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Lecture 8: Catheterization/UA/Hematuria Flashcards

(44 cards)

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1
Q

What are the 2 main purposes of urinary catheterization?

A
  1. Draining the urinary bladder
  2. Collecting the urine for measurement or analysis.
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2
Q

What are the 4 common impediments to urine flow?

A
  1. Acute urinary retention
  2. Bladder outlet obstruction
  3. Severe hematuria with clots
  4. During and after surgery of the GU tract or adjacent structures.
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3
Q

When is urinary catheterization indicated?

A
  1. Impeded urine flow
  2. Diagnostic evaluation
  3. Treatment of GU condition
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4
Q

What are the absolute and relative CIs to urinary catheters?

A

Absolute:

  • Pelvic trauma
  • Blood at urethral meatus or gross hematuria in context of trauma.

Relative:

  • Urethral stricture, recent GU surgery, artifical urinary sphincter
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5
Q

What are the complications associated with using an urinary catheter?

A
  • Infection
  • Mechanical damage
  • Bladder damage
  • Urethral damage
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6
Q

When is an external urinary catheter not very useful?

A
  • When we need accurate urine measurement.
  • When we need to get past a urinary obstruction.
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7
Q

What are the pros of using a suprapubic urinary catheter?

A
  • Bypassing urethra, so no urethral trauma.
  • Increased satisfaction vs indwelling catheter
  • Less infection
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8
Q

How long should we be using a foley for?

A

Up to 3 weeks only!!

Consider urostomy or suprapubic for longer.

High UTI risk!!!
Also uncomfortable af

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9
Q

How does a foley work?

A

Double lumen.

  • Lumen 1 is for the actual catheter part.
  • Lumen 2 is to inflate a balloon with saline to keep it in the bladder.
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10
Q

What makes urine orangey? Brown?

A
  • Orangey: Phenazopyridine or rifampin.
  • Brown: Rhubarb
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11
Q

What makes urine super yellow?

A

Vit B

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12
Q

What does an UTI typically smell like?

A

Foul or fishy odor

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13
Q

What diet makes urine acidic? Alkaline?

A
  • Acidic: protein and cranberries
  • Alkaline: vegetarians, citrus fruit, low-carb

Citric acid is metabolized into alkaline byproducts.

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14
Q

What can cause a false negative for heme in an urine dipstick?

A

Excessive Vit C

Urine dipstick is not confirmatory for hematuria without microscopy.

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15
Q

What does leukocyte esterase imply in a urine dipstick?

A

SUGGESTIVE of UTI

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16
Q

What kind of bacteria makes nitrites?

A

G-

E. coli is prob the most common.

Absence of nitrites doesnt mean no UTI.

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17
Q

What makes urobilinogen and bilirubin?

A
  • Urobilinogen: metabolized biliburin by gut bacteria
  • Bilirubin: Unconjugated
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18
Q

What is the most likely substance to cause a false negative on urine dipstick?

Study These Flashcards
A

Vit C/ascorbic acid

19
Q

What does presence of detectable glucose on an urine dipstick?

Study These Flashcards
A

DM

Unless on SGLT2 inhibitor.

20
Q

What usually causes ketones in urine?

Study These Flashcards
A
  • Fasting
  • Exercise
  • Pregnancy

Generally just suggests ketosis.

21
Q

What is a urine dipstick sensitive for?

Study These Flashcards
A

Albumin only

If they spill out other protein, it can’t catch.

Not as accurate as a urine microalbumin.

22
Q

What is urine SG generally used to estimate?

Study These Flashcards
A

Urine osmolality

23
Q

What is considered positive for RBCs on a urine microscopy?

Study These Flashcards
A
  • 5+ RBCs per HPF
  • 3+ RBCs on multiple HPFs
24
Q

What causes dysmorphic RBCs?

Study These Flashcards
A

Glomerular disease

They’ve been forced through weird holes in the tubules.

Suggestive of nephrotic or nephritic synrome

25
What causes RBC casts?
GN or vasculitis
26
What is an abnormal WBC count on urine microscopy?
> 5 WBCs per HPF | Implies injury to urinary tract
27
What do WBC casts imply?
Inflammation of the kidney | Casts in general suggest poor urine flow.
28
What kind of urine samples containing bacteria are significant?
Catheterized or suprapubic tap. If theres any bacteria at all = significant. | These should be sterile.
29
How much bacteria needs to be present for an UTI?
> 100,000 colony count | MUST BE ROOM TEMP URINE ## Footnote One organism = UTI multiple = contamination
30
What is the MC yeast in urine microscopy?
C. albicans
31
What conditions are suggested by increased shedding of tubular epithelial cells?
* Nephrotic syndrome * Tubular degeneration | They are very round
32
What are lipid filled cells in lipiduria called?
* Oval fat bodies * Maltese crosses * Grape clusters
33
Presence of what kind of epithelial cells suggests cancer in an urine microscopy?
Transitional epithelial cells | If in high numbers.
34
What are granular casts suggestive of?
ATN
35
What are waxy casts suggestive of?
CKD
36
Presence of what findings on a urine dipstick suggest infection?
* WBCs * Leukocyte esterase * Nitrites
37
Presence of what findings on a urine dipstick suggest renal pathology and followups with imaging/nephro consult?
* Proteinuria * RBC casts
38
If we suspect hematuria, what labs are appropriate for evaluation?
* Serum BUN/Cr * CBC * Coags
39
What is the imaging modality of choice for upper tract origins of hematuria?
CT Urography | MRI is 2nd
40
What is a CT abd/pelvis good for in terms of hematuria imaging?
* Checks for neoplasms * Checks for benign conditions
41
What imaging modality is generally NOT recommended for hematuria analysis?
US
42
What is cystoscopy good for in terms of hematuria analysis?
Lower urinary tract. | Best to do while patient is actively bleeding.
43
What conditions should make us cautionary in performing a renal biopsy?
Avoid if on anticoags or has a coagulopathy | Last resort
44
If imaging is negative for hematuria, what shoudl we do?
* Reimage in like 3-6 months. * If recurrent: refer to nephro/uro

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