GU System Quiz Flashcards
1
Q
Pain Referral Patterns: Kidney
A
• Ipsi costovertebral angle
• T-L or L-S area
• Possible diffuse upper abdominal pain
2
Q
Pain Referral Patterns: Ureters
A
• Upper: flank
• Mid: lateral to umbilicus
• Lower: groin and genitalia
3
Q
Pain Referral Patterns: Bladder
A
-Over suprapubic region
4
Q
Dysuria
A
• Defined as painful or uncomfortable urination
– Typically a sharp, burning sensation
– May cause painful ache over bladder or perineum
5
Q
Dysuria is extremely common in _________
A
• Extremely common in women, but can occur in men also & at any age
6
Q
Dysuria: Most Common Causes
A
– Cystitis
– Urethritis due to STD
• Other causes: interstitial cystitis, prostatitis, epididymo-orchitis, cervicitis, atrophic vaginitis, tumors
7
Q
Dysuria: Red Flags
A
– Fever, flank pain, recurrent episodes, known urinary tract abnormality, male
8
Q
Dysuria: Diagnosis
A
– No single uniform approach to testing
– Urinalysis (WBC’s), STD testing
– Sometimes will give antibiotics without testing in young, otherwise healthy person
9
Q
Dysuria: Treatment
A
– Directed at underlying cause-antibiotics, STD
10
Q
Dysuria: Key Points
A
– Not always caused by bladder infection.
– Consider STDs and cancer
11
Q
Dysuria: Potential DDx’s
A
Cystitis, Urethritis, Interstitial cystitis, Tumor
12
Q
Hematuria
A
• Red blood cells in urine
– May be visible (urine is red, bloody, cola colored)
– May not visible (may be microscopic)
13
Q
Reddish color is not always due to RBCs
A
– Hemoglobin/myoglobin in urine, food, drugs
14
Q
Hematuria: Can originate from (5)
A
– kidneys, ureters, bladder, urethra, prostate
15
Q
Hematuria: Most common causes
A
– UTI
– Prostatitis
– Urinary calculi (in adults)
16
Q
_______ can cause transient hematuria
A
Vigorous exercise
17
Q
In patients over 50, hematuria may indicate:
A
Cancer or prostate disease
18
Q
Hematuria: Potential DDx
A
-Infection
-Calculi
-Glomerular disease
-Polycystic kidney disease
-Genitourinary cancer
-Trauma
-Prostatic Hyperplasia
-Prostatitis
19
Q
Polyuria is defined as urine output of ____/day
A
> 3L
20
Q
Urinary Frequency
A
Need to urinate many times during the day or night but in normal or less-than-normal volumes.
21
Q
Polyuria: Common Causes
A
– Taking diuretics (in adults)
– Uncontrolled diabetes mellitus
22
Q
Polyuria: Red Flags
A
– Abrupt onset, night sweats, cough, weight loss (especially if there is a history of smoking)
23
Q
Urinary Frequency: Common Causes
A
– UTI
– Urinary tract calculi
– Urinary incontinence
– BPH
Also: Caffeine intake
24
Q
Urinary Frequency: Red Flags
A
– Lower extremity weakness or signs of spinal cord damage
– Fever and back pain
25
Acute Kidney Injury (AKI): Acute Renal Failure
• Described as the rapid decrease in renal function over days
(Reduced blood flow to kidney allows creatinine and urea build up, leading to fluid/electrolyte disorders)
26
AKI: Complications
Fluid build up in lungs, chest pain, kidney damage, death
27
Acute Kidney Injury: Initial Symptoms & Signs
-Weight gain & peripheral edema
28
AKI: Later symptoms & signs
