Urinary symptoms Flashcards
(164 cards)
1
Q
difference between diabetes mellitus and diabetes insipidus
A
Diabetes insipidus (DI) is a rare condition in which the kidneys are unable to retain water, whereas diabetes mellitus is a condition characterized by the inability of the body to produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high.
diabetes mellitus - glucose in urine
diabetes insipidus - no glucose in urine
2
Q
difference between osmolality and osmolarity
A
osmoLality: measure of osmoles of solute per kg of solvent
osmolaRity: measure of osmoles of solute per L of solution
3
Q
another name for anti dimetric hormone - ADH
A
vasopressin (AVP)
4
Q
what does ADH do to V1 receptors
A
- mediates vascular smooth muscle contraction
- stimulates prostaglandin synthesis
- stimulates liver glycogenolysis
5
Q
what does ADH do to V2 receptors
A
-renal actions via mobilisation of aquaporin-2
6
Q
causes of central diabetes insipidus
A
surgery trauma idiopathic tumours histiocytosis granulomas infection autoimmune familial
7
Q
causes of nephrogenic diabetes insipidus
A
chronic renal disease hypokalaemia sickle cell anaemia drugs: lithium, demeclocycline, colchicine familial protein starvation hypercalcaemia
8
Q
what is nephrogenic diabetes insipidus
A
occurs when there’s a defect in the structures in your kidneys that makes your kidneys unable to properly respond to ADH . The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder.
9
Q
what does water deprivation test test for
A
whether its
- central diabetes insipidus
- nephrogenic diabetes insipidus
- pyschogenic polydipsia
10
Q
describe water deprivation test if they had central diabetes insipidus
A
urine osmolality remains low
does respond to ADH (osmolality increases)
11
Q
describe water deprivation test if they had nephrogenic diabetes insipidus
A
urine osmolality remains low
does not respond to ADH (osmolality remains low)
12
Q
chronic complications of diabetes mellitus
A
CVS disease nerve damage (neuropathy) kidney damage (nephropathy) eye damage (retinopathy) foot damage skin conditions hearing impairment alzhiemers
13
Q
acute complications of diabetes mellitus
A
DKA
hyperosmolar hyperglycemic nonketotic coma,
hypoglycemia
14
Q
Difference in presentation of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar (HHS)
A
DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia.
15
Q
what does insulin do
A
insulin helps your body use glucose (sugar) for energy.
16
Q
what does it mean if leukocytes are present in urine
A
it could be a sign of infection. Leukocytes are white blood cells that help your body fight germs. When you have more of these than usual in your urine, it’s often a sign of a problem somewhere in your urinary tract.
17
Q
what does it mean if nitrites are present in urine
A
if bacteria enter the urinary tract, nitrates can turn into different, similarly named chemicals called nitrites. Nitrites in urine may be a sign of a urinary tract infection (UTI). UTIs are one of the most common types of infections, especially in women.
18
Q
what does it mean if glucose is in urine
A
If a random urine sample shows more than 0.25mg/ml, this is considered glycosuria and can be caused by too high blood glucose levels, a problem with your kidney filters, or both.
19
Q
what does it mean if protein in is urine
A
Protein is normally found in the blood. If there is a problem with your kidneys, protein can leak into your urine. While a small amount is normal, a large amount of protein in urine may indicate kidney disease.
20
Q
what does acidic urine mean
A
Acidic urine can also create an environment where kidney stones can form. If a person has low urine pH, meaning that it is more acidic, it might indicate a medical condition such as: diabetic ketoacidosis, which is a complication of diabetes. diarrhea. starvation.
21
Q
what does alkaline urine mean
A
suggestive of infection with a urea-splitting organism, such as Proteus mirabilis. Prolonged storage can lead to overgrowth of urea-splitting bacteria and a high urine pH.
