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J Renal > Urinary tract conditions > Flashcards

Urinary tract conditions Flashcards

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1
Q

most common cause of urethra obstruction

A

prostatic disease (hyperplasia or malignancy)

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2
Q

what physiological movement happens that causes colicky pain in urethra/ureter obstruction

A

peristalsis

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3
Q

why might there be loin pain in ureter/urethra obstruction

A

hydronephrosis (from back up of urine into kidneys) causing the renal capsule to be stretched

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4
Q

loin to groin pain

A

kidney stones causing obstruction

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5
Q

most common cause of ureter obstruction

A

kidney stones

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6
Q

what are kidney stones made from (4)

A

calcium oxalate usually
struvite
calcium phosphate
uric acid

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7
Q

staghorn calculi

what are they made of

where are they found

A

struvite kidney stones

in pelvicoureteric junction

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8
Q

presentation of kidney stones

whats this similar to

A

loin to groin pain
10/10 pain, nothing makes it better
sudden onset

AAA

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9
Q

where do kidney stones usually get stuck (3)

A

points of ureteric constriction;
pelviureteric junction
pelvic brim
vesicoureteric junction

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10
Q

first line investigation for kidney stones

A

KUB xray

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11
Q

diagnostic investigation if you suspect kidney stones but couldnt see them on xray (eg too small)

A

CT

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12
Q

anatomical where do the ureters lie that makes them easy to follow on xray

A

in from of the transverse processes of the spine

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13
Q

apart from imaging what other tests would you want to do in kidney stones (after youve diagnosed them) (2)

A

leukocytes and nitrites for infection

serum Ca and urate to look for cause

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14
Q

which kidney stones pass on their own

how long

A

<4mm

1 month

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15
Q

initial treatment for kidney stone

A

NSAID for pain
thiazide diuretics to increase Ca absorption
alpha blocker (tamsulosin) bc alpha receptors in ureter

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16
Q

when would you do a stent for kidney stones (2)

A

if still there after 1 month OR presentation with pyrexia/infection/nausea/vomiting/pain unrelieved by opiates

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17
Q

when might you do a percutaneous nephrostomy (with stoma bag) for kidney stones

A

if infected hydronephrosis

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18
Q

what type of UTI microbio is associated with kidney stones (2)

A

proteus

klebsiella

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19
Q

what type of cancer can you get in the ureters/urethra

where else can you get this type of cancer

A

transitional cell carcinoma

bladder

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20
Q

name of upper UTI

A

pyelonephritis

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21
Q

name of bladder UTI

A

cystitis

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22
Q

other causes of cystitis (inflammation) that aren’t bacterial UTIs

A 
urethral trauma (honeymoon cystitis) 
viral (eg chlamydia, gonorrhoea)
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23
Q

honeymoon cystitis

A

inflammation of bladder cause by urethral trauma

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24
Q

what is an uncomplicated UTI

A

in a female (usually young) with no catheter/sepsis/stones etc

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25
are women or men more likely to get UTIs why
women shorter urethra
26
why are pregnant people screened for UTIs
bc they are more susceptible to getting one, and it might turn into pyelonephritis (= bad for baby?)
27
what is the most common route of infection spread in UTI what is an uncommon route
perineal skin/bowel to urethra/bladder haematogenous
28
definition of bacteriuria doe sit mean there is a UTI
bacteria in urine no, could just be bc of catheter
29
most common UTI microbio
ecoli | bowel commensal
30
UTI microbio from catheters
pseudomonas
31
UTI microbio from renal stones
PROTEUS | klebsiella
32
UTI microbio from hospital
enterococcus faecalis
33
UTI microbio urine smells foul (burnt chocolate) swarming cultures
proteus
34
UTI microbio in women of child bearing age
staph saprophyticus (coag neg staph)
35
presentation of lower UTI (4)
supra pubic pain dysuria (pain/burning when passing urine) nocturia haematuria
36
presentation of upper UTI (5)
``` loin pain fever rigors malaise dysuria (pain/burning when passing urine) ```
37
GP investigation for UTI for a young women with ?cystitis what are you looking for when dont you don it
dipstick urine (urinalysis) leukocytes and nitrites hospital, elderly, catheterised
38
more accurate alternative to dipstick urine (urinalysis) when would you do it why is it better
midstream urine (MSU) sample hospital, catheterised patient, elderly midstream is less contaminated than rest of stream
39
when would you do a culture for UTI (2)
hospital | recurrent UTI
40
what number of organisms on culture is diagnostic of UTI
>10^5 organisms/ml
41
if someone has >10^5 organisms/ml but asymptomatic what do you do what is the exception to this
dont treat pregnancy
42
if a young male has a UTI what else do you want to do to find out cause
cystoscopy
43
self management/prophylaxis of further UTIs
``` drink lots pee often cranberry juice/supplements wipe back to front prophylaxis antibiotics if recurrent ```
44
when would you admit someone with a UTI
vomiting fever old signs of sepsis
45
uncomplicated female lower UTI treatment
trimethoprim PO or nitronfurantoin PO 3 days
46
uncatheterised male lower UTI treatment
trimethoprim PO or nitronfurantoin PO 7 days referral to urologist for cystoscopy (to find out cause)
47
which UTI antibiotic is teratogenic in the first trimester of pregnancy what does it do what is the alternative
trimethoprim inhibits folic acid secretion nitrofurantoin
48
which UTI antibiotic only works in the bladder bc it only reaches its therapeutic window in urine (not effective for pyelonephritis)
nitrofurantoin
49
complicated UTI in GP practice treatment
coamoxiclav PO or cotrimoxazole PO 14 days 'Complicated uti in Community' = Coamoxiclav or Cotrimoxazole
50
which UTI antibiotic has c diff risk
coamoxiclav
51
complicated UTI in hospital treatment
amoxicillin/cotrimoxazole IV AND gentamicin IV 3 days 'A Colleague Gets uti in hospital' = Amoxicillin/Cotrimoxazole and Gentamicin
52
what is cotrimoxazole basically the same as
trimethoprim
53
coliform UTI treatment
gentamicin IV
54
coliform UTI treatment if kidney failure
azetreonam
55
pseudomonas UTI treatment
ciprofloxacin (4c antibiotic)
56
UTI treatment in pregnancy when is it given what is there a risk of
cephalexin PO to anyone with bacteruria (<10^5 organisms/ml) even if asymptomatic c diff - 4C antibiotic (type of cephalosporin)
57
treatment of non infectious cystitis
carbonic anhydrase inhibitors (for dysuria) | alkanise urine
58
complications of non infectious cystitis
pyelonephritis, ureteritis (from ascending infection)
59
who get chronic pyelonephritis how does it present
people with anatomical abnormalities no previous UTI, polyuria (kidneys cant concentrate urine)
60
where does tuberculose pyelonephritis originate how does it spread
TB form lungs haematogenous spread
61
how does tuberculose pyelonephritis present
same as all other pyelonephritis; ``` fever malaise loin pain dysuria weight loss night sweats ```
62
investigation results of tuberculose nephritis
no bugs! | white cells/pus in urine instead
63
pathology appearance of tuberculose pyelonephrtitis
kidneys with caseating granulomatous inflammation (looks white and cheesy)
64
painful haematuria
probs UTI

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