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GMED5001 > Urology > Flashcards

Urology Flashcards

1
Q

Urinary Tract Obstruction

A

Interference with flow of urine at any site along the urinary tract
* Can be anatomical or functional

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2
Q

3

Most common causes of urinary tract obstructions

A

Renal calculi
Prostate enlargement
Urethral strictures

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3
Q

7

Complications of urinary obstruction

A

Hydronephrosis
Hydroureter
UTI & cystitis
Residual urine volumes
Low bladder wall compliance
Vesicouretral reflux (backflow)
Pain

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4
Q

What are renal calculi & aetiology

A

Massess of crystals, protein and other substances that form within the urinary sustem

Low water intake, dehydration, high salt/sugar intake, little exercise, obesity, gout, altered pH

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5
Q

Pathophysiology of renal calculi

A

Supersaturation of urine, causing crystalisation of salts and proteins (unable to dissolve) forming a solid precipitate

Can cause obstruction & pain

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6
Q

3

Types of stones

A

Calcium oxalate & phosphate
Struvite stones
Uric acid stones

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7
Q

Manifestations of renal calculi

A

Renal colic
Haematuria

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8
Q

Diagnosis of renal calculi

A

Stone/urine analysis
IV pyelogram or US
Abdominal CT

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9
Q

Treatment of renal calculi

A

High fluid intake
Decrease intake of stone forming substance
Stone removal

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10
Q

Aetiology of prostate enlargement

A

Prostatitis
Benign prostatic hyperplasia
Prostate neoplasia

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11
Q

Pathophysiology of prostate enlargement

A

Partial obstruction of urethra causes detrusor muscle to increase force of contraction

If blockage continues, afferent nerves in the bladder walls are adversely affected = urgency & increased detrusor contractions

Collagen deposition in SM of detrusor causes an inability to stretch and contract

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12
Q

Manifestations of prostatic enlargement

A

Increased frequency
Nocturia
Poor & intermittent force of stream
Urgency
Incomplete emptying

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13
Q

UTI and Causes

A

UTI is an infection of any part of the urinary system

Causes: retrograde bacterial movement, often faecal (E. Coli)

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14
Q

Natural prevention of UTI

A
  • Bacteria washed out by urine during micturition
  • Low pH & high osmolality of urea & epithelial lining secretions = bactericidal
  • Ureterovesical junction (closes during bladder contraction to prevent reflux)
  • Long urethra & prostatic secretions in men (antibacterial)
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15
Q

Pathophysiology of UTI

A
  • Normal flora from bowel, vagina or perineum entering urinary tract
  • Irritation of epithelium, causing pain, inflammation and infection
  • Vasodilation & hyperaemia (swelling, inflammation, hematuria)
  • Increased permeability (oedema)
  • Fullness, small voids, urgency, frequency (oedema on stretch receptors)
  • Cell immune response (+leukocytes)
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16
Q

Risk factors of UTI

A
  • Young women, shorter urethral length, sexual intercourse, pregnancy, past hx
  • IDC, urinary retention/stasis, obstructions, dehydration, incontinence
  • Compromised immune system (DM, CKD), antibiotic use
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17
Q

Types of UTI

A

Asymptomatic bacteriuria
Cystitis
Pyelonephritis
Catheter-associated
Upper UTI
Lower UTI

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18
Q

Manifestations of UTI & in elderly

A

Urine frequency, urge & oliguria
Feeling of fullness
Dysuria
Cloudy, red urine
Pain, fever, chills, N/V (Upper UTI)

Elderly: abdominal discomfort, cognitive impairment/delirium

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19
Q

Diagnostic studies for UTI

A
  • Hx & physical examination
  • Dipstick urinalysis (+nitrites, leukocytes, RBC)
  • Urine culture and sensitivity (for confirmation & antibiotic sensitivity)
  • Imaging (CT urography, ultrasonography)
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20
Q

Treatment of UTI

A

Medication therapy (cefalexin, amoxicillin + clauvulanic acid)
Adjuvant therapy (urine alkaliniser, cranberry juice)
Increased fluid intake
Good hygiene, postcoidal voiding
Probiotic yoghurt with lactobacillus to restore commensal flora