22
Q
what does blood in urine mean
A
Most causes of blood in your urine are not serious, But sometimes red or white blood cells in your urine can mean that you have a medical condition that needs treatment, such as a kidney disease, urinary tract infection, or liver disease
23
Q
what is flexible cystoscopy
A
A flexible cystoscopy is a routine examination of your bladder which is carried out using a flexible telescope (cystoscope). It is passed along your water pipe (urethra) and into your bladder.
24
Q
risk factors for kidney or urinary tract cancer
A
age
smoking
exposures to benzene, aromatic amines (dyes, road fumes), carcinogens, chemotherapy, or high doses of analgesics
A history of: irritative voiding symptoms, chronic UTIs, indwelling urinary catheter, pelvic irradiation
25
what is rhabdomyolysis
Rhabdo is the breakdown of damaged muscle which results in the release of muscle cell contents into the blood. The proteins and electrolytes released into the blood can cause organ damage. Workplace risk factors include heat exposure, physical exertion, and direct trauma
26
treatment of rhabdomyolysis
fluids and electrolytes intravenously (through a vein). These IV fluids flush the toxins from your system. You may need to stay in the hospital for a few days. After treatment, physical therapy can help you strengthen your muscles after an initial period of rest.
27
what is ANCA vasculitis
an autoimmune disease affecting small blood vessels in the body. It is caused by autoantibodies called ANCAs, or Anti-Neutrophilic Cytoplasmic Autoantibodies. ANCAs target and attack a certain kind of white blood cells called neutrophils.
28
causes of haematuria (from urethra)
cancer (prostrate)
infection (prostatitis, STIs)
Trauma
29
causes of haematuria (from bladder)
cancer
infection
non-infective cystitis
stones
30
causes of haematuria (from ureters)
cancer
| stones
31
causes of haematuria (from kidney)
cancer
stones
trauma
32
causes of haematuria (from glomerulus)
IgA nephropathy
ANCA vasculitis
thin-membrane nephropathy
33
what is haemoglobinuria
Hemoglobinuria is the presence of hemoglobin in the urine; it is associated with red to amber colored transparent urine that remains pigmented after centrifugation.
34
what is myoglobinuria
Myoglobinuria is the presence of an excess amount of myoglobin in the urine. It is mostly caused by muscle breakdown, releasing a high amount of myoglobin in the blood. Myoglobinuria can lead to acute kidney injury.
35
what is a renal calculi and how does it form
kidney stone
Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form
36
symptoms of renal colic
- intense pain along the side of your body between your ribs and hip, or in your lower abdomen.
- pain that spreads to your back or groin.
- nausea or vomiting.
37
site of urinary colic
severe form of sudden flank pain that typically originates over the costovertebral angle and extends anteriorly and inferiorly towards the groin or testicle.
38
cause of urinary colic
primarily caused by the passage of solid material along the ureter, most commonly a stone that has originated in the kidney, although an injury or other conditions could also cause the disorder. The disorder may result in permanent damage to the kidney and may be a cause of hypertension.
39
what is hydronephrosis
swelling of one or both kidneys. Kidney swelling happens when urine can't drain from a kidney and builds up in the kidney as a result. This can occur from a blockage in the tubes that drain urine from the kidneys (ureters) or from an anatomical defect that doesn't allow urine to drain properly.
40
hydronephrosis symptoms
Pain in the side and back that may travel to the lower abdomen or groin.
Urinary problems, such as pain with urination or feeling an urgent or frequent need to urinate.
Nausea and vomiting.
Fever.
Failure to thrive, in infants.
