Urology/Renal Flashcards
1
Q
orchitis
A
- inflammation from epididymis spreads to adjacent testical; viral orchitis MC after mumps, but may be caused by viral or bact infxn
- sxs: abrupt onset test pain; if viral, 7-10d after mumps as parotitis resolves
- signs: test swelling and tenderness, + cremasteric reflex
- dx: hx, PE< UA, doppler, hyperechoic and hypervascular areas
- tx: supportive (NSAIDs, scrotal support), abx (cirpo, doxy, rocephin), viral resolves spontaneously after 3-10d
2
Q
epididymitis
A
- inflamm or infxn of epididymis → can spread to entire testicle → orchitis
- etiology: <35yo → Gonorrhea or chlamydia; >35yo → E. coli
- ho: UTI, urethritis, dc, sexual activity, foley cath; MCC scrotal pain in adults
- sxs: unilateral pain, dull ache, swelling, radiation to ipsilateral inguinal canal (flank), sxs of cystitis, fever, chills, urethral dc and pain at tip of penis
- signs: mass, erythema of scrotal skin, Prehn sign (+) → pain relief with elevation of scrotum, + cremasteric reflex, tachycardia
- dx: doppler (increased blood flow), CRP and ESR (elevated ro torsion)
- tx: rest, scrotal elevation, ice, NSAIDs; <35 ceftriaxone and doxy, >35 cipro and bactrim
3
Q
acute prostatitis
A
- rare, class I “sick”, most community acquired, others occur after cath and cystoscopy, or after transrectal prostate bx
- cause: G neg orgs → E. coli, Klebsiella, Proteus, Enterobacter, Staph; peak 20-40
- sxs: acute onset pelvic pain (perineal, sacral, suprapubic pain; irritative UTI sxs (frequ, urg, dysuria)
- obstructive: striaining, hesitancy, poor or interrupted stream, incomplete emptying
- systemic febrile illness; fever/chills, malaise, N/V
- signs: toxic, febrile, sepsis, tachypnea, suprapubic pain
- dx: UA + cx → large WBC, + cx; postvoid residual, elevated WBC, tender, enlarged “boggy” prostate, prostatic massage contraindicated, CBC
- tx: outpt → FQ (cipro), bactrim BID; inpt (systemically ill or unable to urinate, unable to tolerate PO intake, or RF for resistance) → IV ampicillin + gentamicin, noncon pelvic CT if fever persists >36h post abx
4
Q
chronic prostatitis
A
- lasts longer than 3 mos
- causes: BPH, stones, foreign body, bladder cancer, prostatic abscess
- MCC: e. coli
- recurrent or relapsing UTI, urethritis or epididymitis, localized pain in lower back, perineal, testicular region, frequency, urgency, dysuria, NO FEVER
- signs: doesnt appear ill, afebrile
- dx: UA and cx → WBC + and culture +/-, 2-glass pre- and post- prostatic massage test, prostate enlarged and nontender
- tx: cipro, levo, bactrim
5
Q
nephrolithiasis
A
- MC types of stones: calcium ox, calcium phos, uric acid, struvite, cystine; M>F
- RF: family hx, hypercalciuria, wt gain, low urine output, sweet beverages, hot enviro, dieatery (animal protein, oxalate, sodium, sucrose, fructose)
- sxs: unilateral flank pain, radiates ant or ipsilateral testicle or labium; N/V, painless gross hematuria (90%)
- signs: CVAT
- dx: CMP, UA, KUB (cant see cystine or uric acid), helical CT w/out con
- tx: NSAIDs (ketorolac or toradol), PO fluids, alpha blockers, extracorporeal shockwave lithotripsy for stones >6mm up to 2cm; ureteral stent or percutaneous nephrolithotomy, 50% recur
6
Q
types of kidney stones and characteristics: calcium oxalate, calcium phosphate, uric acid, cystine, struvite
A
- calcium oxalate: visible on abd radio, bipyramidal and biconcave ovals; caused by inc calcium, oxalate, uric acid, citrate; tx → high dose thiazide diuretic, allopurinol
- calcium phosphate: pH >6.5MC in pt with RTA and 1ary hyperthy, visible on abd radio; tx → thiazide diuretics, potassium citrate
- uric acid: pH <5.5; RF = met syndrome, gout; CT noncon shows radiolucent stones, flat square plates, rhombic plates, or rosettes; tx → potassium citrate, allopurinol
- cystine: autosomal recessive; CT noncon shows radiolucent stones, stop signs, benzene rings, hexagons, tx → tiopronin and pencillamine, alkalinize urine w/ potassium citrate
- struvite: infxn w/ proteus mirabilis → inc urine pH >8; KUB shows staghorn calculi, coffin lids; hx of recurrent UTIs; tx → complete removal by urologist, acetohydroxamic acid
7
Q
glomerulonephritis
A
- caused by immune-mediated mechs, metabolic or hemodynamic disturbs
- dx: UA (hematuria, proteinuria, RBC casts), blood tests: renal fn tests, needle . bx of kidney
- 1ary disorders: minimal change, membranous, IgA neph (Berger dz)
