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2ND YEAR SYSTEMS: Urinary > Presentation of Diseases of the Kidneys and urinary tract > Flashcards

Presentation of Diseases of the Kidneys and urinary tract Flashcards

1
Q

What makes up the upper urinary tract?

A

Kidneys

Ureters

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2
Q

What makes up the lower urinary tract?

A

Bladder

Bladder outflow tract - urethra

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3
Q

Define Oliguria

A

Abnormally small amounts of urine

Urine output <0.5ml/kg/hour

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4
Q

Define Anuria

A

Absolute anuria - No urine output

Relative anuria - <100ml/24 hours

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5
Q

Define Polyuria

A

Urine output >3L/24 hours

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6
Q

Define Nocturia

A

Waking up at night ≥1 occasion to micturate

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7
Q

Define Nocturnal polyuria

A

Nocturnal urine output >1/3 of total urine output in 24 hours

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8
Q

What is the RIFLE staging criteria used for?

A

Stages of acute Kidney injury

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9
Q

What does the R in RIFLE stand for?

A

Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours

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10
Q

What does the I in RIFLE stand for?

A

Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours

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11
Q

What does the F in RIFLE stand for?

A

Failure - Increase in serum creatinine level, or decrease in GFR by 75%, or serum creatinine level >355μmol/L with acute increase of >44μmol/L; or UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours

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12
Q

What does the L in RIFLE stand for?

A

Loss - Persistent AKI or complete loss of kidney function >4 weeks

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13
Q

What does the E in RIFLE stand for?

A

End-stage kidney disease - complete loss of kidney function >3 months

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14
Q

Functions of the kidney (6)

A 
Endocrine functions 
Body fluid homeostasis
Electrolyte homeostasis 
Acid-base homeostasis
Regulation of vascular tone - BP
Excretory functions - waste + drugs
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15
Q

How does the kidney perform acid-base balance?

A

Excrete H+

Generate HCO3-

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16
Q

Clinical Presentation of chronic renal failure

A

Asymptomatic (found on blood and urine testing)
Tiredness
Anaemia
Oedema
High BP
Bone pain due to renal bone disease or myeloma

In advanced renal failure:
Pruritus 
Nausea/vomiting
Dyspnoea 
Pericarditis 
Neuropathy 
Coma - if untreated
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17
Q

When might the ureter be damaged in surgery?

A

It can be inadvertently cut or tied during hysterectomy (removal of uterus) or colon resection

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18
Q

Hereditary conditions affecting the ureter

A

Pelvic ureteric junction (PUJ) obstruction

Vesicoureteric junction (VUJ) reflux

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19
Q

What can cause intraluminal obstruction in the ureters?

A

Kidney stone

Blood clot

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20
Q

What can cause intramural (within the walls) obstruction in the ureters?

A

Scar tissue

Transitional cell cancer

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21
Q

What can cause extraluminal obstruction in the ureters?

A

Pelvic mass

Lymph nodes

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22
Q

Presentation of ureteric diseases (5)

A

Pain (eg. renal colic)

Pyrexia

Haematuria

Palpable mass (ie. hydronephrosis)

Renal failure (only if bilateral obstruction or single functioning kidney)

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23
Q

Types of bladder inflammation

A

Interstitial cystitis

Colonic diverticulitis resulting in colo-vesical fistula (an open connection between the colon and the bladder) causing infection and other complications

24
Q

Types of bladder cancer

A

TCC of the bladder

Squamous cell carcinoma of the bladder

25
Q

Name a neurological bladder disease

A

Neurogenic bladder dysfunction

26
Q

Presentation of bladder diseases

A 
Pain (suprapubic)
Pyrexia
Haematuria
Lower urinary tract symptoms (LUTS)
Recurrent UTIs
Chronic urinary retention (due to bladder underactivity)
Urinary leak from vagina (i.e. vesico-vaginal fistula)
Pneumaturia (i.e. colo-vesical fistula)
27
Q

Causes of Lower urinary tract symptoms

A

Bladder pathology e.g UTI, interstitial cystitis, bladder cancer

Bladder outflow obstruction e.g enlarged prostate

Pelvic floor dysfunction

Neurological causes e.g neurogenic bladder dysfunction

Systemic disorders e.g chronic renal failure, cardiac failure, DM, diabetes insipidus

28
Q

Where is the micturition centre found?

A

In the pons

29
Q

Function of the cortical centre in control of micturition

A

Bladder sensation and conscious inhibition of micturition

30
Q

Which spinal nerves perform the micturition reflex?

A

S2-S4

31
Q

What are the 2 phases of the micturition cycle?

