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Flashcards

D6: Hematuria

Mica Borgueta English 99 cards

High sodium in urine - can't reabsorb BUN:Cr - not that high Uosm - low (peeing out a lot of water so particles diluted) -…

Cards in this deck (99)

  1. 1Explain Micturition / EmptyingDetrusor muscle contracts
    Internal (smooth & male) and external (skeletal) urethral sphincter relaxes
  2. 2What are the receptors in the bladder?M3 receptors
    Beta 3 receptor
  3. 3What are the nerves in the bladder?Pelvic Nerve
    Hypogastric
    Pudendal
  4. 4What are the types of incontinence? What causes them?1. Urge - MS, Parkinson's, Stroke
    2. Stress
    3. Overflow - diabetes, large prostate
    4. Other - diabetes, parkinson's, MS
  5. 550 yo woman complains of losing moderate amounts of urine consistently. Pees during mild exercise and laughing or coughing.Stress incontinence
    stress from abdominal pressure
  6. 675 yo woman always has the urge to pee. Pees her bed sometimes.Urge incontinence
    - sudden detrusor muscle contraction
  7. 760 yo male urinates frequently or dribbles urine. Can't fully empty bladderOverflow incontinence
    - enlarged prostate, outflow obstruction, constipation
  8. 8How do you treat: 1. Urge incontinence 2. Stress Incontinence 3. Overflow intontinence1. Urge - relaxation techniques, anti-muscarinic meds
    2. Stress - strengthen external sphincter w/ Kegel exercises
    3. Overflow - reestablish clear pathway (catheter or alpha blockers)
  9. 9What is the GFR and fluid and electrolyte levels in obstructive uropathy and nephropathy?Kidney stones!
    GFR - decrease (from decreased renal blood flow)
    Fluid and electrolyte - Increase! Kidney can't filter out
  10. 10What do you have to worry about when you relieve patient of obstruction?Post-obstructive diuresis!
    Peeing a lot of electrolytes and volume out. Need IV if hypotensive and tachycardic
  11. 11How would you treat obstructive uropathy and nephropaty?Drugs:
    - ACE inhibitors
    - Angiotensin blockers
    Surgery:
    - Cystoscopy with uretoscopy; stent
    Stones less than 5-6 mm pass spontaneously
  12. 12What key labs is used for acute renal failure?BUN - blood urea nitrogen (freely filtered and reabsorbed with H2O)
    Creatinine - similar to inulin and freely filtered
  13. 13What causes pre-renal failure?- dehydration
    - shock
    - hypovolemia (heart failure)
  14. 14What causes intrinsic renal failure?Diabetes, Tubular Ischemia, Glomerulonephritis
  15. 15What causes post renal failure?kidney stones, tumors, congenital anomalies
  16. 16—High sodium in urine - can't reabsorb
    BUN:Cr - not that high
    Uosm - low (peeing out a lot of water so particles diluted) - osmolality (concentration of particles in urine)
    Results: RENAL FAILURE    High sodium in urine - can't reabsorb BUN:Cr - not that high Uosm - low (peeing out a lot of water so particles diluted) - osmolality (co...
  17. 17—BUN:Cr very high - pre-renal?
    (high pressure - forces BUN out)
    But... Na in urine is also high not being reabsorbed - renal
    Result: POST-RENAL failure    BUN:Cr very high - pre-renal? (high pressure - forces BUN out) But... Na in urine is also high not being reabsorbed - renal Result: POST-...
  18. 18—BUN:Cr very high! = lots of H2O being reabsorbed
    Urine Na+ = also low...Na+ retention
    Result: PRE-RENAL Failure    BUN:Cr very high! = lots of H2O being reabsorbed Urine Na+ = also low...Na+ retention Result: PRE-RENAL Failure
  19. 19What is acute cystitis?Lower urinary tract infection
  20. 20What is pyelononephritis?Upper urinary tract infection
    - could be from stones, urine going back up ureter
  21. 21What lab criterias are important in diagnosing UTIs?1. Pyuria (more than 5 WBCs in urine)
    2. Leukocyte Esterase
    3. nitrites (from gram negative bacteria)
  22. 2223 yo woman comes in. Frequent and painful urination. Has some blood in urine. No fever. Labs: 7 WBC, blood in urine, no white cell castsAcute cystitis
  23. 2340 yo woman has fever, chills, and flank pain. Frequent urination. Labs: WBC increased, has WBC castsPyelnonephritis
  24. 24What are the common bacterias for cystitis?The Gram negatives!
    E. coli