- 2ary disorders: diabetic, mebranoproliferative, poststrep, Goodpasture
8
Q
UTI (uncomplicated)
A
- definition of uncomplicated: nonpregnant women, healthy pts w/o underlying structural or neuro dz
- RF: recent use of diaphragm with spermicide, frequent interourse, hx of UTI
- in healthy postmen women → sex, DM, incontinence
- MCC: E. coli, proteus, Klebsiella, S. saprophyticus
- sxs: dysuria, urgency, frequency, hematuria
- signs: change in urine color/odor, suprapubic pain, NO fever
- dx: urine dip (nitrate, leuk esterase), UA (pyuria, bacteriuria, +/- hematuria, +/- nitrites), CBC (leukocytosis), urine cx (only get if sxatic → >100000 (F), >1000 (M))
- tx: nitrofurantoin (macrobid), bactrim DS PO x3d
- Recurrent: 2 uncomp in 6mo OR 3+ uncomp in previous year
9
Q
complicated UTI
A
- definition: pt with structural or fnal abnlity that would reduce efficacy of abx tx
- complicated: children, men, noscocomial or nursing home, kidney allograft, pregnancy, immunosuppressed
- MCC: e. coli, enterococci, PsA, S. epidermidis
- catheter associated: yeast, E. coli
- dx: urine cx
- tx: FQ or Bactrim (preg → nitro, ampicillin, cephalosporins) x7-14d
10
Q
urethritis (nongonococcal)
A
- inflamm of urethra cuased by infxs or noninfxs causes (trauma, foreign body)
- MC: M 20-24yo, AA, c. trachomatis, ureaplasma, trichomonas vag, mycoplasma genitalium, HSV
- sxs: urethral dc, dysuria, pruritis
- signs: proximal to distal “milking” of urethra
- dx: NAATs, gram stain, UA w/ cx (+) leukesterase, prostate exam
- tx: if no gonococci → azithro or doxy; if gonococci → ceftriaxone and doxy or azithro; recurrent infxn → flagyl or tinidazole plus azithro
11
Q
pyelonephritis
A
- RF: sex, new sex partner, UTI in previous 12 mos, maternal hx UTI, DM, incontinence; E. coli = MCC
- sxs: dysuria, urgency, frequency, fever + chills, N/V/D
- signs: flank or back pain, CVA tenderness
- dx: UA → pyuria, bacteriuria, WBC casts +/- hem, +/- nitrites; CBC → leukocytosis, left shift; urine cx 100000 W, 1000 M or cath pts; abd CT (ro abscess)
- tx: FQ (cipro) x7d OR bactrim x 14d
- inpt: IV ceftriax OR amp/sulbactam OR aminoglyc
- preg: IV amp +/- gent x14d
- men: FQ or bactrim x 7-14d
12
Q
testicular torsion
A
- twisting of spermatic cord leading to arterial occlusion and venous outflow obstruciton → ischemia → testicular infarction
- adolescent male patients mostly 12-18yo
- sxs: acute severe unilateral testicular pain worse with physical activity, radiates to lower abd, N/V, absent dysuria or bladder sxs
- signs: absent cremasteric reflex on affected side, affected testis higher than opposite, swollen and tender scrotoum, elevated high-riding testicle, bilateral “bell clapper” deformity, horixontal orientation, phren’s signs neg (lift up testicle, no relief)
- dx: collor doppler shows reduced flow, definitive = scrotal exploration
- tx: manual detorsion (rotate caudal to cranial and medial to lateral), immediate surgical deterosion and orchiopexy to the scrotum (bilateral), SURGICAL EMERGENCY - if delayed >6h infarction may not be salvagable → infert
- orchiectomy if nonviable testicle found
13
Q
Urinary Incontinence
A
- Involuntary loss of urine
- NOT a normal part of aging
- Falls often are the result of an overactive bladder, which may cause the individual to rush to the bathroom
- Meds used for urge pattern incontinence are anticholinergic and are of limited use in the elderly
- Stress, Urge, Overflow
14
Q
Renal Failure
A
- Increased serum creatinine >50% or increased Blood Urea Nitrogen/BUN (azotemia)
- AKI results in retention of urea & other nitrogenous waste products as well as dysregulation of extracellular fluid volume & electrolytes.
- RIFLE Criteria:
- 3 progressive levels of AKI: Risk, lnjury, Failure with 2 outcome determinants: Loss & End stage renal disease
- Phases of AKI: oliguric (maintenance) phase (urine output <400m1/d azotemia, hyperkalemia, metabolic acidosis à diuretic phase (urine output, hypotension, hypokalemia) à recovery.
- 3 Types
- PRErenal, POSTrenal (BOTH rapidly reversible) or INTRATenaI (intrinsic)
15
Q
Stress Incontinence
A
- D/t increased intraabdominal pressure; rare in men
- Laxity of the pelvic floor muscles
- Clinical manifestations
- Increased intraabdominal pressure from sneezing, coughing, laughing - urine leakage
- Worse when upright
- Management
- Pelvic floor exercises - Kegel
- Alpha agonists - Midodrine, Pseudoephedrine
