Bladder Disorders & Urinary Incontinence Flashcards Preview

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Flashcards in Bladder Disorders & Urinary Incontinence Deck (79)
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1

Signs of Glomerular Bleeding

Red cell casts: glomerulonephritis
Dysmorphic RBCs
Proteinuria with hematuria with a large percentage being albumin

2

Etiologies for Non-glomerular Hematuria

UTI: acute cystitis, pyelonephritis
Kidney trauma
Stones: calyx, ureter
Contamination at menstruation or postpartum
Fistula
Endometriosis
BPH
Vigorous exercise
Post strep glomerular nephritis
IG nephropathy
Cancer: over 40

3

Risk Factors for Malignancy

Age: 35+
Smoking history
Occupational exposure to chemicals/dyes
Hx of gross hematuria
Hx of chronic cystitis or irritative voiding symptoms
Hx of pelvic irradiation
Exposure to cyclophosphamide
Hx of chronic indwelling FB
Hx of analgesic abuse

4

Hematuria Work-Up

Urine culture
Urine cytology
Imaging: CT IVP, US (pregnant women)
Cystoscopy

5

Negative Work-up of Hematuria in Young & Middle-age Patients

Mild glomerular disease
Predisposition to stone disease

6

Negative Work-up of Hematuria in Patients at High Risk for Malignancy

Need annual UA
May need another work-up in 1-3 years

7

Monitoring for Mild Glomerular Disease

BP: every 6 months
GFR/CrCl: yearly
Proteinuria: yearly

8

Reasons for Cystitis

UTI
Pyelonephritis
Non-infectious
STI-Male

9

Pathogenesis of Cystitis

Colonization of the vaginal introits from fecal flora
Ascension to the bladder via the urethra
Can ascend to the kidneys (pyelonephritis)

10

Most Common Pathogens in Microbiology

E. coli (75-90%)
Proteus
Klebsiella

11

Clinical Presentation of UTI

Dysuria
Frequency
Urgency
Suprapubic pain
Hematuria

12

Clinical Presentation of Pyelonephritis

Symptoms of cystitis may or may not be present
Chills
Flank pain with CVA tenderness
N/V
Appears ill

13

Diagnostic Tests for Cystitis

UA
Positive leukocyte esterase +/- nitrites
Consider urine culture with sensitivities

14

Diagnostic Tests for Pyelonephritis

UA
Urine culture & sensitivities

15

Treatment of Cystitis in Women

Nitrofurantoin
Bactrim
Fosfomycin
Phenozopyridine (Pyridium)

16

Differential for Men with Cystitis

Prostatitis
Urethritis secondary to STI
Urinary tract abnormality
Nephrolithiasis

17

Treatment of Cystitis in Men

Trimethoprim-sulfamethoxazole (Bactrim)
Fluoroquinolone

18

Outpatient Treatment for Pyelonephritis

Mild to moderate illness
Fluoroquinolone resistance low: Cipro or levoquin
Other: Bactrim or Augmentin

19

Inpatient Treatment for Pyelonephritis

Oral fluoroquinolone + aminoglycoside
Extended spectrum cephalosporin

20

Symptoms of Non-infectious Cystitis

Similar to cystitis with nocturne
Pressure in pelvis

21

Irritants of Non-infectious Cystitis

Bubble baths
Feminine hygiene sprays
Tampons
Spermicidal jellies
Chemoradiation
Foods: tomatoes, artificial sweeteners, caffeine & chocolate

22

Work-up of Non-infectoius Cystitis

UA
Urine culture
Sometimes cystoscopy

23

Treatment of Non-infectious Cystitis

Avoiding irritants
Voiding routine
Kegel's

24

Manifestations of Chlamydia in Males

Urethritis: symptomatic or asymptomatic
Epididymitis
Prostatitis

25

Diagnosing Chlamydia in Males

NAAT testing

26

Treatment of Chlamydia

Azithromycin
Rocephin

27

Presentation of Gonorrhea in Males

Symptomatic urethritis
Epididymitis: age

28

Diagnosing Gonorrhea in Males

NAAT testing

29

Treatment of Gonorrhea

Azithromycin
Rocephin

30

Presentation of Overactive Bladder Without Incontinence

Urgency
Frequency
Nocturia