Genitourinary > MDT's Part 1 > Flashcards

MDT's Part 1 Flashcards

(59 cards)

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1
Q

What is hematuria?

A

Presence of blood in urine

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2
Q

Gross vs microscopic hematuria?

A
  • Gross: visible to naked eye
  • Microscopic: only detectable my microscopy
  • Both require further evaluation
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3
Q

Gross hematuria from the lower tract (bladder/urethra) is most commonly found from what?

A

Urothelial carcinoma of the bladder

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4
Q

What is microscopic hematuria most commonly from?

A

Benign prostatic hyperplasia

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5
Q

In gross hematuria, what is the presence of blood at the beginning of the urinary stream called and what area of the urinary tract is the source?

A
  • Initial hematuria

- Anterior (penile) urethral source

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6
Q

In gross hematuria, what is the presence of blood at the end of the urinary stream called and what area of the urinary tract is the source?

A
  • Terminal hematuria

- Bladder neck or prostatic urethral source

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7
Q

In gross hematuria, what is the presence of blood throughout the urinary stream called and what area of the urinary tract is the source?

A
  • Total hematuria

- Bladder or upper tract source

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8
Q

When would hematuria indicate Ureteral stone?

A

Hematuria associated with renal colic

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9
Q

Irritating voiding symptoms in a young woman with hematuria may suggest?

A

Acute bacterial infection and associated cystitis

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10
Q

In UA for hematuria, what does proteinuria and casts suggest?

A

Renal origin

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11
Q

Imaging/Referral for hematuria?

A
  • CT scan without contrast of Upper tract
  • Cystoscopy
  • Urology (anatomic abnormality, urolithiasis, recurrent cystitis)
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12
Q

General considerations for Urinary Tract Infection?

A
  • Coliform bacteria most common (E. coli)
  • Ascending infection most common route
  • Hematogenous spread to urinary tract is uncommon
  • Lymphatic spread is rare
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13
Q

What is acute cystitis?

A
  • Infection of the bladder
  • Most commonly due to coliform bacteria (E. coli)
  • Uncomplicated cystitis in men is rare and implies pathologic process
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14
Q

S/S of acute cystitis?

A
  • Irritating voiding symptoms
  • Suprapubic discomfort (tenderness with palpation)
  • Women experience hematuria and Sx’s appear post sex
  • Usually afebrile
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15
Q

Imagining for acute cystitis?

A
  • Abdominal ultrasonography or cystoscopy

- CT scan is warranted if pyelonephritis are suspected

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16
Q

Treatment of acute cystitis?

A
  • Women:
  • Cipro
  • Nitrofurantoin (Macrobid)
  • Bactrim
  • Men:
  • Depends on underlying etiology
  • Urinary analgesics
  • Pyridium (Phenazopyridine)
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17
Q

Prevention of cystitis in women who have 3 or more episodes in one year?

A
  • Thorough urologic evaluation
  • Prophylactic antibiotic therapy
  • Bactrim
  • Nitrofurantoin
  • Cephalexin
  • Single dose at bedtime or after intercourse
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18
Q

What is pyelonephritis?

A
  • Infectious inflammatory disease involving kidney parenchyma and renal pelvis
  • Gram-negative bacteria most common causative agent
  • E. coli
  • Proteus
  • Pseudomonas
  • Infection usually spreads from lower urinary tract (except S. aureus)
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19
Q

S/s of Pyelonephritis?

A
  • Fever
  • Flank pain
  • Irritative voiding Sx’s
  • Shaking chills
  • Nausea/vomiting
  • Diarrhea
  • Tachycardia
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20
Q

Differential Dx for pyelonephritis?

A
  • Acute cystitis
  • Acute Intra-abdominal disease
  • Males:
  • Epididymitis
  • Acute prostatitis
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21
Q

Imaging for pyelonephritis?

A

Renal ultrasound

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22
Q

Inpatient treatment for pyelonephritis?

A
  • Ampicillin IV and gentamicin continued for 24 hours after fever resolved
  • Then oral antibiotics to 14 day course of antibiotics
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23
Q

Outpatient treatment for pyelonephritis?

A
  • Ciprofloxacin
  • Levofloxacin
  • Phenazopyridine
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24
Q

Complications of pyelonephritis?