    Proteus mirabilis
    Klebsiella pneumoniae (rare)
    Staph saprophyticus (community)
    Pseudomonas (hospital setting and hot tubs)
    Enterobactericae    What are the common bacterias for cystitis?
  25. 25Common virulence factors for EnterobacteriaceaeEndotoxin (LPS and Lipid A)
    Capsule - protect from phagocytosis
    Type III secreiton - transfer bacterial virulence factor to host cell
    Resistance to serum killing
  26. 26Fimbrae (pili) K capsule Lactose fermentorE. coli
    fimbrae attaches to urinary tract
    K capsule - evade phagocytosis & complement    Fimbrae (pili) K capsule Lactose fermentor
  27. 2778 yo lady has catheter. Sudenly has fever, is tachycardic and hypotensive. What are you worried about?Gram negative sepsis!
    Driven by endotoxins (LPS; Lipid A)
  28. 28What are community acquired bacterias for UTIsE. coli (80%)
    Coagulase negative staphylococci
    Proteus Mirabilis
    Gram negss - Kelbsiella, enterobacter, psueodmonas
    Gram pos - Staph epidermis, staph aureus, enterococcus faecalis
  29. 29what are hospital acquired bacteriasE. Coli (40%)
    Pseudomonas, Klebsiella, Enterobacter (25%)
    Staphs, enterococcus
  30. 30Urease + Non-lactose fermentingProteus MirabilisUrease + Non-lactose fermenting
  31. 31Common Treatment for UTIs?3 days:
    1. Nitrofurantoin (not for upper UTI)
    2. Trimethoprim-Sulfamethoxazole (TMP/SMX)
    3. Fosfomycin (not for upper UTI)
  32. 32Alternative UTI treatment? Simple or Complicated?Quinolones!
    - floxacin    Alternative UTI treatment? Simple or Complicated?
  33. 33For complicated UTIs?Levofloxacin
    Flexoxacin
    Clindafloxacin
    Levo, Flexo, Clinda
  34. 34Types of glomerulonephritis?Nephrotic - Albumin! Protein!
    Nephritic - Bloooood (endothelial)
  35. 3516 yo has high blood pressure, hematuria, and renal failure Family history shows sudden death of aneurysmAutosomal Dominant Polycystic Kidney Disease
  36. 36What are the different types of kidney stones?1) Calcium Oxolate
    2) Calcium Phosphate
    3) Struvite Stones
    4) Uric Acid Stones
    5) Cystine Stone
  37. 37Patient has Crohn's Disease and has high sodium dietCalcium/Oxalate stones
  38. 38Why does Crohn's disease cause oxalate stones?You can't absorb fat and is free to roam around and bind to calcium
    Oxalate is left behind
  39. 39How does a high Na+ diet contribute to calcium stones?High sodium = hypertension. Want RAAS to go down
    Less Na Reabsorbed = Less Ca Reabsorbed
    More Ca in urine
  40. 40JV has a UTI - has urease positive bacteria (proteus, staphyloccocus, klebsiella)Struvite Stones
    - Ammonium magnesium-phosphate stones
    Staghorn Calculi - stones form cast of renal pelvis and collecting system (becomes bacterial reservoir)
    Treat: surgery and antibiotics    JV has a UTI - has urease positive bacteria (proteus, staphyloccocus, klebsiella)
  41. 41What's special about urease positive bacteria?Hydrolyze urea to ammonia
    Urine becomes alkaline
  42. 42How do you treat calcium/oxalate stones?Large stones - surgery
    Recurrent stones - take diuretics or CITRATE (binds to Ca2+ and keeps it dissolved)
  43. 43Patient has gout and leukemia and lives in Egypt. Radiography shows no signs of stones, but CT doesUric Acid Stones in collecting duct (acidic)
  44. 446 yo has large, staghorn stone. No UTICystine stone
    - cystinuria - can't absorb cystine in tubule
    Treat: make it basic (Potassium bicarb)
  45. 45What type of bladder cancers are there?1. Transitional Cell Carcinoma
    2. Squamous Cell Carcinoma
    3. Adenocarcinoma
  46. 4670 yo John (smoker) comes in with bloody urine. It's painless and there are no casts in urine.Transitional Cell Carcinoma
    *No casts = glomerular source bleeding)
  47. 4730 yo lady in Africa comes in with UTI (Schistosoma haematobium). Also has a history of kidney stones or cystitis.Squamous Cell Carcinoma
    - Chronic bladder inflammation!
  48. 48What can cause Adenocarcinoma in the bladder? (glandular proliferation in bladder)1. Urachael remnant (connects dome of bladder to umbilicus)
    2. Cystitis history
    3. Exstrophy - bladder protrudes through abdominal wall
  49. 49—
  50. 50—A. Bladder overactivity
