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Session 9 Urinary Flashcards

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1
Q

Features of urinary tract obstruction

A

Can occur at any level

Unilateral or bilateral, complete or incomplete, gradual or acute onset

Increases risk of UTI, reflux and stone formation

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2
Q

Causes of urinary tract obstruction

A
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3
Q

Causes of urinary retention

A

Calculi
Pregnancy
Benign prostatic hypertrophy BPH
Recent surgery
Drugs
Urethral strictures

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4
Q

Why does pregnancy cause urinary retention

A

High levels of progesterone relax muscle fibres in the renal pelvis and ureters and cause a dysfunctional obstruction

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5
Q

Other causes of urinary retention

A

Pelviureteric junction obstruction
Pelvic masses
Constipation
Inflammation
Tumours
Neurogenic disorders

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6
Q

Neurogenic disorders that impact urinary retention result from

A

Congenital abnormalities affecting the spinal cord

External pressure on the cord or lumbar nerve roots

Trauma to the spinal cord

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7
Q

What are Calculi

A

Kidney stones

Hard deposits made of minerals and salts that form inside kidneys

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8
Q

Acute vs chronic urinary retention

A

Acute- painful inability to void, residual volume 300-1500ml

Chronic- painless, may still be voiding, residual volume 300-4000ml

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9
Q

Management of acute urinary retention

A

Catheterise and record residual urinary volume

History

Examination (abdomen, external genitalia, DRE)

Investigations: Urine dip, Us and Es

Treat any obvious cause e.g. constipation,
BPH- alpha blocker, may trial without catheter after 1-2 weeks

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10
Q

Management of chronic urinary retention

A

Catheterise and record residual volume

History

Exam

urine dip, Us and Es

Plan for long term catheterisation or intermittent self-catheterisation. Wouldn’t attempt TWOC

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11
Q

Types of chronic urinary retention

A

High pressure: abnormal U and Es, hydronephrosis, repeat episodes = permanent renal scarring and CKD

Low pressure: Normal renal function, no hydronephrosis

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12
Q

what is post-obstructive diuresis

A

Following resolution of urinary retention through catheter, kidneys can often over-diurese

Leads to worsening AKI. Monitor urine output for 24hrs post catheterisation

Patients with high urine volumes should be supported with IV fluids

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13
Q

What is Diuresis

A

Losing large amounts of water

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14
Q

What is hydronephrosis

A

Dilation of the renal pelvis and calyces due to obstruction at any point in the urinary tract causing increased pressure and blockage

Unilateral - upper urinary tract obstruction

Bilateral- lower urinary tract obstruction

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15
Q

Consequences of hydronephrosis

A

Progressive atrophy of the kidney develops, the back pressure from the obstruction is transmitted to the distal parts of the nephron

GFR declines, if bilateral, renal failure

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16
Q

Hydronephrosis and Hydroureter anatomy

A
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17
Q

Obstruction at the pelviureteric junction causes

A

Hydronephrosis

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18
Q

Obstruction at the ureter causes

A

Hydroureter, eventually leading to hydronephrosis

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19
Q

Obstruction of the bladder neck/urethra causes

A

Bladder distension, hypertrophy, eventually hydroureter and hence hydronephrosis

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20
Q

Features of acute ureteric obstruction

A

Results in renal colic

Usually caused by calculus- can be due to blood clots or sloughed papilla

Usually unilateral

Leads to acute renal failure if bilateral (presents as Anuria or oliguria)

Pyonephrosis can develop- infected, obstructed system

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21
Q

Why does GFR decline in hydronephrosis

A

So much fluid in Bowman’s capsule = pressure bigger than capillaries

Fluid pushed from nephron back into capillaries

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22
Q

What is a sloughed papilla

Study These Flashcards
A

Filling defect in collecting system and ureter

Renal pyramid falls down and blocks urine

23
Q

What is Pyonephrosis

Study These Flashcards
A

Infected, obstructed kidney

Urological emergency

Failure to promptly decompress may lead to death from sepsis and permanent loss of renal function

