GU conditions Flashcards
(8 cards)
UTIs (women) Common causative organisms Risk Symptoms Diagnosis Treatment
Klebsiella pneumoniae (catheter ass.)
Escherichia Coli (moct common)
Enterococcal species
Proteus species
Staphylococcus species (haematogenous spread from spepsis)
Risk: female, sexual intercourse, catheters, diabetes mellitus, obstruction
Symptoms: dysuria, haematuria, frequency, urgency - fever/systemic symptoms/loin/renal angle pain if pyelonephritis (kidney infection)
Diagnosis: midstream urine dipstick shows leukocytes and nitrites, if uncomplicated (eg individual not pregnant/man/child/immunocompomised/recurrent) no culture needed and 3 day course antibiotics. If complicated send for culture, 7 day antibiotics
Treat:
uncomplicated, lower: 3 day nitrofurantoin/trimethoprim. Upper: 7+ dose co-amoxiclav
complicated = longer course, IV, MSU sent for culture
Urethritis
symptoms
diagnose
treat
Infection of the urethra
Can be gonoccocal (sexually transmitted) or non-gonoccocal (UTI)
Common complaint in men.
Usually symptomless in women - can cause dysuria, discharge, pain
Swab test + urine test performed
STI: from chlamydia (treat with azithromycin) or gonorrhoea (ceftriaxone + azithromycin)
UTI: nitrofurantoin/trimethoprim
Complications: reactive arthritis, epididimo-orchiditis
Prostatitis cause diagnose symptoms treat
Infection of the prostate
perform DRE, MSU for culture, STI screen, urine dipstick shows leukocytes and nitrites
Usually caused by STI/catheter
Systemically unwell, voiding LUTS (straining, hesitancy, intermittent stream, incomplete emptying, post micturition dribble, haematuria, dysuria)
Differentiate BPH, prostate cancer
Treat gentamycin + coamoxiclav, then 2-4wks ciprofloxacin
Acute kidney injury definition Cause Symptoms Diagnosis Treat
medical emergency? treat
Abrupt rise in serum urea and creatinine due to decreased GFE
Prerenal: decreased perfusion (hypovolaemia+/-hypotension)
Intrarenal: acute tubular necrosis (from preAKI/tumour lysis syndrome/nephrotoxins), glomerulonephritis, acute interstitial nephritis
Postrenal: obstruction (tumour/BPH/stones)
Symptoms:
oligouria, electrolyte imbalance: hyperkalaemia/uraemia, oedema, thirst, bruising/bleeding, postural hypotension
Diagnosis:
urine dip
albumin: creatinine ratio, GFR
USS bladder scan for stones
FBC/dipstick for infection
Renal biopsy for intrarenal
Treat underlying cause, correct electrolyte imbalance, fluid replacement, antibiotics - usually reversible. Severe - dialysis.
hyperkalaemia = medical emergency ass with AKI, treat with calcium gluconate to stabilise heart, insulin+dextrose red. K+ in blood, IV fluid
Chronic Kidney Disease main cause symptoms diagnosis treatment
Usually caused by hypertension, diabetes
Hypertension: walls of glomeular vessels thicken to withstand pressure, decreasing blood supply and causing ischaemia of cells in glomerulus. Immune cells -> glomerulosclerosis.
Diabetes: glucose damages efferent arteriole, making it stiff, high pressure to overcome = hyperfiltration eventually leads to glomerulosclerosis.
Diagnose
biopsy, GFR monitoring
eGFR <30
albumin creatinine ratio (creatinine excreted at a constant rate)
Symptoms:
Think roles of kidney in homeostasis(Blood vol, K+, acid/base), vit D/bone health, erythropoeitin production
Urea buildup = nausea/anorexia, encephalopathy/bleeds/pericarditis
Electrolyte imbalance = hyperkalaemia = arrhythmias, hypocalcaemia = bone resorption
Renin = hypertension
Erythropoeitin = decreased prod. RBCs, anaemia
Treat
underlying cause
fluid management
dialysis
transplant
Benign prostate hyperplasia what? symptoms diagnosis treatment - indications for surgery?
Benign nodular/diffuse proliferation of prostate glandular/musculofibrous tissue. Inner zone enlarges, unlike carcinoma where peripheral zone enlarges.
Symptoms
LUTS:
Frequency
Nocturia
Urgency
Hesitancy, Straining, intermittent stream, incomplete emptying, post micturition dribble, haematuria, dysuria
Diagnosis:
DRE reveals smooth enlarged prostate
PSA may be raised
Biopsy, endoscopy
Treat:
watchful waiting if minimal symptoms, lifestyle advice such as avoid alcohol/caffeine
Meds:
alpha-1-antagonist tamsulosin relaxes smooth muscle of bladder neck
5-alpha reductase finasteride prevents conversion testosterone to dihydrotestosterone (active, needed for prostate growth)
Surgery - for gross haematuria, renal insufficiency due to obstruction, acute urinary retention, failed medical treatment - TURP (transurethral resection of prostate). 14% impotent, 10% erectile dysfunction, 1% incontinent
Prostatic cancer
risk
Mostly adenocarcinoma (can have transitional/small cell). Proliferation of cells in peripheral zone - do not compress urethra until late stage. Metastasise to bone.
Risk:
obesity, high fat low fibre, BRCA1&2, age
Symptoms
Asymptomatic until compress urethra, LUTS. Metastatic: bone pain, anaemia, weight loss.
Diagnosis:
raised PSA
TRUS (transrectal ultrasound)
biopsy and histology- graded according to Gleason grading (degree of differentiation)
DRE - but won’t be palpable if tumour is anterior peripheral zone
treatment:
active surveillance if non-metastatic and symptomless, over 70yrs
radical prostatectomy
/chemo, radio
metastatic: the tumour is highly hormone sensitive, so androgen deprivation by orchidectomy is effective. LHRH agonist - goserelin
Kidney stones/calices, nephrolithiasis cause/formation types and cause presentation diagnose treat
Caused by urine becoming supersaturated (dehydration, or increased solutes), precipitates and crystals form. These may become lodged - commonly in in the pelviureteric junction, pelvic brim, vesicoureteric junction (sites of constriction).
Most stones are calcium oxalate, which are brown. They form in acidic urine. Others are:
calcium phosphate - dirty white, form in alkaline urine.
uric acid - red brown, form in gout/long term allopurinol use
struviate/infective: mixed components, formed after UTI eg proteus mirabilis makes urine more alkaline. Dirty white.
cysteine stones
Cause:
Calcium stones: hypercalcaemia due to increased absorption/primary hyperthyroidism. Hypercalcuria due to impaired renal absorption.
Gout - diet high in purines
hyperoxaluria - diet high in oxalate, eg rhubarb/choc/beer
Presentation:
renal colic - sharp, excruciating pain, can’t sit still (unlike peritonitis), dysuria, frequency, strangury. Subsides when stone reached bladder.
Diagnose:
XR is first line. NCCT KUB is gold standard.
Urinalysis, MSU for culture.
Treat
Hydration
Strong analgesia for colic - diclofenac
Antibiotic if obstruction –> pyelonephritis
If >5mm, can’t pass:, medical expulsion: nifedipine/tamsulosin.
Laser endoscopy, keyhole surgery.