Study These Flashcards
A
  • Sepsis and shock
  • Abscess formation from inadequate therapy
  • Catheter drainage might be necessary
25
MEDEVAC to Urology or infectious disease for pyelonephritis when?
- Evidence of complicating factors - Severe infections - Evidence of sepsis - Need for parental antibiotics - Absence of clinical improvement in 48 with oral antibiotics
26
What is acute prostatitis?
Inflammation and infection of prostate gland usually caused by gram-negative rods (E. coli and Pseudomonas)
27
Most likely routes of infection for prostatitis?
- Ascent up the urethra | - Reflux of infected urine
28
S/s of prostatitis?
- Perineal, suprapubic, or sacral pain - Fever, high - Irritative voiding symptoms - Obstructive symptoms that may lead to urinary retention - Warm and tender prostate
29
Lab findings prostatitis?
- Leukocytosis and a left shift on UA - Pyuria, Bacteriuria, and hematuria on UA - Urine cultures demonstrate offending pathogen
30
Rad for prostatitis?
No
31
Inpatient treatment of prostatitis?
Ampicillin and gentamicin until 24-48 hours resolution of fever - oral antibiotics for 4-6 weeks
32
Outpatient treatment of prostatitis?
- Cipro - Levofloxacin - Bactrim - Acetaminophen/NSAIDS - Stool softeners
33
What to do if urinary retention develops with prostatitis?
- Percutaneous Suprapubic tube is required | - Urethral catheterization is CONTRAINDICATED
34
MEDEVAC for prostatitis?
- Evidence of urinary retention - Signs of sepsis - Surgical drainage of bladder prostatic abscess - Evidence of chronic prostatitis - Absence of clinical improvement in 48 with oral antibiotics
35
Chronic bacterial prostatitis?
- May evolve from acute prostatitis - Many men have no Hx of acute infection - Gram negative rods are most common - Enterococcus only gram positive organism - Not to be managed by IDC alone
36
S/Sx's of chronic bacterial prostatitis?
- Irritating voiding symptoms - Low back and perineal pain - Suprapubic discomfort - Hx UTI - PE unremarkable - Prostate may be: * Normal * Boggy * Indurate
37
Tx of chronic bacterial prostatitis?
- Bactrim - Cipro - Levofloxacin * Duration lasts 6-12 weeks - NSAIDS - Sitz baths
38
What is Epididymitis?
- Inflammation and/or infection of epididymitis - Can be divided into two categories: * Sexually transmitted forms * Non-sexually transmitted forms - Route of infection is probably urethra to ejaculatory duct
39
Information on sexually transmitted epididymitis?
- Typically occurs in men under 40 year - Associated with urethritis - Results from chlamydia or gonorrhea
40
Information of non-sexually transmitted epididymitis?
- Typically occur in older men - Associated with UTI and prostatitis - Caused by gram negative rods ( E. Coli, Klebsiella)
41
S/Sx's of epididymitis?
- May follow acute physical strain, trauma, or sexual activity - Associated Sx's of urethritis and cystitis - Pain develops in scrotum and may radiate along spermatic cord or to flank - Fever - Scrotal swelling * * epididymis might be distinguishable from testes early on**
42
Later S/Sx's of epididymitits?
- Epididymis and testes can appear as one mass - Prostate may be tender on rectal exam - Prehn sign
43
What is Prehn sign?
Elevation of scrotum above pubic symphysis may relieve pain from epididymitis
44
Imaging for epididymitis?
Scrotal U/S
45
Tx for sexually transmitted epididymitis?
- Ceftriaxone IM PLUS - Doxycycline
46
Tx for non-sexually transmitted epididymitis?
- Trimethoprim/sulfamethoxaz (Bactrim) - Ciprofloxacin - Levofloxacin
47
Symptomatic relief for Epididymitis?
- Bed rest - Scrotal support - Ice packs - NSAIDS
48
Complications of epididymitis?
- Delayed or inadequate Tx may result in: * Epididymo-orchitis * Decreased fertility * Abscess formation
49
Follow up for epididymitis?
Refer to Urology if: - Persistent symptoms or infection despite antibiotic therapy - Signs of sepsis or abccess formation
50
General considerations for renal calculi/urolithiasis/kidney stones?
- Men are more frequently affected than woman (2.5:1 ratio) - Initial presentation predominantly between 3rd and 5th decade - There are five types urinary stones (calcium most common)
51
What are some contributing factors to renal calculi/urolithiasis?
- High humidity - Elevated temperatures - Sedentary lifestyle - HTN - Carotid calcification - Cardiovascular disease - High protein and salt diet with inadequate hydration
52
What are some sign/symptoms of renal calculi/urolithiasis?
- Sudden pain (may be episodic) - Pain localized to the flank - Pt constantly moving to find comfort - Pain may radiate anteriorly over abdomen - Stone size does not correlate to severity of symptoms
53
How do obstructing urinary stones present?
Acute, unremitting and severe colic
54
Urinalysis finding for urolithiasis/urinary stones?
- Microscopic or gross hematuria (absence does not exclude) | - Urinary pH is a valuable clue
55
Imaging for renal caculi/urinary stone?
- Plain abdominal radiograph - Renal U/S - Spiral CT with Pt in prone position
56
Tx for urinary stone?
- Forced IV fluids or diuresis in counterproductive - Medical expulsive therapy (Alpha blockers, NSAIDS, corticorsteroids) - Surgical Tx
57
Prevention of renal calculi?
- Dietary modification: * Increased fluid intake * Restrict sodium intake * Spread animal protein throughout day
58
Complications of urolithiasis?
Obstructing stone with an associated infection is a medical emergency ** MEDEVAC **
59
Referral to urology for urolithiasis is warranted when?
- Obstructing stone with associated infection - Stone fails to pass after 4 weeks - Fever - Intolerable pain - Persistent Nausea/vomiting
Genitourinary
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