Urology and Renal Flashcards
Define balanitis.
Inflammation of the foreskin and head of the penis.
What S/S are most commonly associated with balanitis?
Patient will be uncircumcised male c/o itching and burning of penis presenting with erythema, inflammation, and scant white discharge.
What is the most common pathogen that causes balanitis?
Candida
What is the typical treatment for balanitis?
Improved hygiene, topical antifungal or abx.
What patients are more susceptible to balanitis and how are they treated?
Diabetics –> hygiene, glucose control, clotrimazole
Describe the pathophysilogical process leading to benign prostatic hyperplasia (BPH).
proliferation of fibrostromal prostate tissue –> urethral compression –> obstruction of urinary outlet
What clinical features will be indicative of BPH?
Slightly elevated PSA, enlarged prostate on DRE, hesitancy and straining, post-void dribbling, nocturia, urgency, frequent UTIs.
What are treatment options for BPH?
Behavioral: imit fluids before bed
Pharm: alpha antagonists (prazosin), PDE-5 inhibitors (tadalafil), Anti-Ach agents
Procedures: balloon dilation, microwave irradiation, stent placement, transurethral resection/incision
What is the most common cause of non-gonococcal urethritis?
Chlamydia
Differentiate urethritis caused by chlamydia from that of gonorrhea.
IN chlamydia, discharge is usually watery and less painful than in gonorrhea.
What is the typical presentation of chlamydia in females and what is the risk of disease progression?
Usually asymptomatic –> progress to PID, cervicitis, salpingitis
What is the most common cause of female infertility?
Chlamydia
How is the diagnosis of chlamydia made?
Typically presumptive based on symptoms –> bacteria is gram negative on testing
What is the treatment for chlamydia?
Doxycycline, azithromycin, erythromycin –> preferred in pregnancy
Define cystitis and state the most common cause and progression of the disease.
Bladder infection. Usually E. Coli that ascends from urethra –> often appears in women after sexual intercourse.
What clinical features are consistent with a diagnosis of cystitis?
H&P: Frequency, urgency, dysuria, maybe suprapubic tenderness.
UA: Pyuria, bacteriuria, may have hematuria –> urine culture will be positive for offending organism
What imaging is used to diagnose cystitis?
None needed unless suspected pyelonephritis, recurrent infections, or abnormal anatomy.
What is used in the treatment of cystitis?
Sx relief: hot sitz baths, phenazopyriadine (aka “azo”)
Abx: Bactrim, nitrofurantoin, fluoroquinolones if severe or recurrent.
What type of drug is phenazopyriadine and what is its primary AE?
Urinary analgesic –> turns urine orange
Describe the pathogenesis and causative agents in epididymitis.
Retrograde spread of organism through the vas deferens. YOunger than 35, organism is usually G/C –> older than 35 is E. Coli.
Describe S/S consistent with epididymitis.
Dull ache in scrotum that can radiate up ipsilateral flank, swollen epididymis, fever, chills.
Describe Prehn’s sign and its finding in epididymitis.
Positive when scrotal pain is relieved with elevation of the scrotum –> positive sign indicates epididymitis.
What urinalysis findigns are consistent with epididymitis?
Pyuria, bacteriuria –> urine culture will be positive for offending organism
What is the treatment for epididymitis?
< 35 yoa: ceftriaxone + doxycycline
> 35 yoa: ciprofloxacin
Define and describe glomerulonephritis.
Deposition of inflammatory proteins in glomerular membranes as result of immunologic response
What is the prognosis in glomerulonephritis?
Excellent in kids, worse in adults - especially with pre-existing renal disease.
What are the most common causes of glomerulonephritis?
hematuria, Henoch-schonlein purpura, postinfectious GN, IgA nephropathy, hereditary nephritis
What S/S are associated with glomerulonephritis?
tea/cola colored urine, oliguria, edema of the face and eys in the AM and feet/ankles at night, HTN
What is the most common cause of glomerulonephritis and what would be diagnostic of this condition?
Prior strep infection –> increased antistreptolysin-O titer
What urinalysis and serum lab findings are indicative of glomerulonephritis?
UA: hematuria, RBC casts, proteinuria
Labs: dec GFR, dec serum complement
What is the treatment of glomerulonephritis?
Steroids and other immunosuppressants to control the inflammatory response.
Decrease fluid and salt intake
ACEIs in chronic glomerulonephritis
Treat HyperK, HTN, edema, and acidosis PRN
Define azotemia and how it is treated when present in glomerulonephritis.
Azotemia: elevated BUN and serum creatinine
Symptomatic azotemia in glomerulonephritis indicates a need for dialysis
What is the incubation period for gonorrhea?
2-8 days after exposure
What S/S are most commonly associated with gonorrhea?
