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Y2 Renal > Urinary tract conditions > Flashcards

Urinary tract conditions Flashcards

1
Q

What is cystitis

A

Inflammation of the bladder

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2
Q

What are the causative pathogens of UTI

A

E. coli
Proteus
Pseudomonas aeruginosa
Enterococcus faecalis

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3
Q

What is the most common causative pathogen of UTI

A

E. coli

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4
Q

What is the most common causative pathogen of UTI in an immunosuppressed patient / patients with catheters

A

Pseudomonas aeruginosa

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5
Q

What is the most common causative pathogen of UTI acquired in hospitals

A

Enterococcus faecalis

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6
Q

Risk factors of UTI in adults

A

Female
Catheterised patients

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7
Q

Why are females more susceptible to UTI

A

Shorter, wider urethra
Urethra close to anus

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8
Q

What are the risk factors of UTI in children

A

Girls
Incomplete bladder emptying
Poor hygiene
Vesicoureteric reflux

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9
Q

What can cause incomplete bladder emptying in children

A

Infrequent peeing
Obstruction due to constipation
Neuropathic bladder

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10
Q

What is vesicoureteral reflux

A

Condition in which urine flows backward from the bladder to the ureters

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11
Q

What are the 2 routes of spread of infection for UTI

A

Ascending
Haematogenous

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12
Q

Describe the ascending route of UTI infection

A

Bacteria from bowel -> perineal skin -> enter the lower urethra -> spread into the bladder -> ureter -> kidneys

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13
Q

Describe the haematogenous route of UTI infection

A

Bacteraemia / septicaemia affecting the kidneys

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14
Q

What is considered as uncomplicated UTI

A

Anatomy of the urinary tract is normal, renal imaging is normal
No underlying condition causing the infection

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15
Q

What is considered as complicated UTI

A

Occurs in urinary tracts with stones
Recurrent infection + stone can cause kidney damage

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16
Q

Symptoms of UTI in adults

A

Dysuria (pain when urinating)
Urinary frequency
Urinary urgency
cloudy / offensive smelling urine
Haematuria
Lower abdominal pain

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17
Q

What symptoms may suggest lower UTI spreading to upper urinary tract

A

Loin pain
Fever

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18
Q

Investigations for UTI

A

Midstream specimen of urine (MSU)
Urine dipstick if indicated
Urine culture if indicated

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19
Q

When is urine dipstick indicated

A

Women <65
who do not have risk factors for complicated UTI

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20
Q

When is urine culture indicated

A

Women >65
Recurrent UTI (2 episodes in 6 months)
Pregnant women
Men
Visible / non-visible haematuria

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21
Q

What urine dipstick result can suggest UTI

A

positive for nitrite or leukocyte and red blood cells

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22
Q

What are the symptoms of UTI in children

A

Abdominal pain
Dysuria
Haematuria
Urinary frequency

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23
Q

What symptoms of UTI may show in infants

A

Fever (less common in above 1 year old)
Poor feeding
Vomiting
Irritability

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24
Q

Investigations for UTI in children

A

Urine dipstick
Urine culture with appropriately collected urine

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25
Q

How should urine culture be collected from a child

A

Clean catch
If not possible -> urine collection pads

Suprapubic aspiration is only used if the methods above do not work

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26
Q

What should not be used to collect urine sample from a child

A

Cotton wool balls / sanitary towels

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27
Q

Management of lower UTI in non-pregnant women

A

Trimethoprim or nitrofurantoin for 3 days
Send culture if >65 / visible or non visible haematuria

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28
Q

Management of lower UTI in pregnant women

A

Send culture in all cases
1. Nitrofurantoin UNLESS close to TERM
2. Amoxicillin / cefalexin in THIRD term

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29
Q

Why isn’t trimethoprim used in pregnant women for lower UTI

A

it is teratogenic in the first trimester

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30
Q

Management of lower UTI in men

A

Send culture in all cases
Trimethoprim / nitrofurantoin for 7 days

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31
Q

Management of lower UTI in catheterised patients

A

Do not treat asymptomatic patients
Antibiotics for 7 days if symptomatic
Change catheter

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32
Q

Management of lower UTI in children

A

Refer immediately if <3 months old
Oral trimethoprim / nitrofurantoin

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33
Q

What are the complications of lower UTI

A

Acute bacterial prostatitis
Acute pyelonephritis

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34
Q

Symptoms of bacterial prostatitis

A

Symptoms of UTI +
lower abdominal pain
Penile pain
Perineal pain
Tender prostate on palpation

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35
Q

Investigations for bacterial prostatitis

A

MSU for culture

36
Q

Management of bacterial prostatitis

A

Ciprofloxin for 28 days

37
Q

Management of acute pyelonephritis

A

Cephalosporin (cefuroxime) / quinolone (ciprofloxacin/ofloxacin) for 10-14 days

38
Q

What are the types of renal stones

A

Calcium oxalate and phosphate
Magnesium ammonium phosphate
Uric acid
Cystine

39
Q

Which type of renal stone is the most common

A

Calcium oxalate (calcium phosphate is less common)

40
Q

What are the risk factors for renal stones

A

Males
20-50
Hypercalciuria
Hypercalcaemia
Hyperparathyroidism
Dehydration
Renal tubular acidosis

41
Q

Uric acid renal stones can occur in patients with

A

gout

42
Q

Causes of calcium oxalate stones

A

Mostly idiopathic hypercalciuria
Hyperparathyroidism
High intake of dietary oxalate - rhubarbs, cabbages
Increase in oxalate due to malabsorption in small intestine
Drugs