    Note: Pons - don't have reflex and hypogastric is not working    A. Bladder overactivity Note: Pons - don't have reflex and hypogastric is not working
  51. 51—
  52. 52—C. alpha blocker
    - relaxes prostate capsule    C. alpha blocker - relaxes prostate capsule
  53. 53—
  54. 54—D. Decrease volume of prostate glandD. Decrease volume of prostate gland
  55. 55—
  56. 56—D. Foley
    Diabetic - can't sense bladder is full (neuro disorder)
    If prostate - then use alpha blocker    D. Foley Diabetic - can't sense bladder is full (neuro disorder) If prostate - then use alpha blocker
  57. 57—
  58. 58Meds that can cause interstitial nephritis?Antibiotics
    PPI -proton pump inhibitors - omeprazole
    NSAIDS
    Loop diuretics
  59. 59What is the classic triad for acute interstitial nephritis?1. Rash
    2. Fever
    3. Eosinophilia
  60. 60—A. elevated serum creatinine, elevated BUN, non-anion gap metabolic acidosis, hyperkalemia, pyuria (WBCs in urine)A. elevated serum creatinine, elevated BUN, non-anion gap metabolic acidosis, hyperkalemia, pyuria (WBCs in urine)
  61. 61—E. All of the aboveE. All of the above
  62. 62—A. hypovolemiaA. hypovolemia
  63. 63—
  64. 64—B. Heart FailureB. Heart Failure
  65. 65—A. proteus mirabilisA. proteus mirabilis
  66. 66—D. 80 yo womanD. 80 yo woman
  67. 67—C. Dysmorphic RBCs
    Nephritic Syndrome    C. Dysmorphic RBCs Nephritic Syndrome
  68. 68—E. minimal change disease
    - 6 yo just after respiratory infection    E. minimal change disease - 6 yo just after respiratory infection
  69. 69—A. Ciprofloxacin
    quinilone - floxacin    A. Ciprofloxacin quinilone - floxacin
  70. 70—A. nitrofurantoin orally for 3 days
    Note: Simple UTI
    D. too long    A. nitrofurantoin orally for 3 days Note: Simple UTI D. too long
  71. 71—
  72. 72—
  73. 73—Minimal change disease - nephrotic
    won't see RBCs or WBCs
    You will see Oval Fat Bodies    Minimal change disease - nephrotic won't see RBCs or WBCs You will see Oval Fat Bodies
  74. 74—D. E. ColiD. E. Coli
  75. 75—D. 100,000 CFU/mlD. 100,000 CFU/ml
  76. 76—C. ProteusC. Proteus
  77. 77—E. All of the aboveE. All of the above
  78. 78—A. RBC casts in the urineA. RBC casts in the urine
  79. 79—D. Prednisone - steroids
    nephrotic    D. Prednisone - steroids nephrotic
  80. 80—E. impaired intestinal oxalate binding
    Crohn's - can't absorb fat so circulating fat binds to Calcium and leaves oxalate behind    E. impaired intestinal oxalate binding Crohn's - can't absorb fat so circulating fat binds to Calcium and leaves oxalate behind
  81. 81—D. Thiazides
    Note: citrate binds to calcium and keeps it dissolved so we can excrete it    D. Thiazides Note: citrate binds to calcium and keeps it dissolved so we can excrete it
  82. 82—B. Proteus MirabilisB. Proteus Mirabilis
  83. 83—C. Radical Cystectomy
    plus chemo if needed    C. Radical Cystectomy plus chemo if needed
  84. 84Treat StoneTreat Stone
  85. 85—D. Cystoscopy
    Painless hematuria - think bladder tumor    D. Cystoscopy Painless hematuria - think bladder tumor
  86. 86—D. Radical cystectomy + chemo
    For muscle invasive disease    D. Radical cystectomy + chemo For muscle invasive disease
  87. 87—PSA - Prostatic Specific Antigen
    Tumor marker for prostate cancer    PSA - Prostatic Specific Antigen Tumor marker for prostate cancer
  88. 88How to treat for metastatic prostate cancer?1. Abiraterone
    2. Anti-androgen therapy
    - since prostate cancer is endocrine dependent tumor
    DHT - stimulates growth and keeps from dying
  89. 89—D. CalciumD. Calcium
  90. 90—A. Calcium OxalateA. Calcium Oxalate
  91. 91—B. increase fluid intakeB. increase fluid intake
  92. 92—F. All of the aboveF. All of the above
  93. 93—E. Confined in bladder urotheliumE. Confined in bladder urothelium
  94. 94Bladder cancer: T1? T2? T3? T4?T1 - within urothelium
    T2 - invades muscle
    T3 - invades fat
    T4 - spread to adjacent tissues
  95. 95—C. Subclinical upper tract infectionC. Subclinical upper tract infection
  96. 96—
  97. 97—
  98. 98—
  99. 99—

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Flashcards on D6: Hematuria , created by Mica Borgueta on 31/10/2017.
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