-Oligouria
-Anorexia
-Nausea, vomiting
-Back pain
-Confusion, anxious, restless
-Diarrhea
-Fatigue, lethargy
-Hypertension
-Weakness
29
AKI: Diagnostics
-Increased uria & creatinine (takes 24 hours for creatinine to increase)
30
AKI: Treatment
-Immediate Care (Can be serious-lead to coma, death)
31
Kidney (Renal) Trauma
-Kidney is injured by outside force: Penetrating/Blunt Trauma
32
Kidney (Renal) Trauma: Possible other symptoms
– Hematuria
– Diffuse abdominal tenderness
– Flank contusion
– Lower rib fractures
– Skin wound
33
Kidney (Renal) Trauma: Exam
– Look for any signs of trauma, contusion or redness
34
Kidney (Renal) Trauma: Lab Test
– Hematuria, low hematocrit
35
Kidney (Renal) Trauma: Treatment
– Depends on injury & situation
– May need surgery
– Most blunt trauma is low grade: Treatment is bed rest until gross hematuria resolved)
36
Chronic Kidney Disease
• Defined as long-standing, progressive deterioration of renal function
37
Chronic Kidney Disease: Risk Factors
– Analgesic use
– Hypertension
– Smoking
– Obesity
– African-American or Native American
– Older age
– Family history of kidney disease
38
Chronic Kidney Disease: Most common causes
• Diabetic nephropathy
• Hypertension
• Glomerulonephritis
39
Chronic Kidney Disease: Additional Causes
• Polycystic kidney disease
• Vesicoureteral reflux
• BPH
40
Chronic Kidney Disease: Possible Symptoms
(Typically asymptomatic or few symptoms)
• Anorexia
• Nausea, vomiting
• Nocturia
• Fatigue
• Pruritus
• Edema of feet/ ankles
• Urinary issues
• Muscle twitches and cramps
41
Chronic Kidney Disease: Complications
• Pulmonary edema, hyperkalemia, heart issues
• Central nervous system: difficulty concentration, personality change
42
Glomerular Disease
• Reduces kidneys ability to filter
• Red blood cells and protein may be excreted into the urine while toxins may be retained
43
Glomerular Disease: Basic Types
Nephrititic & Nephrotic
44
Glomerular Disease: Complications
• Hypertension, kidney failure
45
Nephritic Syndrome (glomerulonephritis)
• Bacterial or viral infection causes diffuse inflammation and damages the glomeruli
46
Nephritic Syndrome ( Glomerulonephritis): Epidemiology
– Most common in children (60% ages 2-12, 10% >40)
– Predominately males
47
Nephritic Syndrome (Glomerulonephritis): Causes
– Previous infections such as strep
– Other causes: lupus, polyarteritis nodosa, etc.
48
Nephritic Syndrome: Signs/Symptoms
▪ Hematuria
▪ Mild proteinuria (less than 3 g/ 24 hours)
▪ Edema
▪ Hypertension
▪ Oliguria
49
Nephritic Syndrome: Acute vs. Chronic Cases
-Acute: Abrupt onset of hematuria with mild proteinuria
-Chronic: May develop silently over months to years
50
Nephrotic Syndrome:
• Syndrome in which too much protein is releases in urine
51
Nephrotic Syndrome: MC secondary cause
Diabetes
52
Nephrotic Syndrome: Key Features
Massive proteinuria (and no hematuria)
-How we differentiate from nephritis
53
Nephrotic Syndrome: Signs/Symptoms
– Edema (most obvious clinical manifestation)
– Massive proteinuria (at least 3.5 g protein/ 24 hours)
