urinary tract pathology Flashcards by Evie Mander

what is another name for renal calculi

kidney stones

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what causes renal calculi

urine becomes excessively supersaturated with a mineral, leading to crystal formation

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name some modifiable risk factors for kidney stones

obesity, chronic dehydration, high ambient temperatures, diet

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name some non-modifiable risk factors for kidney stones

white, family history, structurally abnormal kidneys, diabetes, hyperparathyroidism, gout etc

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what are the 4 main types of kidney stones

calcium (oxalate and phosphate)
uric acid
struvite
cystine

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what is the most common type of kidney stones

calcium oxalate stones

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what are calcium oxalate stones associated with

low urine volume and hypercalciuria

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what is hypercalciuria

elevated calcium in the urine

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what are calcium phosphate stones associated with

renal tubular acidosis and primary hyperparathyroidism

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what kind of kidney stones are not visible on xray

uric acid stones

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what are uric acid stones associated with

diabetes, obesity and gout
malignancy - especially chemo

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what are struvite stones made of

magnesium, ammonium and phosphate

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what usually precedes struvite stones

upper urinary tract infection

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what can be a complication of struvite stones

staghorn calculi

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what are staghorn calculi

stones that form in the shape of the renal pelvis

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what causes the formation of cystine stones

cystinuria

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what is cystinuria

autosomal recessive condition affecting renal absorption of amino acids

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classic presentation of kidney stones

renal colic

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what is renal colic

unilateral loin to groin pain that fluctuates as the stone moves

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where are common sites of obstruction due to kidney stones

uteropelvic and vesicouteric junction

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what are the 2 main complications of kidney stones

infection and obstruction

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name some other symptoms of kidney stones

N+V, haematuria, signs of sepsis if infection

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first line investigation in suspected kidney stones

urinalysis

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imaging done in suspected kidney stones (+exceptions)

non-contrast CT KUB
pregnant women and children = ultrasound

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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 specimen

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