A 
Storage phase (or filling)
Voiding phase
32
Q

Infections/inflammation of the bladder outflow tract (2)

A

Prostatitis

Balanitis - inflammation of the glans of the penis - can cause narrowing of the urethra

33
Q

How can damage to the bladder outflow tract occur?

A

Pelvic floor damage after traumatic vaginal delivery or hysterectomy

Urethral injury from catheterisation

Pelvic fracture

34
Q

What is a hysterectomy?

A

A hysterectomy is a surgical procedure to remove the uterus.

35
Q

Cancers of the Bladder outflow tract in Males

A

Prostate cancer

Penile cancer

36
Q

Obstructive diseases of the bladder outflow tract

A

Primary bladder neck obstruction

Benign prostatic enlargement (BPE) causing obstruction

Urethral stricture

Meatal stenosis

Phimosis - foreskin is too tight to retract it

37
Q

Presentation of bladder outflow tract diseases

A

Pain (suprapubic or perineal)

Pyrexia

Haematuria

Lower urinary tract symptoms (LUTS)

Recurrent UTIs

Acute urinary retention

Chronic urinary retention

38
Q

What are some Lower urinary tract symptoms?

A

Voiding or obstructive symptoms such as hesitancy, poor flow, straining, prolonged micturition, feeling of incomplete bladder emptying, dribbling

39
Q

What is Acute urinary retention?

A

A painful inability to void with a palpable and percussible bladder

Residuals vary from 500ml to 1 litre

40
Q

What is the main risk factor for Acute urinary retention

A

Benign Prostatic Obstruction

41
Q

Other causes of acute urinary retention

A 
UTI
Urethral stricture
Alcohol excess
Post-operative
Acute surgical or medical problems
42
Q

What is the immediate treatment for acute urinary retention?

A

Catheterisation (either urethral or suprapubic)

43
Q

What is chronic urinary retention defined as?

A

A painless, palpable and percussible bladder after voiding

Patients often able to void but with residuals ranging from 400ml to >2 litres depending on stage of condition

44
Q

What is the main aetiological factor of chronic urinary retention?

A

Detrusor underactivity - can be primary or secondary

45
Q

How does chronic urinary retention present?

A

Presents as LUTS or complications e.g UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure.

46
Q

Treatment for chronic urinary retention

A

Asymptomatic patients with low residuals do not necessarily need treatment

Patients with symptoms or complications need treatment (but no role for medical therapy!)

47
Q

Immediate treatment for chronic urinary retention

A

Immediate treatment is catheterisation (either urethral or suprapubic initially, followed by clean intermittent self-catheterisation if appropriate

48
Q

What is CISC?

A

Clean intermittent self-catheterisation (CISC) = Gold standard in bladder management

Intermittent insertion of a catheter into the bladder by the patient in order to assist drainage of the urine when normal voiding is not possible.

49
Q

What are the 2 types of diuresis (excessive urine production) that may occur if high-pressure chronic urinary retention persists?

A

Physiological (usually <200ml/hour)

Pathological (usually >200ml/hour)

50
Q

Post-obstructive diureses dangers

A

At risk of severe dehydration, electrolyte imbalances, hypovolemic shock, and even death if fluid and electrolyte replacement is not initiated

51
Q

Diagnosis of UTI requires what?

A

Microbiological evidence and symptoms/signs

52
Q

2 types of UTI

A

Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)

Complicated UTIs (everyone else!) - these always need to be investigated

53
Q

Definition of a UTI

A

Infection affecting urinary tract (including kidneys, bladder, prostate, testis and epididymis)

54
Q

Investigations done for UTI

A

MSSU/CSU - mid stream samples of urine, catheter sample

Lower tract: flow studies, residual bladder scan, cystoscopy

Upper tract: USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan

55
Q

What is a DMSA scan?

A

Dimercapto succinic acid => a radioisotope that goes directly to the kidneys once inside the body and only stays radioactive for a few hours

56
Q

Emergencies related to urinary tract diseases (11)

A

Acute renal failure

Sepsis due to UTI +/- upper or lower urinary tract obstruction

Renal colic - pain you get when urinary stones block part of your urinary tract.

Severe haematuria causing haemorrhagic shock

Metastatic disease causing metabolic derangements (eg. hypercalcaemia from bony metastases), spinal cord compression from vertebral metastases, etc.

Acute urinary retention

Chronic high-pressure urinary retention

Iatrogenic injury/Trauma to upper or lower urinary tracts, penis and testis

Testicular torsion

Phimosis - only affects uncircumcised males - foreskin becomes swollen and stuck

Priapism - persistent and painful erection of the penis

2ND YEAR SYSTEMS: Urinary (25 decks)

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