– Hypoalbuminemia (<3 g/dl)
– Hyperlipidemia/hyperlipiduria
54
Nephritic vs. Nephrosis: Pathogenesis
-Nephritic Syndrome: Inflammation of Glomeruli
-Nephrosis Syndrome: Abnormal glomerular permeablility
55
Nephritic vs. Nephrotic: Causes
-Nephritic: Many causes; MC post-strep infection
-Nephrotic: Many causes; 2nd MC Diabetes
56
Nephritis vs. Nephrosis: Lab Findings
-Nephritic: Hematuria & proteinuria (mild)
-Nephrosis: No blood & proteinuria (>3.5g/24 hours)
57
Nephritic vs. Nephrosis: Clinical Findings
-Nephritic: Edema, Hypertension, Oliguria
-Nephrotic: Edema, Hypoalbuminia, Hyperlipidemia
58
Nepthritis vs. Nephrosis: Inflammation
-Nephritis: Inflammation
-Nephrosis: Non-Inflammatory
59
Nephritis vs. Nephrosis: Hematuria
-Nephritis: Hematuria
-Nephrosis: No Hematuria
60
Nephritis vs. Nephrosis: Proteinuria
-Nephritis: Proteinuria: <3.5g/day
-Nephrosis: Proteinuria: >3.5g/day
61
Polycystic Kidney Disease
• Genetic disorder: cluster of cysts develop in kidney
– Causes kidney to enlarge
– Reduces function
62
Cysts in PKD are:
Non-cancerous
63
PKD: Predominant age of diagnosis
Usually diagnosed by 45
(Equal to both genders)
64
PKD: Complications
• Hypertension
• Recurrent UTI or pyelonephritis
• Kidney stones
65
PKD: Signs & Symptoms
-Flank, low back & abdominal pain
-Dysuria
-Hematuria
-Nocturia
-Polyuria
-Hypertension (might notice 1st)
-Hepatomegaly
66
PKD: Exam
• Possible increased size of abdomen
• Palpable kidneys
67
PKD: Treatment
-Supportive Care
-Possible kidney transplant
68
Nephrolithiasis
• Hard deposits that form in kidney
69
Kidney stones are ___ composed of calcium
85%
70
Nephrolithiasis: Epidemiology
Predominately male
71
Nephrolithiasis: Risk Factors
• Family history
• Dehydration
• Diet: high protein, salt, sugar
• Obesity
• Medications & supplements: Vitamin C, antacids
72
Nephrolithiasis: Other conditions
• Gastric by pass surgery
• IBD
• Chronic diarrhea
73
Nephrolithiasis: Other kidney conditions are known risk factors
– Repeated UTIs
– Polycystic kidney disease
– Previous history of stone
74
Nephrolithiasis: Alternate Names
– Urinary calculi
– Renal calculi
– Renal lithiasis
– Urolithiasis
75
Nephrolithiasis: Symptoms
• Sudden onset
• Colicky & agonizing flank pain
• Nausea, possible vomiting
• Hematuria
• Chills & fever
76
Nephrolithiasis: Discomfort
• May not be able to lie down
• Constantly shift positions
77
Nepholithiasis: Exam
• Tachycardia
• Abdominal tender w/ deep palpation
• Costovertebral angle tenderness
(+Murphy’s kidney punch)
78
Nephrolithiasis: Labs/Diagnostics
• Urinalysis
• Kidney ultrasound
79
Nephrolithiasis: Treatment
• If stone larger than 6 mm, may need intervention
– Pain medication, increased hydration, surgery
• 85% of time: pass stone with urination within 72
hours
80
Nephrolithiasis: Prevention
-Drink enough water
-Avoid large doses vitamin C
-Low oxalate diet
81
Low Oxalate Diet
– If stones made from calcium oxalate: limiting the amount of dietary oxalate may prevent stones
– Limit oxalate to 40-50 mg day
– High oxalate foods include spinach, beets, blackberries, etc.