41
what is perinephric stranding
Perinephric stranding refers to the appearance of oedema within the fat of the perirenal space on CT or MRI
Perinephric stranding is a nonspecific sign pointing to an underlying inflammatory problem with the kidney and/or collecting system. Depending on the situation, it could result from. pyelonephritis (usually heterogeneous enhancement in the ipsilateral kidney)2
42
what is capillary hydrostatic pressures generated by
generated by propulsive forces
43
what is colloidal osmotic pressures generated by
generated by impermeable proteins
44
what is raised hydrostatic capillary pressure originated from
originates from a rise of venous pressures
45
what's reduced plasma colloid osmotic pressure originated from
originates from excessive loss or reduced synthesis of plasma proteins
46
what is a pleural effusion
an accumulation of excess fluid between the pleural spaces
47
what symptoms are pleural effusions associated with
can be asymptomatic or:
chest pain
dry cough
dyspnoea/orthopnoea
48
common causes of transudate pleural effusions
```
cardiac/hepatic/renal failure
nephrotic syndrome
peritoneal dialysis
pericarditis
pulmonary embolism
```
49
common causes of exudate pleural effusions
```
pnuemonia/tuberculosis
inflammatory conditions
cancer
pancreatitis
pulmonary embolism
```
50
what is transudate and what is it generally caused by
a filtrate of plasma with low protein content: <30g/L
generally caused by factors that:
-increase capillary hydrostatic pressure (increase blood pressure within capillaries)
-reduce colloid osmotic pressure (form of osmotic pressure brought on by proteins, usually albumin, that causes a pull back of fluid back into the capillaries)
51
what is exudate and what is it generally caused by
a filtrate of plasma with a high protein content:>30g/L
generally caused by factors that:
-increase extravascular colloid osmotic pressure (increased capillary permeability to protein)
52
what is non cardiogenic pulmonary oedema
is a disease process that results in acute hypoxia secondary to a rapid deterioration in respiratory status. The disease process has multiple etiologies, all of which require prompt recognition and intervention.
53
major causes of non cardio-genic pulmonary oedema
acute respiratory distress syndrome
fluid overload
pancreatitis
inhalation injury
drowning
re-expansion: after draining pleural effusion or pneumothorax
neurogenic causes: head injury, haemorrhage
54
what is ascites
fluid build up in the abdomen
55
most common cause of ascites
portal hypertension due to live cirrhosis
56
what can portal venous pressures arise from (that might contribute to ascites)
hepatic damage and fibrosis
raised post hepatic venous pressures
reduced hepatic venous drainage
increased venous inflow
57
what is drainage of ascitic (from ascites) fluid useful for
to prevent damage to abdominal tissues
| provide fluid samples to understand the aetiology
58
how would you drain fluid from ascites
```
physical drainage (paracentesis)
fluid excretion through diuretics (single morning dose of furosemide and spironolactone)
```
59
what is non pitting oedema
a swollen area , such as a limb, that does not leave a lasting indentation after external pressure
60
what is non pitting oedema caused by
may be caused from reduced lymphatic drainage (lymphoedema)or thyroid problems (myxoedema)
61
what is myxoedema associated with
severe hypothyroidism
62
3 major functions of lymph
- return protein and fluid from extravascular fluid to maintain a low protein concentration
- aid absorption and transport of fat from the small intestine
- immunoloigcal role - lymph glands, circulation of immune cells, removal of Bacteria
63
what is lymphoedema
a condition where the lymphatic system fails to properly drain lymph, which accumulates in the tissues, usually in the arms and legs
64
what is primary lymphoedema
a rare genetic condition whereby the lymphatic system fails to develop properly
65
what is secondary lymphoedema
lymphoedema caused by:
surgery- removal of or injury to lymph nodes
radiation - treatment for cancer can damage lymph nodes
cancer - blockage of lymph vessels/nodes
infection or parasitic invasion, blocks lymph vessels
inflammatory conditions: rheumatoid arthritis
venous disease: DVT, varicose veins
66
Examples of oedema from increased hydrostatic capillary pressure
cardiogenic pulmonary oedema
| systemic pitting oedema
67
Examples of oedema from decreased capillary colloid osmotic pressure
excessive plasma protein (albumin) loss
| impaired albumin production
68
Examples of causes of oedema from increased interstitial colloid osmotic pressure
sepsis
burns
inflammatory conditions (including non-cardiogenic pulmonary oedema
69
type 1 diabetes mellitus
autoimmune destruction of insulin producing beta cells
70
type 2 diabetes mellitus
combination of insulin resistance and relative insulin deficiency
71
most common acute complication for type 2 diabetics
HHS - hyperglycaemic hyperosmolar state
72
long acting insulin
levemir
lantus
humulin
degludec
73
short acting insulin (with meals)
NovoRapid
humalog
Humulin S
Fiasp
74
what does SIADH stand for
syndrome of inappropriate antidiuretic hormone secretion
75
what is SIADH
Syndrome of Inappropriate Antidiuretic Hormone Secretion is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water.
