uro Flashcards
capacity of bladder
300 - 500 ml
(less than a litre)
tamsulosin
used for BPH
helps relax the bladder/prostate allow urine to flow through
Lower uti drugs
Nitrofurontoin or TMP
UTI upper drugs
Khadijah said
Gent
Ceftriaoxone (if go home ?) aor co Amox (if to be admitted)
How often do you take co amoz
Every 8 h
why would you use a bladder scanner?
to see if the patient has urinary retention e.g like f the patient has a large post void residual so even after thyeve peed they still have a urinary retention
signs of urinary retntion
- discomfort
- usuprpubic sweeling
- overflow inconvenience
- havent been to the toilet in ages
how can we measure the amount of urine in the bladder ?
- bladder scan
- catheter completely empty the bladder
- transvaginal
indwelling catheter
can stay for weeks, also called a foley
prophylactic abx
types of catheters
- foley/indwelling
- straight or intermittent
3.suprapubic
ANALGESIA RENAL COLIC
NSAIDS ARE 1ST LINE
IF CI
IV paracetomol
if neither available then consider opiod like tramdol
whats contentious in renal colic
giving spasomodyanmic
when would you consider admission for a person wit renal colic
- signs of infection
- bilateral obstruction
- evidence of hydronephroiss
4.pt has previous renal history,ckd, transplant etc
The person is dehydrated and cannot take oral fluids due to nausea and/or vomiting
secondary effects of stones
- migration
2.ulceration - malignancy
4.sepsi s - obstruction - hydronephrosis
investigations of renal colic
- bloods - check kindey function u+e
- urine dip - hematuria, nitrites, leukocyte esterase
- CT KUB - non contrast
- pain relief - nsaid
- antiemetic if feeling naseus
- abx - if infection
hot to definitively diagnose renall colic
CT KUB
but if CI- pregnancy or young person ultrasound
rf stones
obese
diet in salt , purines (meats )
chronic dehyration
structural kidney abnormalities, - horshoe kideny, pckd
diabetes, IBD, hyperparathyrodim
how to treat urinary retention
catherterize
urine ph
struvite stones cause by proteus mirabilis
causes of retention
often in older male patients who have recently undergone anaesthesia for surgery. SO POST OP
prostate - BPH
UTI
spinal cord problems like CES
Stenosis/stricture
elderly! constipation
- anticholinergic drugs
wbc in urine
UTI
or irration due to something like a stone
prevention of stones
Drink 2.5-3 litres of water per day
Avoid carbonated drinks (may acidify urine)
Add fresh lemon juice to water (contains citrate which reduces stone formation)
Eat a balanced diet and maintain a healthy weight
Reduce salt intake
Do not restrict dietary calcium intake
What size renal stone can be managed conservatively?
less than 5mm can pass naturally a watch and wait
staghorn
proteus
takes the shap of the kideny
Postobstructive diuresis
Postobstructive diuresis is a polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction
common agents of UTI
E.coli
Proteus mirabilis
Klebsiella pneumonia
Staphylococcus saprophyticus
TYPES OF urinary retention a
acute - more dangerous as you need to alleviate the pressure immedaitely
chronic
why would you consider a DRE in a case of urinary retention
- prostate either BPH OR CANCER
- CES - check tone
- any other pelevic apthology that could be causing retention like colocn cancer etc
how does constipation affect bladder
the rectum enlarges pressing on the urethra squeezing it shut and can lead to retention (elderly )
or the opposite and actually irrates the bladder feelign the need to go more freuqnetly
signs of rention
Inability to pass urine
Lower abdominal discomfort
Pain or distress
Suprapubic tenderness
Suprapubic mass (due to an enlarged bladder)
Delirium (hypoactive or hyperactive)
medical management of BPH
Medical therapy such as Tamsulosin and/or Finasteride may be commenced. If medical management fails, patients may be suitable for a transurethral resection of the prostate. If not fit for surgery, patients may require a long-term catheter.
PSGN VS IG A
nephritic syndrome,
usually happens around 2/3 weeks after an strep infection
IG A
- days after
- c3 usually normal
-IG a deposits
Which common neurological disorders can cause urinary retention
Stroke, multiple sclerosis, spinal cord injuries