82
Obstructive Uropathy
83
Obstructive Uropathy
Functional or anatomic obstruction of urinary flow
84
Obstructive Uropathy: Causes by age
-Young: Anatomic abnormalities
-Adults: Calculi (kidney stones)
-Older men: BPH and prostate cancer
85
Obstructive Uropathy: Consequences
Urine accumulates proximal to obstruction, causing distention which can cause pain
86
Obstructive Uropathy: Lower urinary tract symptoms
-Frequency, nocturia, incontinence, dysuria, hesitancy weak stream or straining to void
87
Obstructive Uropathy: Upper Urinary Tract Symptoms
Asymptomatic
-If caused by stone, can have renal colic (sudde, severe, flank pain that may radiate to groin)
88
Obstructive Uropathy: Vitals
-Hypertension
-Fever
89
Hydronephrosis
-Accumulation of urine in the kidney causes it to dilate; Usually due to an obstruction
90
Hydronephrosis: Most common cause in Adults
Nephrolithiasis (kidney stones)
91
Hydronephrosis: Other causes
-Acquired: prostate hyperplasia, cancer, neurogenic bladder
92
Hydronephrosis: Risk Factors
-Kidney stones
-Prostate hypertrophy/cancer
-Diabetes mellitus
-Analgesic abuse
93
Hydronephrosis: Upper Obstruction
Flank pain
94
Hydronephrosis: Lower Obstruction
May radiate to ipsilateral testicle/labia
95
Hydronephrosis other symptoms
Changes in urination, thirst, edema
96
Hydronephrosis: Exam
-Costovertebral angle tender
- (+ Murphy’s kidney punch)
-If severe, kidney may be palpable (also bladder)
-If caused by lower obstruction: Suprapubic area tender
97
Urethritis
Lower urinary tract infection in urethra
98
Cystitis
Lower urinary tract infection in bladder
99
Pyelonephritis
Upper urinary tract infection in kidney
100
Prostatitis
Infection in prostate
101
UTI: Epidemiology (Adults 20-50 yoa)
-Far more common in female
102
UTI: MC Types in Female
Cystitis or pyelonephritis
103
UTI: MC types in Male
Urethritis or prostatitis
104
UTI: MC Cause
MC Cause: Bacteria
105
Urethritis: MC Cause
STI: Gonorrhea, chlamydia
106
Urthethritis
Infection of the urethra
107
Urethritis: Complications
-Can cause urethral scarring & stricture
-May spread into bladder
-May spread into gender organs
108
Urethritis: Signs & Symptoms
-Dysuria
-Discharge (penile, vaginal)
-Itching/tenderness
-Edema, inflammation
109
Urthethritis: Female symptoms
Vaginitis, cystitis, cervicitis
110
Urethritis: Risk Factors
-Multiple partners
-STI history
-Unprotected intercourse
111
Urethritis: Labs
Perform STI testing
112
Cystitis
Inflammation of bladder mucosa due to infection or irritation
113
Cystitis is more common in
Women
114
Cystitis: Causes
Acute infection (E. coli 90% of time)
115
Cystitis: Risk factors/causes
-Sexual activity, pregnancy, incomplete bladder emptying
-Previous UTI, STI (chlamydia)
-Catherization
116
Cystitis: Symptoms & Signs
-Burning or pain during urination
-Urgency, frequency
-Sense of incomplete bladder emptying
-Blood in urine
-Offensive odor
-Nocturia
-Lower abdominal or back pain, tenderness or cramping
117
Cystitis: Lab
Urinalysis
118
Cystitis in Men
-Uncommon <50 yoa
-Usually result of ascending infection from urethra or prostate
119
Cystitis in Men: Risk Factors
-Catherization, Urethral strictures
120
Cystitis in Men: If Fever
Concomitant pyelonephritis or prostatitis
121
Pyelonephritis
Acute, diffuse infection of kidneys or one or both kidneys
122
Pyelonephritis: Epidemiology
More common in females
123
Pyelonephritis: Risk Factors
-Frequent bladder infections
-Anything causing obstruction
-DM
-Other: Neurogenic bladder, vesicoureteral reflux
124
Pyelonephritis: Symptoms shared w/ Cystitis
-Dysuria
-Urinary Frequency
-Hematuria
125
Pyelonephritis: Unique symptoms
-Location of Pain: Flank Px, colicky abdominal pain
-High fever
126
Pyelonephritis: Exam
-Murphy’s kidney punch: Positive on affected side
-Kidney may be palpable and tender if enlarged
127
Pyelonephritis: Diagnostic Procedures
-Urinalysis, urine culture
-CT, US
128
Interstitial Cystitis
-Non-infectious bladder inflammation
129
Intersititial cystitis is more common in:
