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METABOLIC > UROLOGY - SIGNIFICANCE OF SYMPTOMS AND SIGNS > Flashcards

UROLOGY - SIGNIFICANCE OF SYMPTOMS AND SIGNS Flashcards

1
Q

What are the 2 types of haematuria?

A

Visible and non-visible (found on microscopic or dipstick)
Note that non-visible haematuria is divided into symptomatic and asymptomatic

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2
Q

What percentage of patients with visible haematuria have urological cancers?

A

20-25%

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3
Q

How do we investigate urinary tract disease?

A

Bladder diary
Urinalysis
Urine culture
Routine bloods - FBC, U&Es, PSA
Post-voiding bladder scan
Urodynamic studies
Cystoscope - gold standard
Upper urinary tract imaging e.g. US or CT

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4
Q

What are LUTS?

A

Storage symptoms - urgency, daytime urinary frequency, Nocturia, urinary incontinence, increased sense of urgency to urinate

Voiding symptoms - hesitancy, weak or intermittent stream, straining, dysuria

Post-micturition symptoms - terminal dribbling, incomplete emptying of bladder

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5
Q

What scoring system is used for classifying the severity of the impact of LUTS on quality of life in men?

A

International prostate screening score

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6
Q

What can cause LUTS?

A

BPH
UTI
Cancers
Detrusor muscle weakness
Pelvic floor dysfunction
Inflammation e.g. prostatic is
Urethral structure
Neurological disease
Lifestyle - drinking fluids late at night, excess alcohol or caffeine, polyuria secondary to DM or diuretics

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7
Q

What does acute vs chronic loin pain suggest?

A

Acute loin pain is more likely to be something obstructing the ureter
Chronic loin pain suggests disease within the kidney or renal pelvis

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8
Q

How do we manage LUTS conservatively?

A

Treat underlying pathology
Regulate fluid intake - think about type of drink and time of day
Urethral milking or double voiding
Pelvic floor exercises
Bladder training techniques

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9
Q

How do we manage LUTS pharmacologically?

A

Anticholinergic for overactive bladder e.g. oxybutinin and tolterodine
Alpha blockers e.g. tamsulosin
5 alpha reductase inhibitors e.g. finasteride
Loop diuretics taken mid-afternoon to prevent Nocturia

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10
Q

What are the complications of retaining urine post-micturition?

A

Increased risk of infection and formation of renal and bladder calculi due to stagnation of urine

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11
Q

What are the complications of a chronic obstruction in the urinary tract?

A

Bladder wall muscle hypertrophy or distension which can lead to overflow incontinence
Renal failure
Bilateral hydronephrosis
Acute urinary retention in men with progressive BPH

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12
Q

When should you refer to urology for review within 2 weeks with haematuria?

A

Unexplained visible haematuria without UTI if >45
Visible haematuria that persist or recurs after successful treatment of UTI if >45
Unexplained no visible haematuria and either dysuria or raised WCC on blood test if >60

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13
Q

What can cause haematuria?

A

Cancer of kidney, ureter, bladder, prostate, urethra
Stones
BPH*
Recent urological intervention
Clotting disorders
Rhabdomyolysis
Glomerulonephritis
ATN
Multi-system diseases such as Henoch schonlein purpura or goodpasteurs disease
Trauma to kidneys, urethra
Cystitis, prostatis, uretitis, pyelonephritis
UTI
Parasitic infection e.g. schistosomiasis
Haemolytic uraemic syndrome
Polycystic kidney disease
Recent vigorous activity
Coagulopathies

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14
Q

What can cause pseudo-haematuria?

A

bilirubinuria
Haemoglobinuria
Myoglobinuria
Medications - Rifampicin and methyldopa
Beetroot or rhubarb
Menses or recent intercourse

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15
Q

What is osmolality?

A

Concentration of osmotically active particles in urine

(Harder to measure but more accurate concentration of urine)

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16
Q

What is specific gravity?

A

The ratio of urine density compared with the density of water and is based on the number and types of solutes in the urine (easier to measure but less accurate concentration of urine)

17
Q

What can cause acidic urine?

A

Meat diet
Diabetic or metabolic acidosis
Starvation
Glycosuria
Hyperchloraemia
Diarrhoea
Drugs e.g. ammonium chloride

18
Q

What can cause alkaline urine?

A

Vegetable diet
Systemic alkalosis
UTI (bacteria produce urea)
Over-exposed urine
Vomiting
Drugs e.g. acetazolamide, citrate and sodium bicarbonate

19
Q

What causes a fruity smell to urine?

A

Ketosis

20
Q

What causes a fishy smell to urine?

A

Urea splitting organisms e.g. proteus or klebsiella

21
Q

What causes a maple syrup odour to urine?

A

Maple syrup urine disease

22
Q

What causes frothy urine?

A

High protein content

23
Q

What can you tell from the timing of haematuria?

A

Start of micturition suggests lesions in the lower urinary tract or genital tract; end or throughout micturition indicates urinary bladder or upper urinary tract disorders.

24
Q

What should you check for in general examination of haematuria patient?

A

Periorbital puffiness or peripheral oedema
Trauma
Purpura and rashes

25
Q

What does haematuria with resp symptoms suggest?

A

Post-streptococcal (1-2 weeks after URTI, with proteinuria and low complement)
Goodpastures (antibodies attack lungs and kidneys)
IgA (1-2 days after URTI, young males and haematuria is macroscopic)

26
Q

What do urine hyaline casts suggest?

A

Common and non-specific
May be seen after exercise or dehdyration (low urine flow, concentrated urine or acidic environment can cause it)

(Solidified tam-horsfall mucoprotein secreted from tubular epithelial cells)

27
Q

What do granular casts in urine suggest?

A

CKD
Acute tubular necrosis

28
Q

What do waxy casts in urine suggest?

A

Advanced CKD/long standing kidney failure

29
Q

What do red cell casts suggest?

A

Glomerulonephritis
Renal ischaemia and infarction

30
Q

What do white cell casts in urine suggest?

A

Inflammation, infection, pyelonephritis, post-streptococcal glomerulonephritis
Nephrotic syndrome
Acute allergic interstitial nephritis

31
Q

What do epithelial casts in urine suggest?

A

Acute tubular necrosis
Toxic ingestion e.g. mercury, diethylene glycol and salicylate

32
Q

What do fatty casts in urine suggest?

A

Nephrotic syndrome

33
Q

What can cause urinary incontinence?

A

Overactive bladder
Incompetent urethral sphincter
Under active bladder
Bladder outlet obstruction
Neurological bladder dysfunction
Infections
Pharmacological agents - ACEi, diuretics, antidepressiants, HRT, sedatives
Stool impaction
Increase intraobdiminal pressure e.g. pregnancy
Drinking too much alcohol/caffeine
Not drinking enough fluids

34
Q

Why can not drinking enough fluid cause incontinence?

A

Strong concentrated urine collects in the bladder and irritates the bladder to cause symptoms of over activity

METABOLIC (43 decks)

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