final - GU Flashcards
(16 cards)
objectives
- Identify common chronic and acute urinary tract disorders in both males and females.
- Treatment strategies associated with common urological disorders in family practice.
- When to escalate to a higher level of care from the family practice office.
Urology Basics
- A nephron has three functions:
- Glomerular filtration-of water and solutes within the blood
- Tubular reabsorption-the return of water and required molecules to the circulation
- Tubular secretion-elimination of waste or excess molecules – including water -into a distal tube
- Kidney plays a crucial role in water homeostasis, electrolyte and acid-base balance, and red blood cell production
sx of a GU problem chart
Urinary tract infections
- UTIs are the most common bacterial infection managed in the family practice
- 50% of women will have a UTI at some point in their life
- Males > 60 with BPH have an increased risk of UTI
- TYPES of UTI
Lower Urinary Tract
- Cystitis
- Urethritis
- Prostatitis
Upper Urinary Tract
- Pyelonephritis
Risk Factors UTI
- Advanced age (incomplete emptying of bladder)
- DM
- Urinary retention
- Female (shorter urethra)
- Males (BPH)
- Extra-renal obstruction(Urethral Strictures)
- Obstruction (Renal calculi, bladder stones, neurogenic bladder)
- Immunocompromised (transplant pts, DM )
Acute Cystitis- Bladder infection - RF, sx, complications
Risk Factors:
- Being Female
- Sexually active
- Certain birth control (diaphragms w/spermicide)
- Inference with flow of urine (BPH)
- Menopause(changes in hormones can lead to improved environment for bacteria
Symptoms:
- Dysuria, Frequency, Urgency
- Abdominal tenderness
Complications:
- Pyelonephritis
- Hemorrhagic cystitis (drugs, environment, radiation)
- Chronic Cystitis- bacteria becomes imbedded in the wall of the tissue covered by a biofilm (Urinalysis will be negative
UTI-Treatment (complicated vs. Uncomplicated)Prevention is always the first line:
- Wipe in the correct direction, from front to back.
- Use a clean, gentle liquid soap because it tends to be much cleaner than bar soap.
- Clean the bladder area first whenwashing to prevent contamination with bacteria from other parts of the body.
- Drink extra water and take some extra vitamin C (makes the urine more acidic)Avoid caffeine containing foods and drink, spicy food, alcohol
- Thepatient can consider using an estrogen cream twice a week (or as prescribed by the clinician) ifthey are past menopause.
- Don’t wear tight clothes, more cotton underwear
- Avoid activities that inc chance of bladder infection (horseback riding, bicycling, crossing legs for a prolonged time)
- Take special precautions after sexual intercourse (Empty bladder after sex, increase water intake, some with chronic
- Avoid baths and prolonged time in water
- Acute Uncomplicated UTI (Non-pregnant, Premenopausal, immunocompetent Women)
- Trimethoprim-sulfamethoxazole (TMP-SMZ)/Bactrim DS 1tablet BID x 3 days
- Nitrofurantoin/Macrobid 100mg BID x 5 days
- Fosfomycin/Monurol 3g as a single dose
- Prevent recurrence by changing high risk behaviors
- Acute Complicated UTI (Pregnant Women, Males, Fever, chills, CVA tenderness stones, catheter history, Immunocompromised, history of childhood UTIs)
- Ciprofloxacin 500mg BID 7-14 days
- Bactrim second line
- Admit for IV abx if suspect urosepsis ( especially in pregnant women, immunocompromised,
Urethritis (gonococcal vs non-Gonococcal): Rf, complications, sx
Risk Factors:
- Being Female
- Many sexual partners
- High risk behavior (Anal sex w/o condom)
- H/o STIs
Complications:
- PID-> Fitz-Hugh Curtis Syndrome (usually from Chlamydia or Gonorrhea infection)
- Reiter’s Syndrome ( arthritis, post-urethritis, conjunctivitis, balantitis)
Gonococcal and Non-Gonococcal (NGU) Urethritis are STDs.
- Gonoococcal- Ceftriaxone 250mg IM x1 + Azithromycin 1g PO x 1
- NGU- Azithromycin 1g PO x1 + Doxycycline 100mg BID x 7 days
Symptoms:
- Dysuria, Frequency, Urgency
- Discharge from the penis/urethra
- Itching, tenderness and swelling
- Dyspareunia
Prostatitis
- Ascending infection of gram-negative rods in prostatic ducts (E.Coli most common, <35 STD gonorrhea/chlamydia)
Risk factors:
- Indwelling catheter
- Immunocompromised
- Phimosis or urethral stricture ( back up flow of urine)
- Recent urological procedure
Sx: Dysuria, rectal pain or pressure, discharge from penis, lower back pain, discharge through penis during bowel movement. Pain at the tip of the penis
- PE: DRE- boggy prostate, discharge from penis after DRE exam.
