urinary tract pathology Flashcards
what is another name for renal calculi
kidney stones
what causes renal calculi
urine becomes excessively supersaturated with a mineral, leading to crystal formation
name some modifiable risk factors for kidney stones
obesity, chronic dehydration, high ambient temperatures, diet
name some non-modifiable risk factors for kidney stones
white, family history, structurally abnormal kidneys, diabetes, hyperparathyroidism, gout etc
what are the 4 main types of kidney stones
calcium (oxalate and phosphate)
uric acid
struvite
cystine
what is the most common type of kidney stones
calcium oxalate stones
what are calcium oxalate stones associated with
low urine volume and hypercalciuria
what is hypercalciuria
elevated calcium in the urine
what are calcium phosphate stones associated with
renal tubular acidosis and primary hyperparathyroidism
what kind of kidney stones are not visible on xray
uric acid stones
what are uric acid stones associated with
diabetes, obesity and gout
malignancy - especially chemo
what are struvite stones made of
magnesium, ammonium and phosphate
what usually precedes struvite stones
upper urinary tract infection
what can be a complication of struvite stones
staghorn calculi
what are staghorn calculi
stones that form in the shape of the renal pelvis
what causes the formation of cystine stones
cystinuria
what is cystinuria
autosomal recessive condition affecting renal absorption of amino acids
classic presentation of kidney stones
renal colic
what is renal colic
unilateral loin to groin pain that fluctuates as the stone moves
where are common sites of obstruction due to kidney stones
uteropelvic and vesicouteric junction
what are the 2 main complications of kidney stones
infection and obstruction
name some other symptoms of kidney stones
N+V, haematuria, signs of sepsis if infection
first line investigation in suspected kidney stones
urinalysis
imaging done in suspected kidney stones (+exceptions)
non-contrast CT KUB
pregnant women and children = ultrasound
analgesia used for kidney stones
NSAIDs
what is cystitis
inflammation of the bladder
what is cystitis cystica
reactive infolding of the bladder mucosa into cysts
what is another name for interstitial cystitis
bladder pain syndrome
what is interstitial cystitis
chronic syndrome of urinary frequency, urgency and pelvic pain
who usually presents with interstitial cystitis
middle age - older females
what is a main complication of indwelling urinary catheters
persistent inflammation of the bladder
what is the most common causative organism for LUTI
e.coli
what is hydronephrosis
swelling of a kidney due to the build-up of urine
pathophysiology of hydronephrosis
obstruction of the tract meaning urine is unable to drain from the kidneys or is able to flow the wrong way up the tubes
management of hydronephrosis
removal of obstruction + drainage of accumulated urine
name some causes of hydronephrosis
kidney stones, BPH, pregnancy, cancers, prolapse, neurogenic bladder
what is bladder diverticulum
formation of a pouch in the bladder wall
name some risk factors for urinary incontinence
female, anatomical disorders, childbirth, surgery, radiotherapy, diabetes, neuro disorders
name some promoting factors of urinary incontinence
smoking, obesity, caffeine, increased fluid intake, poor mobility, ageing
what are the 3 main types of urinary incontinence
stress, urge and mixed
what is stress incontinence
leakage on effort or exertion, sneezing or coughing
what causes stress incontinence
weakness or dysfunction of the pelvic floor muscles or urethral sphincter
what is urge incontinence
leakage accompanied or immediately preceded by urgency
what is overflow incontinence
when you leak or dribble urine because your bladder is too full
what causes overflow incontinence
bladder obstruction, impaired bladder contraction or detrusor muscle weakness
what are some red flags in patients with incontinence
pain, haematuria, recurrent UTI, history of surgery or radiotherapy
what can be used to differentiate between types of incontinence and evaluate bladder muscle function
urodynamics
bedside investigations for urinary incontinence
bimanual and speculum exam
bladder diary
urinalysis
medical management of stress incontinence and when it is indicated
only if surgery is unsuitable
duloxetine - helps enhance sphincter contraction
conservative management of stress incontinence
avoid caffeine, weight loss, smoking cessation, pelvic floor exercises
management options for urge incontinence
bladder retraining
anticholinergics e.g. tolterodine, oxybutynin
mirabegron as alternative drug
botox injections
who is more likely to get urothelial cancer
men
what are the 2 main risk factors for urothelial cancer
smoking and increased age
what cancer have aromatic amines been linked to
bladder cancer
worked in a dye factory !!
what is the most common type of urothelial cancer
transitional cell carcinoma
what is a risk factor for squamous cell carcinoma of the bladder
schistosomiasis infection
long term catheterisation
what is the cardinal sign of bladder cancer
painless, visible haematuria
first line imaging for people with suspected urothelial cancer
flexible cytoscopy
CT urogram
first line management of urethelial cancer
TURBT - transurethral resection of the bladder tumour
+ chemo to reduce recurrence
what is the most common cause of urinary retention
BPH
what is a complication of catheterising an overextended bladder
post-obstructive diuresis
what is the most common route of infection in a UTI
ascending from bacteria in the bowel
how else can you get a UTI and what is the most common causative organism
haematogenous - staph aureus
clinical presentation of cystitis
increased frequency and urgency, dysuria, nocturia, haematuria
clinical presentation of pyelonephritis
back/flank pain, fever/chills/malaise, N+V
first line investigation for a UTI
midstream urine specimin
why do we not use first pass urine in a sample for microbiology
likely to be contaminated
signs of infection on urinalysis
nitrates = bacteria
leukocytes = inflammation
empiric antibiotics for UTI in women
3 days of nitrofurantoin or trimethoprim
management of UTI in pregnant women
7 days of nitrofurantoin
second line amoxicillin
management of UTI in men
7 days of trimethoprim or nitrofurantoin
MOA of trimethoprim
inhibits bacterial folic acid synthesis
who should avoid taking trimethoprim
women in 1st trimester
what is a complication of a UTI in men
acute bacterial prostatitis
management of acute bacterial prostatitis
ciprofloxacin for 28 days