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21
Q

Follow up care for UTI

A

Repeat urine examination for bacteriuria (required for pregnant women)
* If recurrent uncomplicated cystitis occurs 2x in 6 months or 3x in 12 months = US & specialist
* If recurrent in postmenopause = check for pelvic organ prolapse and vaginal atrophy (mimic symtoms)
* If in elderly = screen for DM

22
Q

Asymptomatic bacteriuria

A

Bacteria present in urine (>105 CFU/mL) without No signs & symptoms
Usually in elderly
No treatment except pregnancy or urological patients

23
Q

Acute cycstitis, aetiology & risk factors

A

Most common UTI
Inflammation of the bladder that occurs due to bacterial retrograde movement into the bladder, usually E.coli

Risks: women, sexually active, pregnancy, elderly, antibiotics that disrupt flora, DM, IDC, incomplete voiding, neurogenic bladder, obstruction

24
Q

Types of acute cystitis

A

Uncomplicated: symptomatic infection in individual with structurally and functionally normal UT

Complicated: symptomatic in men OR abnormality (obstruction, CKD, DM, immunosuppression, catheter)

25
Q

Pathophysiology of acute cystitis

A

Bacterial irritation of the bladder epithelium causing infection & inflammatory response (vasodilation, hypereamia, permeability = redness, swelling, oedema of mucosal lining of bladder, hematuria)

Oedema stimulates stretch receptors, causing a feeling of fullness and urgency on small urine volumes

26
Q

Manifestations of acute cystitis

A
  • Dysuria (mucosal inflammation)
  • Urgency & frequncy, bladder fullness (oedema)
  • Flank pain (referred inflammatory pain)
  • Hematuria
  • Cloudy urine (leukocytes)
  • Odour (bacteria)
27
Q

Diagnosis and Treatment

A

Urinalysis & urine culture
Tx: antibiotics, repeat cultures, prevention (pass urine after sex, wipe away from vagina)

28
Q

Acute pyelonephritis
(summary)

Aetiology, PP, M, Types

A

Infection of the renal pelvis and interstitium with positive urine culture

A: by stones, vesicoureteral reflux or pregancy (E. coli, proteus, pseudomonas)

PP: WBC infilration, inflammation, renal oedema, purulent urine, involvement of blood stream

M:
* Mild: low grade fever, no N/V, pain (oral tx)
* Severe: systemic symptoms (fever, N/V, severe pain, injury (IV tx, admission)

29
Q

Chronic pyelonephritis

A

Recurrent kidney infections, usually occurs with other renal pathology

PP: inflammation causes tubule destruction, atrophy, scarring and kidney disease, pain, HTN

Dx: IVPyelography, US

30
Q

Glomerular disorders, causes and most common type

A

Any condition affecting the glomerulus

C: immune response, toxins, drugs, vascular disorders, systemic diseases, metabolic disorders

Most common: glomerulonephritis

31
Q

Glomerulonephritis & aetiology

A

Inflammation of the glomerulus

A: caused most commonly by immunological abnormalities, also drugs, vascular/systemic diseases (DM, lupus), viral

Most common cause of end stage kidney disease

32
Q

Acute glomerulonephritis

A

Usually following streptococcus infection
Deposition of antigen-antibody complexes on basement membrane, triggering Cā€™ and antibody mediated damage to epithelium of glomerulus

33
Q

Acute glomerulonephritis manifestations

A

Hematuria, proteinuria, low GFR, oliguria, HTN, oedema

Most recover without permanent damage

34
Q

Chronic glomerulonephritis

A

Several glomerular diseases that progressively lead to end stage kidney disease due to sclerosis and interstitial injury
Strong presence of hematuria and proteinuria

35
Q

Nephrotic syndrome

A

Glomerular injury resulting in excretion of > 3.5g protein in urine/day

36
Q

Oliguria & causes

A

Low urine output less than 30mls/hr

Caused by HoTN, dehydration, blood volume loss, UTI, obstruction

37
Q

Enuresis & types

A

Involuntary passage or urine (diurnal or nocturnal)

Primary: continence never established

Secondary: aquired due to a number of factors
* UTI, neurological, structural abnormalities, DM/DI, CKD, sleep distubances/REM, stress

38
Q

Diuretics & types

A

Treat HTN and fluid volume excess by modifying kidney function (inducing diuresis and NaCl excretion through reabsorption inhibition)