24
Q

Diagnosis of upper urinary tract obstruction

Study These Flashcards
A

CT or USS- show structure not function

Diuretic Renography (MAG3) is a functional test

25
How do you drain upper urinary tact
Nephrostomy JJ stent
26
Features of Urolithiasis (urinary Calculi)
10% of population, more common in men and Caucasians Dehydration = predisposing factor High recurrence rate 60-80%
27
Kidney stones form
Anywhere in urinary tract. 3 common sites: - Pelviureteric junction - Pelvic brim - Vesicoureteric junction
28
Diagnosis of kidney stones
CT scan of kidneys, ureter and bladder
29
Compositions of urinary Calculi
5 types - Calcium Oxalate stones (most common) - Mixed calcium phosphate and calcium oxalate stones - Magnesium ammonium phosphate stones - Uric acid stones - Cystine stones
30
What are calcium oxalate stones associated with
Hyeprcalcemia and primary hyperparathyroidism and hyperoxaluria
31
What are mixed calcium phosphate and calcium oxalatate stones associated with
Alkaline urine
32
What are magnesium ammonium phosphate stones associated with
Urea splitting bacteria
33
What are uric acid stones associated with
Gout and myeloproliferative disorders
34
What are cystine stones associated with
Patients with inherited cystinuria
35
Clinical presentation of kidney stone
Depends on site - Dull continuous ache in loins - Renal colic - Strangury - Recurrent and untreatable UTIs, haematuria or renal failure - Aasymptomatic
36
Why do ureteric stones cause classical renal colic
Increase in peristalsis in the ureters in response to the passage of a small stone Radiated from loin to groin, patient appears sweaty, pale and restless with nausea and vomiting
37
What is Strangury
The urge to pass something that will not pass
38
Main stream treatment for urinary stones
Adequate analgesia and a high fluid intake Urine is Sieved for analysis Stones of 4-5mm or less usually pass spontaneously Larger stones might require surgical intervention
39
Other treatment options for kidney stones
Extracorporeal shock wave lithotripsy- show waves shock Calculi into small pieces which will then pass into urine
40
Prevention of further stone formation is achieved with a
High fluid intake, correction of any underlying metabolic abnormality
41
Disorders of the prostate
42
Where is the prostate gland
43
Main pathogens for prostatitis
E. coli, proteus and staphylococcus STI = C trachomatis and Neisseria gonorrhoea
44
Presentation of acute prostatitis
Inflammation can be focal or diffuse Malaise, rigours and fever Difficulty in passing urine, dysuria and perineal tenderness Rectal examination reveals a soft, tender and enlarged prostate
45
Why does chronic prostatitis occur
Inadequately treated infection Some antibodies cannot penetrate the prostate effectively History of recurrent prostatic and urinary tract infections
46
Management of chronic prostatitis
Some patients asymptomatic- prevent with no preceding acute phase Diagnosis confirmed by: histological examination showing neutrophils, plasma cells and lymphocytes Positive culture from prostatic secretion
47
What is chronic non-bacterial prostatitis
Most common type of prostatitis, results in enlargement of the prostate Often no history of recurrent UTIs Usually pathogen = C trachomatis (sexually active men affected) Fibrosis as a result of chronic inflammation
48
What does this show
Chronic non-bacterial prostatitis Fibrosis as a result of chronic inflammation
49
What is BPH
Non-neoplastic enlargement of the prostate gland, can lead to bladder outflow obstruction Detectable in nearly all men over 60 Cause unknown but may be related to male sex hormones (testosterone)
50
Presentation and examination for BPH
Enlarging prostate gland compresses on the prostatic urethra Men present with obstructive lower urinary tract symptoms: - Difficulty or hesitancy in starting to urinate - A poor stream - Dribbling post micturition - Frequency and nocturia Digital rectal examination for the prostate, which is firm, smooth and rubbery
51
Untreated BPH presentation
Acute urinary retention + distended and tender bladder- desperate urge to pass urine Or Progressive bladder distension- chronic painless retention and overflow incontinence Can lead to bilateral upper tract obstruction and renal impairment with the patient presenting in CKD
52
Treatment for BPH
Alpha blockers, relax smooth muscle at bladder neck and within prostate Finasteride (5a-reductase inhibitor) Surgery- transurethral resection of the prostate TURP
53
How does Finasteride work
Prevents the conversion of testosterone to the more potent androgen dihydrotestosterone

Urinary (20 decks)

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