76
symptoms of psychogenic polydipsia
Excessive thirst and Dry mouth (or xerostomia), leading to overconsumption of water.
Hyponatraemia, causing headache, muscular weakness, twitching, confusion, vomiting, irritability etc., although this is only seen in 20% – 30% of cases.
77
what are diuretics (brief description)
they increase urine output by kidney
most diuretics reduce sodium reabsorption in different regions of the tubular nephron and hence increase sodium excretion
a greater excretion of sodium in the urine causes enhanced water loss by osmosis
78
mannitol (diuretic) brief description
- filtered at glomerulus and is poorly reabsorbed
- increases plasma and tubule osmolarity, thus generates a diuresis with less loss of sodium
- useful to drain relatively inaccessible oedema accumulations
79
mannitol is useful to manage
- raised intracranial pressure before surgery
- raised intraocular pressure, glaucoma
- forced diuresis, e.g. in poisoning
80
side effects of mannitol
transient fluid overload
complicates congestive heart failure, pulmonary oedema
headache, nausea, vomiting
81
furosemide inhibits the sodium/potassium/chloride co-transport in order to do what?
- reduce the medullary interstitial concentrating gradient
- maintain a greater tubular osmolarity
- both of these factors reduce water reabsorption from the collecting duct
82
Na+ handling by the renal tubule
Sodium is absorbed (in exchange for potassium) passively through open channels in principal cells. These open channels are increased in response to aldosterone. Absorption of sodium facilitates passive chloride absorption in this segment as well as the nearby sections of the distal tubule.
83
site of action of thiazide diuretics
Thiazide diuretics increase salt and water excretion primarily by inhibiting mechanisms for electroneutral sodium and chloride transport by distal convoluted tubule cells.
84
site of action of loop diuretics
Loop diuretics are diuretics that act on the Na-K-Cl cotransporter along the thick ascending limb of the loop of Henle in the kidney.
85
site of action of k sparing diuretics
Amiloride, triamterene, and the spirolactones are potassium-sparing diuretics which act on the distal parts of the nephron, from the late distal tubule to the collecting duct.
86
what are carbonic anhydrase inhibitors used for? and what class of drugs do they come under
come under diuretic s
used in the management and treatment of glaucoma, idiopathic intracranial hypertension, altitude sickness, congestive heart failure, and epilepsy, among other diseases.
87
common side effects of diuretics
- too little potassium in the blood
- too much potassium in the blood
- low sodium levels
- headache
- dizziness
- thirst
- increased blood sugar
88
when would combination diuretic therapy be used
in patients with oedema resistant to treatment with one diuretic
89
which diuretic is commonly used in pulmonary oedema
Doctors commonly prescribe diuretics, such as furosemide (Lasix), to decrease the pressure caused by excess fluid in your heart and lungs.1
90
which diuretic is used in ascites
the diuretics most commonly used in the treatment of cirrhotic patients with ascites are loop diuretics, particularly furosemide (frusemide), and distal, or 'potassium-sparing' diuretics such as spironolactone.
91
which diuretic is used in hypertension
chlortalidone and indapamide are the preferred diuretics in the management of hypertension. Thiazides also have a role in chronic heart failure.
