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GMED5001 > Urology > Flashcards

Urology Flashcards

(52 cards)

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1
Q

Urinary Tract Obstruction

A

Interference with flow of urine at any site along the urinary tract
* Can be anatomical or functional

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2
Q

3

Most common causes of urinary tract obstructions

A

Renal calculi
Prostate enlargement
Urethral strictures

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3
Q

7

Complications of urinary obstruction

A

Hydronephrosis
Hydroureter
UTI & cystitis
Residual urine volumes
Low bladder wall compliance
Vesicouretral reflux (backflow)
Pain

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4
Q

What are renal calculi & aetiology

A

Massess of crystals, protein and other substances that form within the urinary sustem

Low water intake, dehydration, high salt/sugar intake, little exercise, obesity, gout, altered pH

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5
Q

Pathophysiology of renal calculi

A

Supersaturation of urine, causing crystalisation of salts and proteins (unable to dissolve) forming a solid precipitate

Can cause obstruction & pain

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6
Q

3

Types of stones

A

Calcium oxalate & phosphate
Struvite stones
Uric acid stones

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7
Q

Manifestations of renal calculi

A

Renal colic
Haematuria

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8
Q

Diagnosis of renal calculi

A

Stone/urine analysis
IV pyelogram or US
Abdominal CT

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9
Q

Treatment of renal calculi

A

High fluid intake
Decrease intake of stone forming substance
Stone removal

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10
Q

Aetiology of prostate enlargement

A

Prostatitis
Benign prostatic hyperplasia
Prostate neoplasia

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11
Q

Pathophysiology of prostate enlargement

A

Partial obstruction of urethra causes detrusor muscle to increase force of contraction

If blockage continues, afferent nerves in the bladder walls are adversely affected = urgency & increased detrusor contractions

Collagen deposition in SM of detrusor causes an inability to stretch and contract

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12
Q

Manifestations of prostatic enlargement

A

Increased frequency
Nocturia
Poor & intermittent force of stream
Urgency
Incomplete emptying

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13
Q

UTI and Causes

A

UTI is an infection of any part of the urinary system

Causes: retrograde bacterial movement, often faecal (E. Coli)

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14
Q

Natural prevention of UTI

A
  • Bacteria washed out by urine during micturition
  • Low pH & high osmolality of urea & epithelial lining secretions = bactericidal
  • Ureterovesical junction (closes during bladder contraction to prevent reflux)
  • Long urethra & prostatic secretions in men (antibacterial)
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15
Q

Pathophysiology of UTI

A
  • Normal flora from bowel, vagina or perineum entering urinary tract
  • Irritation of epithelium, causing pain, inflammation and infection
  • Vasodilation & hyperaemia (swelling, inflammation, hematuria)
  • Increased permeability (oedema)
  • Fullness, small voids, urgency, frequency (oedema on stretch receptors)
  • Cell immune response (+leukocytes)
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16
Q

Risk factors of UTI

A
  • Young women, shorter urethral length, sexual intercourse, pregnancy, past hx
  • IDC, urinary retention/stasis, obstructions, dehydration, incontinence
  • Compromised immune system (DM, CKD), antibiotic use
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17
Q

Types of UTI

A

Asymptomatic bacteriuria
Cystitis
Pyelonephritis
Catheter-associated
Upper UTI
Lower UTI

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18
Q

Manifestations of UTI & in elderly

A

Urine frequency, urge & oliguria
Feeling of fullness
Dysuria
Cloudy, red urine
Pain, fever, chills, N/V (Upper UTI)

Elderly: abdominal discomfort, cognitive impairment/delirium

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19
Q

Diagnostic studies for UTI

A
  • Hx & physical examination
  • Dipstick urinalysis (+nitrites, leukocytes, RBC)
  • Urine culture and sensitivity (for confirmation & antibiotic sensitivity)
  • Imaging (CT urography, ultrasonography)
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20
Q

Treatment of UTI

A

Medication therapy (cefalexin, amoxicillin + clauvulanic acid)
Adjuvant therapy (urine alkaliniser, cranberry juice)
Increased fluid intake
Good hygiene, postcoidal voiding
Probiotic yoghurt with lactobacillus to restore commensal flora