Loop, thiazide, K-sparing

39
Q

Loop diuretics

A

Frusemide (oral, IV)
Potent inhibitor of Na and Cl at ascending limb of loop of Henle, & convoluted tubules
* Better for oedema as this transporter absorbs more Na than others in the nephron

Adverse: electrolyte imbalance (hyponatraemia, hypokalaemia, hypermagnasemia) - serum levels must be monitored

40
Q

Thiazide diuretics

A

Hydrochlorothiazide (oral)
Inhibit absorption of Na and Cl in the proximal segment of the distal convuluted tubule
* Excrete water, Na, Cl, K, Mg but decrease excretion of uric acid and Ca
* Less potent for oedema but first choice for HTN

41
Q

K-sparing diuretics

A

Amilodide, spironolactone
Act on distal tubules and collecting ducts with reduced diuretic capacity BUT spare K excretion therefore are used in combination with other diuretics

42
Q

Oxybutynin

& side effects

A

Oral
Urinary antispasmodic drug - enuresis & detrusor overactivity
Inhibit muscarinic action of acetylcholine on bladder SM

SE: palpitations, tachy, constipation, dizziness

43
Q

Amoxicillin-Clavulanic acid (Augmentin Duo)

A

Oral penicilin antibiotic for UTI infections
Has bactericidal effect on sensitive organisms during active multiplication
SE: N, D, headache

44
Q

Cephalexin

A

Oral cephalosporin antibiotic for genitourinary infections including acute prostatitis (streptococci, E. coli)
Work by inhibiting bacterial wall synthesis
SE: N

45
Q

Chronic Kidney Disease & PP

A

Progressive loss of renal function due to systemic or renal disease, staged by level of GFR

PP: renal injury leads to loss of nephrons = increased glomerular permeability and filtration
* Proteinuria increases tubule injury, causing inflammation and scarring and increased angiotensin II

46
Q

CKD Manifestations

A

Uraemia
High plasma creatinine
Oedema & HTN (electrolyte disturbances)
Hypocalcaemia, hyperlipidaemia, immune suppression, headache, impaired cognition, bad breath, easy bruising

47
Q

Neurogenic bladder

A

Bladder dysfunction caused by neurological disorder
Can be overactive, flaccid, leakage

48
Q

Acute Kidney Injury & types

Explain most common

A

Sudden decline in kidney function, indicated by low GFR, uremia and high plasma creatinine
* Prerenal: most common, from impaired blood flow causing cell injury (hypovolaemia, haemorrhage, HoTN, cardiac failure)
* Intrarenal
* Postrenal

49
Q

Types of functional and structural abnormalities

5

A

Hypospadias: urethral meatus located on ventral side of penis
Polycycstic kidneys: cyst formation causes cell proliferation, BM remodelling and oedema
Renal agenesis: absence of one of both kidneys
Vesicoureteral reflex: issue with junction
**Enuresis: **involuntary urine passage beyond bladder control age

50
Q

Upper vs Lower UTI

A

Upper UTI affects renal parenchyma, pelvis and ureters, and causes systemic symptoms (pain, fever, chills)

Lower UTI has local but not systemic symptoms

51
Q

Nursing Assessment of UTI

A

Health history
* Previous UTI, UT abnormalities, pregnancy, cancer, STI
* Antibiotics, antispasmodics, IDC/IMC, urinary hygiene
* S: N/V, anorexia, chills, frequency, urge, nocturia, back pain, dysuria, burning

Objective Data
* Fever, hematuria, odour, pyuria, tender on palpation, +(bacteria, RBC, leukocytes, nitrites), US/CT/IVP

Intervention
* Increase fluid intake, local heat to lower back
* Educate about medication course, SE, monitor own SS, persistant S or signs of recurrent infection
* Monitor for tx efficacy and delirium in elder

Health promotion
* At risk individuals, regular voiding & empty bladder completely, wipe front to back, adequate fluids, cranberry juice, post coidal void, temp dicontinue use of diaphragm

52
Q

Prevention of CAUTI

A
  • Avoid unecessary catheterisation & early removal
  • Aseptic technique
  • Wash hands before and after
  • Routine perineal care
  • Avoid incontinent episodes

GMED5001 (13 decks)

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