Flashcards in Bladder Disorders Deck (53)
43YO smoker presents for annual exam - found to have microscopic hematuria - most likely dx?
- bladder cancer
Signs of glomerular bleeding?
- red cell casts (pathognomonic for glomerulonephritis)
- dysmorphic RBCs
- proteinuria w/ hematuria w/ large percentage bing albumin
Nonmalignant etiologies of hematuria?
- UTI: pyelo, acute cystitis - present w/ suprapubic pain, dysuria, and frequency
- trauma to kidneys
- menstruation or endometriosis
- vigorous exercise
- PSGN or IgA nephropathy
- over 40: at high risk for cancer
RFs for malignancy?
- age: over 35
- smoking hx (extent of exposure correlates with risk)
- occupational exposure to chemicals/dyes - painter, printers
- hx of gross hematuria
- hx of chronic cystitis or irritative voiding sxs
- hx of pelvic irradiation
- exposure to cyclophophamide
- hx of chronic indwelling fb
- hx of analgesic abuse (also assoc increased risk of kidney cancer) - NSAIDs
Work up of hematuria?
- urine culture - if positive tx and repeat UA (all pts)
- urine cytology: all w/ gross hematuria and those w/ risk factors
- imaging: CT urography preferred - US in pregnant women
US CT w/o contrast or MRI may be used
- cystoscopy: obtaining urine for cytology just b/f in high risk pts
(CT and cystoscopy done together)
What should be done if you get a negative work-up for hematuria?
- in young and middle aged pts usually is:
mild glomerular disease (monitor PP, GFR, CrCl), have predisposition to stone disease
- pts at high risk for malignancy:
need annual UA
may need another work-up q 3-5 yrs (esp if wt loss, night sweats)
Should you screen for hematuria in asx pts?
Pathogenesis of cystitis?
- colonization of vaginal introitus from fecal flora
- acension to bladder via the urethra
- can ascend to kidneys causing pyelonephritis
- route much more difficult in males b/c longer and urethra not sitting right above anus - Much less common in men
MC pathogens of cystitis?
- 75-90% E. coli
Clinical presentation of UTI?
- suprapubic pain
Clinical presentation of Pyelonephritis?
- sxs of cystitis may or may not be present
- flank pain w/ CV angle tenderness
Dx tests for cystitis and pyelonephritis?
- UA is a must: looking for positive leukocyte esterase and/or positive nitrites
- in women who dx is uncertain or resistance is consideration a urine cuture w/ sensitivities should be done
- ALL males with cystitis should have a culture
- for pyelo:
urine culture and sensitivities
Women with cystitis - what should be ruled out? Tx?
- common, r/o vaginal source though
Nitrofurantoin (100 mg BIDx5days)
bactrim (1 DS BID x 3 days)
fosfomycin 3 gmsx 1 dose
reserve fluoroquinolones for other uses
Diff for man presenting with cystitis sxs?
- urethritis secondary to STI
- urinary tract abnormalitiy
Tx for men w/ cystitis?
- want to cover possible prostatitis
Tx for outpt and inpt pyelonephritis?
-mild to moderate illness: can keep meds down
-where fluoroquinolone resistance is low: cipro or levuoquin
- other: trimethoprim-sulphamethoxazole or augmentin
or extended spectrum cephalosporin
Sxs of noninfectious cystitis? Epidemiology? Irritants?
- sxs similar to cystitis w/ nocturia, pressure in pelvis
- epidemiology: women of childbearing yrs
bubble baths, feminine hygiene sprays, tampons, spermicidial jellies
foods: tomato, artificial sweetners, caffeine and chocolate
W/u and tx of noninfectious cystitis?
Chlamydia manifestations in a male? Dx? Tx?
- MC cause of nongonococcal urethritis
NAAT - some tests are expensive and don't produce results quickly
- xpert CT/NG assay is a NAAT provides testing in 90 minutes
- Tx: rocephin and Azithro
Presentation of gonorrhea in males? Dx, Tx?
- urethritis: sx
- epididymitis: younger than 35
- dx: NAAT
- tx: Azithro and rocephin
Presentation and PP of overactive bladder w/o incontinence?
- urgency, frequency, nocturia
detrusor muscle contracts irregularly at smaller volumes of urine, usually idiopathic, can be secondary to DM, stroke, spinal disease
Tx of OAB? Mechanism, agents used?
- MOA: increase bladder capacity, block basal release of acetyl choline during bladder filling
solifenacin (vesicare) - once a day
SE: anticholinergic - constipation, dry mouth, blurred vision
- new agent:
Mirabegron (Myrbetriq) - beta 3-adrenoceptor agonist, can use alone or w/ other agents
HTN, incomplete bladder emptying (relaxes detrusor so much), dry mouth
Epidemiology of urinary incontinence?
- prevalence in women: 25-45%
- prevalence increases with age (both men and women)
- 6-10% nursing home admissions in US due to urinary incontinence
Medical morbidity - from incontinence?
- perineal candida infection
- cellulitis and pressure ulcers
- UTIs and urosepsis
- falls and fractures from slipping on urine
- sleep interruption and deprivation
- psychologically: poor self esteem, social withdrawl, depression and sexual dysfxn
Continence depends on?
- intact micturition physiology
- intact fxnl ability to toilet onself
RFs for incontinence?
- fxnl impairment
- family hx
- others: diabetes, stroke, depression, estrogen depletion, genitourinary surgery, radiation
- non-hispanic white women higher rates than non-hispanic black and hispanic women
Transient causes of incontinence? DIAPERS?
A: atrophic vaginitis
P: pharm - sedatives, diuretics, anticholinergics
P: psychological: depression
E: excessive urine production (DI, hypercalcemia, psychogenic polydipsia)
R: restricted mobility
S: stool impaction
Incontinence questions for screening?
- in past 3 months: have you leaked urine?
- which precipitants led to leakage?
- which precipitant caused leakage most often?
- do you ever wears pads, tissues or cloth in your underwear to catch urine?
Hx questions to ask pt about incontience?
- questions about incontinence
- bowel and sexual fxn
- status of other medical conditions, parity, meds
- any prior continence therapy, particularly surgical tx