92
what is chronic kidney disease
abnormal kidney function present for more than 3 months, with implications of health
93
symptoms of chronic kidney disease (CKD)
Non-specific
- fatigue
- loss of appetite
- nausea and vomiting
- itchy skin
- cramp
94
signs of chronic kidney disease (CKD)
CKD is not a disease it is a syndrome so signs will likely be for the underlying disease/pathology
non-specific signs of the most advanced stages are pallor, waxy skin, weight loss
95
what is ‘estimated glomerular filtration rate’ (eGFR)
The estimated glomerular filtration rate (eGFR) is a test that measures your level of kidney function and determines your stage of kidney disease. Your healthcare team can calculate it from the results of your blood creatinine test, your age, body size, and gender.
96
3 common causes of chronic kidney disease
diabetes
high blood pressure
cvs disease
97
3 facts about CKD
- its common
- usually reversible
- often preventable
98
what is AKD
acute kidney disease
| -abnormal kidney function present for less than 3 months, with implications for health
99
what is AKI
acute kidney injury
| -abnormal kidney function present for less than one week, with implications for health
100
causes of (pre renal) acute renal failure
sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys form severe injury or illness
101
causes of (intrarenal) acute renal failure
direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
102
causes of (post renal) acute renal failure
sudden obstruction of urine flow due to enlarged prostrate, kidney stones, bladder tumour, or injury
103
in acute renal failure is it most likely to be a pre renal, intra renal or post renal cause
most likely pre renal
then intra renal
then post renal
104
describe pre-renal disease
```
True "volume loss" due to:
-diarrhoea, vomiting, starvation
-bleeding
-burns
effective intra-arterial hypovolaemia due to:
-sepsis
-cardiac failure
```
105
describe renal disease (some causes)
- acute tubular necrosis
- Drug induced (gentamycin, NSAID)
- autoimmune (glomerulonephritis)
- loads of others (rhabdomyolysis)
106
describe post renal disease (some causes)
- prostatic bladder outflow (acute urinary retention)
| - catheter occlusion
107
who typically gets some type of renal disease
older people
| people with underlying kidney disease
108
approach to patient with an AKI (acute kidney injury)
```
history
examination
urine dip
ultrasound renal tract
renal biopsy
```
109
biochemistry and haematology profile of a patent with AKI (Acute kidney injury)
```
USS - shows normal kidney size
calcium is normal
Hb normal unless there is blood loss/hemolysis/bone marrow suppression
bone radiographs are normal
(raised potassium
acidic pH
decreased bicarbonate
increased volume) - also present in AKD
```
110
biochemistry and haematology profile present in a patient with AKI (acute kidney injury) or AKD (acute kidney disease)
- raised potassium (involves late distal tubule and causes direct injury of cells that secrete potassium)
- acidic pH (because of impaired secretion)
- decreased bicarbonate (sign of metabolic acidosis)
- increased volume
111
biochemistry and haematology profile present in a patient with AKD (acute kidney disease)
```
USS - shows small kidneys
calcium can be decreased or normal and increased PTH
decreased Hb with no bleeding or haemolysis
bone radiographs abnormal with:
-bone resorption
-decreased mineralization
-osteomalacia
-soft-tissue calcification
```
112
should you use eGFR in patients presenting with AKI
no
113
nearly every person with eGFR <20 drug list
- treatment for nephropathy driving disease (e.g. diabetes): insulin, oral hypoglycaemic agents
- treatment for hypertension: ramipril/candesartan
- treatment for salt and water overload: diuretics like furosemide
- agents to reduce cvs events: statins, antihypertensives, aspirin if previous event
- agents to treat or prevent renal bone disease/ hyperphosphataemia : activated vitamin d, phosphate binders
- treatment for renal anaemia: synthetic erythropoietin analogue and iron supplements
114
which of the following is not likely to be seen in kidney failure?
- serum pH of 7.62 (7.35-7.45)
- serum urea of 44 (<10)
- serum haemoglobin <54g/L (130-150)
- serum potassium of 8.1 (3.5-5.5)
- Serum PTH of 62 (<7)
serum pH of 7.62
| usually acidic not alkaline
115
what does ESKD stand for
end stage kidney disease
116
define ESKD/ENRD (end stage kidney/renal disease)
is the final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own.