Women (90%)
130
Intersitial Cystitis: Triggers
-Excess caffeine
-Tobacco, alcohol
-Food w/ high potassium, spicy
-Seasonal allergies, menstruation, stress, sexual intercourse
131
Interstitial cystitis may be initially
Asymptomatic
132
Interstitial Cystitis: Sx/SI
(Similar to UTI)
-Dysuria
-Increased frequency
-Urgency
-Pressure in bladder/pelvis
-Nocturia
-Pelvic floor dysfunction/tension
-Pain w/ intercourse
-General discomfort
133
Interstitial Cystitis: Differentials
UTI, overactive bladder, urethritis, urethral syndrome, prostatitis
134
Interstitial Cystitis: Labs
Normal unless another condition is involved
135
Neurogenic Bladder
-Bladder dysfunction caused by neurologic damage
136
Neurogenic Bladder: Many causes
CNS, PNS, Other
137
Neurogenic Bladder: Different Types
-Flaccid Bladder: Contractions absent
-Spastic Bladder: Involuntary contractions
-Mixed patterns: Both
138
Neurogenic Bladder: Symptoms
-Flaccid: Overflow incontinence
-Spastic: Frequency, nocturia, urgency, leakage
139
Neurogenic Bladder: Common complications
-Recurrent infections
-Vesicoureteral reflux
140
Loss of bladder control
Urinary incontinence
141
Urinary incontinency is more common in
Elderly and women
142
Urinary incontinence: Risk factors (5)
-Diabetes, MS, obesity
-BPH, Multi-parity
143
Urinary Incontinence: Types
-Stress
-Urge
-Overflow
-Functional
-Mixed
144
Urinary Incontinence: Stress
-Caused by coughing, sneezing, laughing, exercising, or lifting something heavy
145
Urinary Incontinence: Urge
-Sudden, intense urge followed by involuntary loss
-Causes: Infection or Conditions (DM or neurologic)
146
Urinary Incontinence: Overflow
Dribbling as bladder doesn’t empty completely
147
Urinary Incontinence: Overflow
Dribbling as bladder doesn’t empty completely
148
Urinary Incontinence: Functional
-Physical or mental impairment impedes getting to the toilet on time
149
Incontinence: Causes
-Obstruction such as BPH
-DM
-Pelvic floor weakness
-Infection
-Stones
-Tumor
150
Enuresis
Involuntary loss of urine
-Involuntary voiding of urine > 2x/month during the day or night
151
Enuresis is more common in:
Male Children (3:1)
152
Enuresis: Primary classification
Children: Never were dry/were not potty trained
153
Enuresis: Secondary Classification
-Begins after 6 months of dryness
154
Enuresis: Secondary Classification (Causes)
-ADD
-Stress
-Anxiety
-Pinworm
-Food Allergies
155
Retrograde flow of urine from bladder into ureters or kidneys
Vesicoureteral Reflux
156
Vesicoureteral Reflux: Epidemiology
More common in infants and young children
157
Vesicoureteral Reflux: MC Causes
Congenital defect at ureterovesical junction
158
Vesicoureteral Reflux: Symptoms
-Dysuria, urgency, frequent urination, hematuria, abdominal pain
159
Bladder Injury: Signs/Symptoms
-Suprapubic pain, urinary retention, hematuria (90%), muscle rigiditiy over lower abdomen
160
Most common renal cancer (90-95%)
Renal Cell Carcinoma
161
Renal Cell Carcinoma affects people between:
50-70 yoa
162
Renal Cell Carcinoma: Symptoms
-Appear late when the tumor is large & metastatic
-Hematuria, flank pain, palpable mass, fever
163
Most common type of bladder, ureter, urethra cancer
Transitional Cell Carcinoma
164
Transitional Cell Carcinoma: Causes
Certain drugs, radiation, mutation, cigarette smoke
165
Wilms’ Tumor/Neuroblastoma manifests in _____
Children <5 yoa
166
Wilms’ Tumor/Neuroblastoma: Cause
Possible genetic abnormalities
167
Wilms’ Tumor: Symptoms
Painless, palpable abdominal mass
168
Wilms’ Tumor: Prognosis
Good, but may recur within 2 years
169
UTI vs. Interstitial Cystitis
UTI: Hematuria may be present, WBC in urine
Interstitial Cystitis: Normal labs, Dx by exclusion
170
Abdominal and Posterior Flank Area: Exam Findings
-Bruit: Renal artery stenosis
-Murphy’s Kidney Punch: Pyelonephrtitis
-Palpable Kidneys: Masses potentially
171
Abdominal and Posterior Flank Area: Exam Findings
-Bruit: Renal artery stenosis
-Murphy’s Kidney Punch: Pyelonephrtitis
-Palpable Kidneys: Masses potentially