- TX: Cipro 500mg BID x 4-6 weeks
- Avoid catheterization during acute prostatitis-> can lead to Urosepsis
Pyelonephritis
- Most common infection of the kidney
- Caused by an ascending UTI
- Most common Gram-negative (E.Coli) Unique ability to adhere (P-fimbriae) and colonize
- Other bacteria- Proteus( struvite stones), Klebsiella, Enterobacter
- Sx: Fever( over 103 F), chills, Flank Pain (loin pain), N/V, Inc frequency/urgency. Elderly- present w/ AMS, fever, sepsis
- Diagnostic Testing: CT Abd/Pelvis- perinephric stranding, gas in collecting duct, edema, stones with hydronephrosis
- Tx: antibiotics, analgesics, and antipyretics.
BPH-Benign Prostate Hyperplasia
- Normal occurrence for growth of the prostate as males get older. Problem when Lower urinary tract symptoms develop (LUTS)
- Storage Sx: Frequency, urgency, nocturia or incontinence
- Voiding Sx: slow stream, hesitancy, terminal dribbling
- More complaints from storage sx.
- PE: non-tender, enlarged prostate during DRE. ( Walnut size is normal)
- Boggy appearance- Prostatitis
- Nodular or asymmetricp– Malignancy
- Referral to a Urologist:
- Complaints of pain, males <45 y/o, hematuria, abnormal DRE, Incontinence, PVR >250cc, Eleveated PSA >4
- Tx: Before medical treatment can be started:
- r/o UTI
- Lifestyle modification first, voiding diary
- Review current medications that could worsen sx (diuretics, anticholinergics)
- Selective Alpha-1 adrenergic blockers- relaxes smooth muscle
- Tamsulsin/Flomax 0.4mg Daily
- 5 Alpha-Reductaste Inhibitor- blocks conversion testosterone to DHT (Prostates >35g)
- Finasteride/Proscar 5mg Daily
Nephrolithiasis- Risk Factors
- poor oral fluid intake
- high animal-derived protein intake
- high oxalate intake (found in foods such as beans, beer, berries, coffee, chocolate, some nuts, some teas, soda, spinach, potatoes)
- high salt intake
- Family history of renal stones
Nephrolithiasis
- Most common renal stone is calcium oxalate.
- Drug-induced urolithiasis are not susceptible to lithotripsy ( gelantinous in material )
- Struvite stones are known as “infection stones” and can form staghorn calculi. (most common bacteria- Proteus or Klebsiella)
- Stones less than 5-6mm should pass spontaneously
- Medical treatment: Hydration, analgesia, antiemetics, alpha-receptor antagonist (Flomax)
- Surgical Intervention: Failed medical treatment
- ESWL (Extracorporeal shock wave lithrotripsy
- Cystoscopy/Ureteroscopy w/stent placement
Nephritic vs. NephroticSyndrome
Nephritis:
- Inflammation leads to capillary walls to leak (immune triggered response)
- Hematuria
- Azotemia
- Oliguria
- Hypertension
- Causes: Post streptococcal glomerulonephritis (Occurs 7-10 days after strept throat), Goodpasture syndrome (immune system attacks glomeruli), Endocarditis, Vasculitis, Viral (mononucleosis, measles, mumps)
- Tx: Supportive, steroids, diuretics, Antihypertensives, Antibiotics, Dialysis
nephrotic syndrome:
- Increased permeability in basement membrane of glomerulus
- Low serum albumin
- Edema
- Proteinuria ++++++
- Hyponatremia
- Hypercoagulability (loss of ATIII)
- Reduced immunity (loss of immunoglobulins)
- SX: frothy urine, recurrent infections, fatigue, SOB (pleural effusions)
- Causes: Amyloidosis, SLE, Minimal change disease (most common in children), Diabetic nephropathy
- Tx: Steroids, ACE-Inhibitors ( reduce protein loss), diuretics, anticoagulants
Chronic renal failure - Causes of Renal Disease:
- Diabetes
- Chronic uncontrolled BP
- Chronic glomerulonephritis
- Polycystic kidney disease
stages of CKD