117
what is dialysis
When your kidneys fail, dialysis keeps your body in balance by: removing waste, salt and extra water to prevent them from building up in the body. keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate. helping to control blood pressure.
118
difference between haemodialysis and peritoneal dialysis
The biggest difference in hemodialysis vs peritoneal dialysis is that hemodialysis requires an artificial kidney machine to filter blood while peritoneal dialysis does not. Rather than using a machine, peritoneal dialysis uses the lining on the inside of the belly as a natural filter for blood.
119
how does peritoneal dialysis work
During peritoneal dialysis, a cleansing fluid (dialysate) is circulated through a tube (catheter) inside part of your abdominal cavity (peritoneal cavity). The dialysate absorbs waste products from blood vessels in your abdominal lining (peritoneum) and then is drawn back out of your body and discarded.
120
symptoms of a simple cystitis
```
dysuria
nocturia
increased frequency
urgency
incontinence
haematuria
suprapubic pain
progressive symptoms
```
121
signs of a simple cystitis
afebrile (not feverish)
| suprapubic tenderness
122
symptoms of pyelonephritis
```
dysuria
frequency
urgency
incontinence
haematuria
fever
rigors
flank pain
```
123
signs of pyelonephritis
fever
raised HR, low BP
renal angle tenderness
124
positive leucocyte, nitrites and blood on a urine dipstick
| what is the likely diagnosis
consistent with a UTI
125
positive leucocyte
negative nitrite and blood on urine dipstick
likely diagnosis ?
possible UTI
126
negative leucocyte, nitrite and blood on urine dipstick
| likely diagnosis?
less likely to be a UTI
127
most common bacterial growth on a urine sample
bowel flora escherichia coli
| staphylococcus saphrophyticus
128
why are urinary catheters used long term
to relieve obstruction
129
why are urinary catheters used short term
surgery
| to measure urine output
130
how should you take a urine sample from someone with a. catheter
the Catheter can get colonised within hours
| you should take a sample from the port during catheter insertion
131
asymptomatic bacteriuria
presence of bacteria in the urine without an infection
- increases with age
- urine dipstick is not useful
- urine cultures need clinical interpretation
- exception is in pregnancy, midstream sample in early pregnancy reduces risk of pyelonephritis
132
when would you send a urine culture in
- over 65 if symptomatic and antibiotic given
- suspected pyelonephritis or sepsis
- suspected UTI in men
- -failed antibiotic treatment or persistent symptoms
- recurrent UTI (2 episodes in 6 months or 3 in 12m)
- if prescribing antibiotic in someone with a urinary catheter
133
how long should antibiotics be given for a women with a simple UTI
3 days
134
how long should antibiotics be given for a patient with a complicated UTI (pyelonephritis, men, catheter)
7-14 days
135
usual urinary problem for women
sphincter damage - problems with leakage
136
usual urinary problem for men
obstruction due to enlarged prostrate
137
nervous system control of bladder filling
-parasympathetic nerves from S2-S4 to the bladder and outflow tract are inactive
-sympathetic nerves from T11-L2 maintain bladder relaxation
-pudendal nerve fibres from S2-S4 maintain a closed external sphincter
(parasympathetic make bladder contract )
138
nervous system control of bladder voiding
- parasympathetic nerves active, release acetyl-choline to contract bladder and relax outflow tract
- sympathetic nerves now inactive
- pudendal nerves less active and external sphincter opens
139
4 places urinary stones can lodge
kidney
renal pelvis
bladder
all regions of the ureter
140
4 main types of urinary tract stones
```
calcium stones (60-80%)
uric acid stones (5-10%)
cystine stones (1%)
sturvite stones (10-15%)
```
141
how are small urinary tract stones treated
usually treated conservatively with fluids and analgesics
may need hospital if:
-symptoms do not improve with analgesics
-risk of renal failure
-patient is dehydrated, pregnant or >60
-presence of UTI, fever, sepsis, pyronephrosis
142
treatment for urinary tract stones bigger than 7mm
stent placement
percutaneous nephrolithotomy (PCNL)
extracorpeal shockwave lithotripsy
