Urinary tract Flashcards
Organs of Urinary Tract
A.Upper urinary tract
B.Male urethra
C.Female Urethra
Urinary tract infection (UTI)
The second most common bacterial disease & most comnmon bacterial infection in women.
More than half of all women will have a UTI & up to 50% of these will have another infection within a year.
Pregnant women are at increased risk for UTI’s.
Escherichia coli is the most common pathogen to cause a UTI
Pyelonephritis: inflammation & infection of the renal parenchyma & collecting system
Cystitis: inflammation of the bladder wall
Urethritis: inflammation of the urethra
Urosepsis: is a UTI that has spread into the systemic circulation and is a life-threatening condition requiring emergency treatment
UTI’s can be classified as complicated or uncomplicated
Uncomplicated
those that occur in an otherwise normal urinary tract & usually involve the bladder
Complicated
Include those with coexisting obstruction, stones or catheters, diseases such as diabetes, neurological diseases, pregnancy-induced changes or recurrent infections
- Pathophysiology of UTI
The urinary tract above the urethra is normally sterile and several defence mechanisms assist in maintaining this sterility & preventing UTI’s
Normal voiding with complete emptying of the bladder
Ureterovesical junction competence & peristaltic activity that propels urine forward towards the bladder
Antibacterial characteristics of urine: acidic pH (less than 6.0), high urea concentration, abundant glycoproteins
Alterations in any of these defences can increase the risk of a UTI developing
Organisms that cause UTI’s are introduced via the ascending route from the urethra & originate in the perineum.
Other less common routes are the blood stream or lymphatic system
Predisposing Factors to UTI’s
- Urinary stasis
obstruction (stone, tumour, stricture, benign prostatic hyperplasia)
urinary retention
renal impairment - Foreign bodies
urinary tract calculi
catheters, uridomes, ureteral stent, nephrostomy tube
instrumentation of the urinary tract: cystoscopy, urodynamics
3. Anatomical factors congenital defects leading to obstruction or urinary stasis fistual shorter female urethra obesity
- Immune responce compromised
ageing
HIV
diabetes mellitus - Functional disorders
constipation
voiding dysfunction
6. Other pregnancy menopause multiple sex partners contraceptive diaphragm, spermicidal agents poor personal hygeine
Clinical Manifestations of UTI
Dysuria Frequent urination Urgency Suprapubic discomfort or pressure Haematuria Cloudy, sedement urine Flank pain Chills Fever
Urinary Tract Obstruction
Urinary obstruction refers to any anatomical or functional condition that blocks or impedes the flow of urine
Urinary Tract Calculus
The term calculus refers to the stone. Lithiasis refers to stone formation
Pathophysiology
Risk factors involved in stone formation include:
Metabolic: increased calcium, oxaluric, uric or citric acid in the urine
Dietary: increased proteins increases uric acid; excessive tea or fruit juice increases oxaluric acid; low fluid intake increases urinary concentration
Climatic: warm climates increases fluid loss, low urine volume & increased solute concentration
Genetic: family history of stones, gout or renal acidosis
Lifestyle: sedentary occupation, immobility
Occupational incluences: as above
Clinical Manifestations
Urinary stones cause clinical manifestations when they obstruct urine flow
- Abdominal or flank pain usually severe
- Haematuria
- Renal colic due to increase in ureteral peristalsis
- Nausea & vomiting in response to pain
- Men may experience testicular pain
- Women may experience labial pain
- UTI symptoms
Urinary Incontinence
Urinary incontinence is an uncontrolled leakage of urine
The prevalence of incontinence is higher among older women and older men but is not a consequence of ageing
Causes of incontinance
Confusion Depression Infection Atrophic vaginitis Urinary retention Restricted mobility Faecal impaction Drugs Post surgery (prostate) Pregnancy/Menopause (stress incontinence)
Types of Incontinence - stress
Stress incontinence
Most common in women
Relaxed pelvic floor from vaginal delivery or multiple pregnancies
Structures of the femal urethra atrophy when oestrogen decreases
Prostate surgery
Types of Incontinence - Urge incontinence
Uncontrolled contraction or overactivity of detrusor muscle CNS disorders (brain tumour, stroke), bladder disorders (cancer, cystitis), spinal injury
Types of Incontinence - Overflow incontinence
Caused by bladder or urethral outlet obstruction, underactive detrusor muscle
Can also occur after anaesthesia & surgery
Neurogenic bladder
Types of Incontinence - Reflex incontinence
Spinal cord lesion above S2 interferes with CNS inhibition results in detrusor hyperreflexia & interferes with pathways coordinating detrusor contraction & sphincter relaxation