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21
Q

Follow up care for UTI

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A

Repeat urine examination for bacteriuria (required for pregnant women)
* If recurrent uncomplicated cystitis occurs 2x in 6 months or 3x in 12 months = US & specialist
* If recurrent in postmenopause = check for pelvic organ prolapse and vaginal atrophy (mimic symtoms)
* If in elderly = screen for DM

22
Q

Asymptomatic bacteriuria

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A

Bacteria present in urine (>105 CFU/mL) without No signs & symptoms
Usually in elderly
No treatment except pregnancy or urological patients

23
Q

Acute cycstitis, aetiology & risk factors

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A

Most common UTI
Inflammation of the bladder that occurs due to bacterial retrograde movement into the bladder, usually E.coli

Risks: women, sexually active, pregnancy, elderly, antibiotics that disrupt flora, DM, IDC, incomplete voiding, neurogenic bladder, obstruction

24
Q

Types of acute cystitis

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A

Uncomplicated: symptomatic infection in individual with structurally and functionally normal UT

Complicated: symptomatic in men OR abnormality (obstruction, CKD, DM, immunosuppression, catheter)

25
Pathophysiology of acute cystitis
Bacterial irritation of the bladder epithelium causing infection & inflammatory response (vasodilation, hypereamia, permeability = redness, swelling, oedema of mucosal lining of bladder, hematuria) Oedema stimulates stretch receptors, causing a feeling of fullness and urgency on small urine volumes
26
Manifestations of acute cystitis
* Dysuria (mucosal inflammation) * Urgency & frequncy, bladder fullness (oedema) * Flank pain (referred inflammatory pain) * Hematuria * Cloudy urine (leukocytes) * Odour (bacteria)
27
Diagnosis and Treatment
Urinalysis & urine culture Tx: antibiotics, repeat cultures, prevention (pass urine after sex, wipe away from vagina)
28
Acute pyelonephritis (summary) | Aetiology, PP, M, Types
Infection of the renal pelvis and interstitium with positive urine culture A: by stones, vesicoureteral reflux or pregancy (E. coli, proteus, pseudomonas) PP: WBC infilration, inflammation, renal oedema, purulent urine, involvement of blood stream M: * **Mild:** low grade fever, no N/V, pain (oral tx) * **Severe:** systemic symptoms (fever, N/V, severe pain, injury (IV tx, admission)
29
Chronic pyelonephritis
Recurrent kidney infections, usually occurs with other renal pathology PP: inflammation causes tubule destruction, atrophy, scarring and kidney disease, pain, HTN Dx: IVPyelography, US
30
Glomerular disorders, causes and most common type
Any condition affecting the glomerulus C: immune response, toxins, drugs, vascular disorders, systemic diseases, metabolic disorders Most common: glomerulonephritis
31
Glomerulonephritis & aetiology
Inflammation of the glomerulus A: caused most commonly by immunological abnormalities, also drugs, vascular/systemic diseases (DM, lupus), viral Most common cause of end stage kidney disease
32
Acute glomerulonephritis
Usually following streptococcus infection Deposition of antigen-antibody complexes on basement membrane, triggering C' and antibody mediated damage to epithelium of glomerulus
33
Acute glomerulonephritis manifestations
Hematuria, proteinuria, low GFR, oliguria, HTN, oedema Most recover without permanent damage
34
Chronic glomerulonephritis
Several glomerular diseases that progressively lead to end stage kidney disease due to sclerosis and interstitial injury Strong presence of hematuria and proteinuria
35
Nephrotic syndrome
Glomerular injury resulting in excretion of > 3.5g protein in urine/day
36
Oliguria & causes
Low urine output less than 30mls/hr Caused by HoTN, dehydration, blood volume loss, UTI, obstruction
37
Enuresis & types
Involuntary passage or urine (diurnal or nocturnal) **Primary:** continence never established **Secondary:** aquired due to a number of factors * UTI, neurological, structural abnormalities, DM/DI, CKD, sleep distubances/REM, stress