Men: burning with urination, milky/yellow discharge
Women: Often asymptomatic –> may have frequency, urgency, purulent urethral discharge
What complications may present if gonorrhea is untreated?
Men: prostatitis, epididymitis, chronic infection
Women: vaginitis, cervicitis, PID, infertility
What are the S/S of gonococcal bacteremia?
Peripheral skin lesions, septic arthritis of the knee, ankle, or wrist.
What will a culture show when gonorrhea is present?
Gram negative intracellular diplococci
What is the treatment for gonorrhea?
IM ceftriaxone
Treat chlamydia as coinfection with doxycycline (previously azithromycin)
Define hernia.
Protrusion of organ or structure through wall that normally contains it
Describe and state the treatment for various types of hernias.
Umbilical: congenital –> often resolves on its own but may require surgery
Hiatal: Protrusion of stomach trhough esophageal hiatus. Treat with acid reducers or surgery.
Inguinal: passage of intestine through external inguinal ring. Treatment is surgery
Ventral: passage through a weakness in the anterior abdominal wall. If treated, requires surgery.
Describe the three types of inguinal hernias.
Indirect: Intestine passes through inguinal canal and may enter scrotum.
Direct: Intestine passes through Hesselbach’s triangle and rarely enters the scrotum.
Femoral: Intestine passes through the femoral ring
Which type of inguinal hernia is most and least common?
Most common: indirect
Least common: femoral
What structures make up the boundaries of Hesselbach’s triangle?
Rectus abdominus (medial) Inferior epigastric vessels (lateral) Inguinal ligament (inferior)
What are the common causes of kidneys stones (nephrolithiasis)?
Saturation of urine with Ca, oxalate, other solutes or lack of inhibitors to crystal formation (citrate).
List types of stones from most common to least common.
Ca –> uric acid –> cystine –> struvite
Describe S/S associated with nephrolithiasis.
Unilateral, colicky flank pain, hematuria, dysuria, frequency, fever, chills, N/V
What diagnostic evaluatins are consistent with nephrolithiasis?
Normal serum labs (possible leukocytosis)
UA: hematuria, leukocytes, crystals
CT without contrast: detect stones as small as 1mm
Renal US: can ID stones in kidney, ureter, or ureterovesicular junction
What is the treatment for nephrolithiasis?
5mm or less: inc fluids and analgesia
5-10 mm: fluid, analgesia, lithotripsy or ureteroscopy with stone basket extraction
10+ mm: ureteral stent (percutaneous nephrostomy) is gold standard. Vigorous hydration and analgesia
Define orchitis and state the common pathophysiology.
Inflammation of one or both testicles. Commonly caused by ascending infection from urinary tract.
What infection in post-pubertal males is often followed by orchitis?
Mumps
What S/S are commonly associated with orchitis?
Unilateral swelling and tenderness, fever, tachycardia
What findings on urinalysis are consistent with orchitis?
pyuria and bacteriuria with bacterial infection
Define pyuria.
Pus in the urine caused by inc WBCs
What is treatment for orchitis?
If mumps, treat mumps. If bacterial, same treatment as epididymitis …
< 35 yoa: ceftriaxone + doxycycline
> 35 yoa: ciprofloxacin
Define prostatits.
Ascending infection of gram-negative rods into prostatic ducts
What S/S are commonly associated with prostatits?
Frequency, urgency, dysuria, fever, chills, low back pain, tender and swollen prostate.
What does a urinalysis typically show in prostatitis and what is/are the common causative pathogens?
UA: pyuria, hematuria, bacteriurua
How is prostatitis treated?
Fluoroquinolones or Bactrim –> FQs preferred in chronic. IV FQs if hospitalization necessary. Add NSAIDs and/or alpha-1 blocker if lower urinary tract symptoms present.
How should prostatitis be treated if fever persists more than 36 hours after abx treatment?
Consult urology for suspected abscess
Define pyelonephritis and state in which population it is more common.
Infection involving parenchyma and renal pelvis. More common in diabetics and elderly women.
What S/S are commonly associated with pyelonephritis?
fever, flank pain, chills, irritative voiding symptoms, N/V/D, abdominal pain in kids, pronounced CVA tenderness in adults.
What diagnostic evaluations are used to evaluate pyelonephritis and what are the results?
CBC: leukocytosis with left shift
UA: pyuria, bacteriuria, hematuria, WBC casts
US: hydronephrosis s/p obstruction
What is the treatment for outpatient and inpatient pyelonephritis?
In: FQs or Bactrim for 1-2 weeks
Out: IV –> FQs, ceftazidime/cefepime (3rd/4th gen), ES PCNs (zosyn), or gentamycin
What is the most common malignancy in young men (age 15-35) and what are risk factors?
Testicular cancer –> r/f: Hx of cryptorchidism or previous testicular CA
What is the most common clinical feature of testicular cancer?
painless, solid testicular swelling