43
Q

What drugs may increase risk of calcium stones

A

Loop diuretics
Steroids
Acetazolamide

44
Q

Magnesium ammonium phosphate renal stones often occur

A

After infection

45
Q

Where are the common sites of obstruction due to renal stones

A

Uretopelvic junction
Vesicoureteric junction (most commonly obstructed)

These are natural constrictions of the ureter

46
Q

Where is the vesicoureteric junction

A

Where the ureter joins the bladder

47
Q

Symptoms of renal stones

A

Severe sharp, localised, intermittent loin to groin pain
Nausea and vomiting
Haematuria (negative haematuria DOES NOT exclude renal stone)
Sepsis

48
Q

Investigations for renal stones

A

Non-contrast CT KUB
Urinalysis
Serum creatinine, U+E - check renal function
ultrasound KUB may be helpful in some

49
Q

When is ultrasound KUB used

A

In pregnant women / children with suspected renal stones

But less effective than CT KUB

50
Q

Why isn’t Xray really used for renal stones

A

Because not all stones are visible - uric acid and cystine stones are radiolucent

51
Q

Management of renal stones

A

If <5mm - watchful waiting + NSAID +/- antiemetics
If >10mm - surgery

Urgent renal decompression + IV antibiotics if signs of obstruction and infection (may be sepsis)

52
Q

What are the options for treating big renal stones

A
  1. Shock wave lithotripsy
  2. Percutaneous ureterolithotomy
53
Q

If a patient with large renal stone is obese, what surgical method should be used

A

Percutaneous ureterolithotomy

54
Q

Which analgesia is preferred for renal stones

A

NSAID - IM diclofenac for rapid relief

55
Q

What are the methods to reduce risk of another calcium stone

A

High fluid intake
Low salt diet
Thiazide diuretics - increases distal tubular calcium resorption

56
Q

Risk factors of urinary incontinence

A

Increasing age
Females
Previous vaginal delivery
Pregnancy
FH
Smoking - causes cough
Obesity
UTI

57
Q

What are the types of urinary incontinence

A

Stress UI
Urge UI / overactive bladder
Mixed UI (urge + stress)
Functional incontinence
Outflow incontinence

58
Q

What is stress UI

A

Small amounts of urinary leakage when intra-abdominal pressure is raised e.g. laughing, coughing, sneezing

59
Q

What is urge UI

A

Urinary leakage due to detrusor overactivity / infection of the bladder (less common)

60
Q

What is the detrusor muscle

A

Smooth muscle fibres that line the bladder wall

61
Q

Classic symptom of urge UI

A

Urge to urinate quickly followed by uncontrollable leakage of urine

62
Q

What is overflow incontinence

A

when you have the urge to urinate but can release only a small amount

63
Q

What causes overflow incontinence

A

Bladder outlet obstruction - prostate enlargement / constipation

Underactivity of detrusor muscle

64
Q

What is functional incontinence

A

when comorbidities impair the patient’s ability to get to a bathroom in time

65
Q

What may cause functional incontinence

A

Sedating medications
Alcohol
Dementia

66
Q

Investigations for urinary incontinence

A

Bladder diaries
Examinations - vaginal, abdominal, rectal
Urinalysis
Urodynamic studies - Xray/US when bladder fills and empties

67
Q

Why do you do vaginal examination for females with urinary incontinence

A

To check for prolapse of pelvic organs
Check pelvic floor muscle strength

68
Q

Why do you do rectal examination for patients with urinary incontinence

A

To check for prostate enlargement / constipation / rectal mass

69
Q

Management of stress urinary incontinence

A
  1. Pelvic floor muscle training for 3 months
  2. Surgery
  3. Duloxetine if decline surgery
70
Q

Function of duloxetine in managing stress UI

A

Stimulates urethral sphincter

71
Q

Management of urge UI

A
  1. Bladder retraining for 6 weeks
  2. Antimuscarinics - Oxybutynin / tolterodine
  3. Beta agonist - Mirabegron
72
Q

Function of oxybutynin / tolterodine (antimuscarinics) in managing UI

A

Inhibit contraction

73
Q

Function of Mirabegron (beta agonist) in managing UI

A

Induce detrusor relaxation

74
Q

When is mirabegron (beta agonist) used in managing UI

A

In frail elderly patients who should NOT use antimuscarinics because it is associated with causing confusion

75
Q

Types of bladder malignancy

A

Urothelial carcinoma (transitional cell carcinoma)
Squamous cell carcinoma
Adenocarcinoma

76
Q

Most common type of bladder cancer

A

Urothelial carcinoma

77
Q

Risk factors for urothelial cancer

A

Smoking
Increasing age
Aromatic amines - used in dyes and rubber industries

78
Q

What is the most common presentation of urothelial cancer

A

Papillary growth

79
Q

Compare the prognosis of the different bladder cancers

A

Urothelial cancer - best prognosis
Others have worse prognosis because most present as higher grade tumour

80
Q

Symptoms of bladder cancer

A

Painless macroscopic haematuria

81
Q

Investigations for bladder cancer

A

Refer urgently if present with painless haematuria

CT urogram
Flexible cystoscopy

82
Q

Management of bladder cancer

A

If early - TURBT (transurethral resection of bladder tumour)

If higher grade - intravesical chemotherapy

If muscle invasive - cystectomy

83
Q

What staging of bladder cancer is muscle invasive

A

T2 and above

84
Q

What causes urinary retention in men

A

Benign prostatic hyperplasia
Prostate cancer
Urethral stricture

85
Q

What causes urinary retention in females

A

Pelvic prolapse
Pelvic mass

86
Q

Management of urinary retention

A

Immediate catheterisation

Y2 Renal (12 decks)

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