ureteroscopy
143
what is ureteroscopy
a rigid or flexible ureteroscope is passed via the urethra and bladder to locate the stone and is either pulled out in a basket or broken up with a holmium laser
144
what is extracorporeal shock wave lithotripsy
ultrasonic shock waves are focussed onto a stone under X-ray guidance
the stone is shattered into fragments that can pass out into the urine or if necessary be removed with a basket
145
what is the micturition cycle
he micturition cycle involves two phases: bladder filling/urine storage and bladder emptying
146
what does OAB stand for
overactive bladder
147
what does OAB wet mean
overactive bladder with incontinence
148
what does OAB dry mean
overactive bladder without incontinence
149
what does urgency mean (urinary symptom)
complaint of sudden, compelling desire to pass urine which is difficult to defer
150
3 drugs for management of an overactive bladder
antimuscarinics
beta 3 agonists
botulinum toxin
151
describe antimuscarinics for treatment of an overactive bladder
```
first line therapeutic management
poor patient compliance because of side effects:
-dry mouth
-constipation
-lower cognition
```
acetylcholine is the primary contractile neurotransmitter in the human detrusor, and antimuscarinics exert their effects on OAB/DO by inhibiting the binding of acetylcholine at muscarinic receptors M(2) and M(3) on detrusor smooth muscle cells and other structures within the bladder wall.
152
brief description for botulinum toxin for overactive bladder
- only administered ins specialist centres
- requires direct injection into the bladder wall
- has to be repeated every 9 months
153
contra-indications for botulinum toxin for treatment of overactive bladder
- risk of urinary retention and UTI
- willingness of patient to self catheterise if necessary
- some patients have hypersensitivity to it
154
what is enuresis
involuntary urination, especially by children at night.
155
conservative methods for nocturia and enuresis
bladder retraining and lifestyle changes (particular drinks)
156
medications for nocturia and enuresis
antimuscarinics
short acting diuretics taken in the day
imipramine (approved for nocturnal enuresis in children)
desmopressin - synthetic ADH analogue
157
two more invasive treatment options for overactive bladder (OAB) or detrusor overactivity (DO)
```
sacral neuromodulation (stimulator activates the pelvic nerves and dampens overactive bladder contractions)
augmentation surgery (de-epitheliased section of bowel is sewn into the bladder wall to augment its size)
```
158
what is detrusor sphincter dyssynergia
Detrusor-external sphincter dyssynergia (DESD) is characterized by involuntary contractions of the external urethral sphincter during an involuntary detrusor contraction. It is caused by neurological lesions between the brainstem (pontine micturition centre) and the sacral spinal cord (sacral micturition centre).
159
what is stress incontinence
Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine. Stress incontinence is not related to psychological stress.
leakage occurs because of a failure of the outflow tract to maintain an adequate resistance. In particular , the striated muscle sphincter fails
160
what is stress incontinence exacerbated with
during childbirth
| with age
161
three types of bladder outflow obstruction (BOO)
men prostatic enlargement (malignant or benign prostate hyperplasia)
Women Fowlers syndrome (urinary retention in young women caused by poorly relaxing external urethral sphincter, associated with polycystic ovaries)
children (boys) posterior urethral valves
162
treatment for urine flow of men with benign prostrate hyperplasia
alpha-adrenoreceptor antagonists
| 5 alpha reductase inhibitors
163
what is nephrotoxicity
rapid deterioration in the kidney function due to toxic effect of medications and chemicals. There are various forms, and some drugs may affect renal function in more than one way. Nephrotoxins are substances displaying nephrotoxicity.
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what is nephrotic syndrome
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. The condition causes swelling, particularly in your feet and ankles, and increases the risk of other health problems.
