q

Stress Incontinence

A
  • common in women >65

- urethral underactivity

39
Q

Sxs of Stress Incontinence

A

loss of small amounts of urine from increased abdominal pressure (sneezing, coughing, laughing)

40
Q

Tx of Stress Incontinence

A
  • Kegel exercises
  • SNRI Duloxetine
  • TCA imipramine
  • pseudoephedrine
41
Q

Overflow Incontinence

A
  • most common in men

- urethral overactivity +/- bladder underactivity

42
Q

Sxs of Overflow Incontinence

A
  • high post void residual volume
  • dribbling
  • weak urinary stream
  • hesitancy
  • frequency
  • nocturia
43
Q

Tx of Overflow Incontinence

A

cholinomimetics: Bethanechol

44
Q

Functional Incontinence

A

-physical or cognitive disability prevents a person from reaching toilet

45
Q

Tx of Functional Incontinence

A

-scheduled bathroom breaks

Spring 15 - GU, Nephro (9 decks)

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