Week 7 - Urinary System Disorders and Female Reproductive System Flashcards
Identify the patient groups that are more likely to develop a lower UTI. Can you explain why these patient groups are at greater risk?
- Women (short urethra tract)
- sexually active (microtrauma)
- pregnant
- changes in balance of commensal organisms of perineum tract/genital tract (e.g. antibiotics)
- Immunocompromised
- Neonates
- Diabetes mellitus
- Bladder instrumentation
- Lower urinary tract obstruction
Name the organism that is most commonly involved in lower UTIs. What is the source of this organism?
E. Coli. Travels from bowel, to perineum, to urethra
Describe the clinical features that might make you suspect the presence of a lower UTI.
- foul-smelling, cloudy urine
- +/- haematuria
- SSx of cystitis
- suprapubic pain
- inflammation and spasm (intense sensation that bladder is not empty)
- tenderness on palpation
What factors can lead to the development of a upper UTI?
spread of infection further into kidney can occur via two routes:
- E. coli responsible for 75% of upper UTIs
- rarely, blood-borne infection can induce acute pyelonephritis
Summarise the pathophysiology of acute pyelonephritis
Pyelonephritis describes severe infectious inflammatory disease of the renal parenchyma, calices and pelvis, that can be acute, recurrent, or chronic
Ascending infection begins in the lower urinary tract.
Predisposing factors:
- urinary tract obstruction, congenital or acquired
- catheterization of the urinary tract, cytoscopy
- pregnancy
- gender and age (young women are more affected than men in ratio of 6:1)
- diabetes mellitus
- immunosuppression and immunodeficiency
Compare the clinical features of acute pyelonephritis to those associated with a lower UTI.
UUTIs SSx:
- SSx of LUTIs
- fever, rigors, nausea and vomiting can occur
- sudden onset of pain and radiations to iliac fossa/groin
- tenderness and muscle guarding
Outline the risk factors for renal calculi
- conditions with increased stone-forming minerals e.g. gout
- dietary intake of stone-forming minerals
- highly concentrated urine e.g. hot climates, dehydration
- correlation with chronic diseases e.g. diabetes mellitus
What are the most common types of renal calculi?
- calcium oxalate phosphate (75-85%)
- uric acid stones (5-10%; more common in males)
Describe the pathophysiology associated with a calcium oxalate stone.
- Begin as deposits of calcium phosphate in the sub-endothelial space around the renal papilla
- Deposits are referred to as Randall’s plaques
- The plaques extrude into the urinary lumen, acting as nuclei for crystal overgrowth
- Aggregation gradually leads to the formation of discrete stones
Summarise the clinical features associated with renal calculi
- +/- pain and tenderness on palpation
- insidious onset of dull flank pain
- +/- radiations of pain to the groin
- blood or stony fragments in urine
- +/- increased pain with urination
The ureteric impaction of a kidney stone can lead to pain in the groin and genital region. Explain the neurology of this referred pain pathway
- visceral afferents supply the ureter enter the spinal cord at levels T11-L2.
- this can lead to pain referral from genitofemoral nerve (L1-L2)
- T11/12 supplies skin in the groin region. Referral of pain can occur here also.
Define the term chronic kidney disease (CKD)
Refers to the progressive loss of renal function over a period of months to years. A spectrum of disease ranging from mild (eGFR 60-89mL/min) to renal failure (eGFR <15mL/min).
List some potential causes and risk factors associated with CKD
Aetiology:
- complication of systemic disease e.g. hypertension, diabetes
- or, can arise secondary to renal disease e.g. chronic glomerulonephritis, chronic pyelonephritis
Risk factors:
- family history, advanced age (>50 years), ASTI
- obesity, type 2 diabetes, smoking, hypertension (changing vessels of kidneys)
Summarise the clinical features associated with CKD. Which features are particularly relevant to osteopathic practice?
- systemic in nature and reflect a decline in normal renal function:
- accumulation of nitrogenous wastes and toxins
- fluid overload, electrolyte imbalances and metabolic acidosis
- neuromusculoskeletal changes arise due to disturbances in calcium and phosphate metabolism
- musculoskeletal changes
- bone pain, increased fracture risk, muscle weakness, myalgia, arthralgia
- neurological changes
- peripheral neuropathies (especially sensory in lower limb)
- cognitive or behavioural effects
- neuromuscular irradiation: muscle cramps, twitching
- increased fracture risk is a contraindication for HVLA
- myalgia and arthralgia may present as a typical musculoskeletal concern, but when taken in context with other SSx, may lead to visceral DDxs
Identify the most common form of bladder malignancy.
98% of bladder cancers are primary tumours.
Transitional cell carcinoma (TCC) contributes to 90% of bladder cancer
