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Spring 15 - GU, Nephro > Urinary Tract Issues > Flashcards

Urinary Tract Issues Flashcards

(45 cards)

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1
Q

What is another word for a lower UTI?

A
  • cystitis

- bladder infection

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2
Q

What are complicating factors of a lower UTI?

A
  • age > 65
  • DM
  • immunocompromised
  • male
  • pregnancy
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3
Q

How is pyelonephritis differentiated from lower UTI?

A

-lower UTI has no white cell casts and usually no fever

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4
Q

What are some risk factors for lower UTI?

A
  • female
  • pregnancy
  • instrumentation (eg catheter)
  • incontinence
  • sexual activity
  • DM
  • recent abx
  • poor hygiene
  • abnormal anatomy
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5
Q

What is the symptom triad for lower UTIs?

A
  • frequency
  • urgency
  • dysuria
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6
Q

Aside from frequency, urgency, dysuria - what are other possible sxs of lower UTI?

A
  • hematuria
  • abdominal pain
  • subrapubic tenderness
  • odor
  • nocturia
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7
Q

What findings are common on a UA in a lower UTI?

A
  • high specific gravity (dehydrated)
  • > 5 RBC per HPF (hematuria)
  • nitrates
  • leukocyte esterase
  • > 100,000 bacteria/mL (diagnostic)
  • > 10 WBC/mm3 (pyuria)
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8
Q

When should a urine culture be done in cases of complicated cystitis?

A

-before antibiotics +/- 1-2 wks after tx is finished

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9
Q

When should a urine culture be done in cases of cystitis in pregnant women?

A

-before antibiotics and 1-2 wks after tx is finished

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10
Q

When should a urine culture be done in cases of cystitis with clinical failure?

A

-after clinical failure and 2 wks after tx is finished

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11
Q

Non-pharm Tx for Lower UTI

A
  • cranberry juice and hydration
  • wipe front to back
  • post intercourse voiding
  • estrogen replacement
  • yogurt
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12
Q

Pharm Tx for Uncomplicated UTI

A

-TMP/SMX 1 DS po bid x3 days

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13
Q

Pharm Tx for Complicated UTI:

  1. Pregnancy
  2. At risk for STD
A
  1. ampicillin 7 days

2. doxycycline 7 days

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14
Q

Pharm Tx for Male UTI

A

TMP/SMX 10-14 days

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15
Q

Lower UTI Prophylaxis for Recurrence in Young Women

A
  • > 3 UTI per year

- 1 DS TMP/SMX po qday or po x1 post intercourse

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16
Q

What is another word for pyelonephritis?

A
  • upper UTI

- kidney infection

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17
Q

What is pyelonephritis?

A

-infection of renal parenchyma and renal pelvis

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18
Q

Complicating Factors of Pyelonephritis

A
  • pregnancy
  • immunosuppression
  • fever > 40C
  • age > 65
  • DM
  • persistent N/V
  • possible urosepsis
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19
Q

Signs and Sxs of Pyelonephritis

Study These Flashcards
A
  • dysuria, frequency, urgency
  • flank pain, CVA tenderness
  • fever, rigors
  • HA
  • N/V, abdominal pain
20
Q

What are common UA findings in pyelonephritis?

Study These Flashcards
A

-same as for lower UTI plus white cell casts

[-high specific gravity (dehydrated)

  • > 5 RBC per HPF (hematuria)
  • nitrates
  • leukocyte esterase
  • > 100,000 bacteria/mL (diagnostic)
  • > 10 WBC/mm3 (pyuria)]
21
Q

Risk Factors for Pyelonephritis

Study These Flashcards
A
  • same as UTI: pregnancy, DM, immunosuppressed, instrumentation, catheter, tract abnormalities
  • renal calculi
  • neurologic deficit
  • prostatic enlargement
  • stress incontinence
  • hospital-acquired
22
Q

Tx of Pyelonephritis

Study These Flashcards
A
  • supportive care
  • uncomplicated: cipro or TMP/SMX x14 days
  • complicated: hospitalize, IV quinolone, amp and gent
23
Q

What is another name for renal calculi?

Study These Flashcards
A
  • kidney stones

- nephrolithiasis

24
Q

What are kidney stones typically made of?

Study These Flashcards
A
  • 75% calcium oxalate

- some uric acid, some struvite

25
How can kidney stones be differentiated from appendicitis and pancreatitis?
- lay still in appy - hands and knees in pancreatitis - walking around with kidney stones
26
What are the most likely areas of obstruction with kidney stones?
- ureter-pelvic junction - pelvic brim - ureter-vesical junction
27
How can kidney stones be avoided?
- increase water intake - decrease salt and meat intake - avoid oxalate-rich foods
28
Risk Factors for Kidney Stones
- male - age 20-40 - genetic predisposition - dehydration, warm climate, summer - diet rich in protein, obesity - diuretics - white > AA
29
Signs and Sxs of Kidney Stones
- "renal colic": acute severe pain at rest originating in flank - hematuria - fever, tachycardia - pain may wax and wane - anxious, pacing - urgency, frequency - CVAn tenderness possible
30
What is the test of choice for kidney stones and why?
-non-contrast CT: shows size of stone and can help predict probability of passage
31
What will be found on urine dipstick in kidney stones?
- blood - microscopic RBCs - crystals
32
Treatment Options for Kidney Stones
- none (pass on own) - control pain, give fluids, antiemetic - ESWL (lithotripsy) - cystoscopy to remove stone - stent placement - nephrostomy
33
Who is more likely to have incontinence problems?
women 2x more likely than men
34
Reversible Causes of UI
- medication side effects - recent prostatectomy - excess fluid intake - atrophic vaginitis - fecal impaction - UTI - impaired mobility - glycosuria
35
Urge Incontinence
- most common type in elderly - bladder overactivity - strong desire to void followed by moderate to large loss of urine
36
Sxs of Urge Incontinence
- frequency - abrupt urgency - nocturia
37
Tx of Urge Incontinence
- oxybutynin (anticholinergic) - topical estrogen in women w/ urethritis - TCA: imipramine
38
Stress Incontinence
- common in women >65 | - urethral underactivity
39
Sxs of Stress Incontinence
loss of small amounts of urine from increased abdominal pressure (sneezing, coughing, laughing)
40
Tx of Stress Incontinence
- Kegel exercises - SNRI Duloxetine - TCA imipramine - pseudoephedrine
41
Overflow Incontinence
- most common in men | - urethral overactivity +/- bladder underactivity
42
Sxs of Overflow Incontinence
- high post void residual volume - dribbling - weak urinary stream - hesitancy - frequency - nocturia
43
Tx of Overflow Incontinence
cholinomimetics: Bethanechol
44
Functional Incontinence
-physical or cognitive disability prevents a person from reaching toilet
45
Tx of Functional Incontinence
-scheduled bathroom breaks

Spring 15 - GU, Nephro (9 decks)

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