38
Diuretics & types
Treat HTN and fluid volume excess by modifying kidney function (inducing diuresis and NaCl excretion through reabsorption inhibition) Loop, thiazide, K-sparing
39
Loop diuretics
**Frusemide** (oral, IV) Potent inhibitor of Na and Cl at ascending limb of loop of Henle, & convoluted tubules * Better for **oedema** as this transporter absorbs more Na than others in the nephron **Adverse:** electrolyte imbalance (hyponatraemia, hypokalaemia, hypermagnasemia) - serum levels must be monitored
40
Thiazide diuretics
**Hydrochlorothiazide** (oral) Inhibit absorption of Na and Cl in the proximal segment of the distal convuluted tubule * Excrete water, Na, Cl, K, Mg but decrease excretion of uric acid and Ca * Less potent for oedema but first choice for **HTN**
41
K-sparing diuretics
**Amilodide, spironolactone** Act on distal tubules and collecting ducts with reduced diuretic capacity BUT spare K excretion therefore are used in combination with other diuretics
42
Oxybutynin | & side effects
Oral Urinary antispasmodic drug - enuresis & detrusor overactivity Inhibit muscarinic action of acetylcholine on bladder SM SE: palpitations, tachy, constipation, dizziness
43
Amoxicillin-Clavulanic acid (Augmentin Duo)
Oral penicilin antibiotic for UTI infections Has bactericidal effect on sensitive organisms during active multiplication SE: N, D, headache
44
Cephalexin
Oral cephalosporin antibiotic for genitourinary infections including acute prostatitis (streptococci, E. coli) Work by inhibiting bacterial wall synthesis SE: N
45
Chronic Kidney Disease & PP
Progressive loss of renal function due to systemic or renal disease, staged by level of GFR PP: renal injury leads to loss of nephrons = increased glomerular permeability and filtration * Proteinuria increases tubule injury, causing inflammation and scarring and increased angiotensin II
46
CKD Manifestations
Uraemia High plasma creatinine Oedema & HTN (electrolyte disturbances) Hypocalcaemia, hyperlipidaemia, immune suppression, headache, impaired cognition, bad breath, easy bruising
47
Neurogenic bladder
Bladder dysfunction caused by neurological disorder Can be overactive, flaccid, leakage
48
Acute Kidney Injury & types | Explain most common
Sudden decline in kidney function, indicated by low GFR, uremia and high plasma creatinine * Prerenal: most common, from impaired blood flow causing cell injury (hypovolaemia, haemorrhage, HoTN, cardiac failure) * Intrarenal * Postrenal
49
Types of functional and structural abnormalities | 5
**Hypospadias:** urethral meatus located on ventral side of penis **Polycycstic kidneys:** cyst formation causes cell proliferation, BM remodelling and oedema **Renal agenesis:** absence of one of both kidneys **Vesicoureteral reflex**: issue with junction **Enuresis: **involuntary urine passage beyond bladder control age
50
Upper vs Lower UTI
Upper UTI affects renal parenchyma, pelvis and ureters, and causes systemic symptoms (pain, fever, chills) Lower UTI has local but not systemic symptoms
51
Nursing Assessment of UTI
Health history * Previous UTI, UT abnormalities, pregnancy, cancer, STI * Antibiotics, antispasmodics, IDC/IMC, urinary hygiene * S: N/V, anorexia, chills, frequency, urge, nocturia, back pain, dysuria, burning Objective Data * Fever, hematuria, odour, pyuria, tender on palpation, +(bacteria, RBC, leukocytes, nitrites), US/CT/IVP Intervention * Increase fluid intake, local heat to lower back * Educate about medication course, SE, monitor own SS, persistant S or signs of recurrent infection * Monitor for tx efficacy and delirium in elder Health promotion * At risk individuals, regular voiding & empty bladder completely, wipe front to back, adequate fluids, cranberry juice, post coidal void, temp dicontinue use of diaphragm
52
Prevention of CAUTI
* Avoid unecessary catheterisation & early removal * Aseptic technique * Wash hands before and after * Routine perineal care * Avoid incontinent episodes

GMED5001 (13 decks)

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