Alyssa Shared "Urinary System" - 22 Picmonics

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Urinary System

Incontinence
1) Stress Incontinence
Kegel Exercises
Pessary
Urethral Sling Surgery
Diagnose with Q-tip test
2) Overflow Incontinence
A) Due to detrussor underactivity:
Loss of urine with no warning
Large or small volume loss
B) Due to Obstruction
Due to pelvic organ prolapse, fibroids
Weak stream, difficulty initiating
Sensation of incomplete emptying
Identify underlying cause
Bethanechol
Occasional self-cath
3) Urgency Incontinence
Oxybutinin
Bladder training
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Urinary Incontinence Drugs
Bladder Overactivity/ Urge Incontinence
Muscarinic Receptor Antagonists
Oxybutynin
Tolterodine
Fesoterodine
Trospium
Solifenacin
Darifenacin
Mirabegron
Onabotulinumtoxin A
Urethral Underactivity
Estrogens
Alpha Adrenergic Agonist
Duloxetine
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Pyelonephritis Assessment
Cause/Mechanism
Ascending Urethral Bacteria
Assessment
Dysuria
Fever
Fatigue
Flank Pain
Costovertebral Tenderness
Nausea and Vomiting
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1 min
Urinary Tract Infection Symptoms
More common in Elderly
Most common in Females and Babies
Change in LOC
Dehydration
Fever
Urgency
Urethra Infection
Burning
Smelly Urine
Dark Cloudy Urine
Frequency of Urination
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54 secs
UTI Tx in Pregnancy
Nitrofurantoin
Amoxicillin
Cephalexin
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Lower UTI (cystitis) and Upper UTI (pyelonephritis) clinical features
Lower UTI (cystitis)
Urinary Frequency and Urgency
Hematuria
Bladder fullness
Dysuria
Upper UTI (pyelonephritis)
Fever/Chills "Shake and Bake"
Nausea and Vomiting
Abdominal Pain
Dehydration
WBCs
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Renal Calculi Assessment
Cause/Mechanism
Hypercalcemia (Most Commonly)
Signs and Symptoms
Flank Pain
Radiates Toward Bladder
Renal Colic
Urinary Tract Infection
Urinary Retention
Hematuria
Considerations
Stone Recurrence
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2 mins
Renal Calculi Interventions
Interventions
Increase Fluid Intake
Opioids
NSAIDs
Antibiotics
Lithotripsy
Surgical Stone Removal
Considerations
Identify Type CT-KUB
Low Sodium Diet
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2 mins
Urinary tract infections
Cystitis presents with dysuria, frequency, urgency, suprapubic pain, and WBCs (but not WBC casts) in urine. Primarily caused by ascension of microbes from urethra to bladder. Males— infants with congenital defects, vesicoureteral reflux. Elderly—enlarged
prostate
Ascension to kidney results in pyelonephritis, which presents with fever, chills, flank pain, costovertebral angle tenderness, hematuria, and WBC casts.
Escherichia coli Leading cause of UTI. Colonies show green metallic sheen on EMB agar.
Staphylococcus saprophyticus 2nd leading cause of UTI in sexually active women.
Klebsiella pneumoniae 3rd leading cause of UTI. Large mucoid capsule and viscous colonies.
Serratia marcescens Some strains produce a red pigment; often nosocomial and drug resistant.
Enterococcus Often nosocomial and drug resistant.
Proteus and pseudomonas.Diagnostic markers: ⊕ Leukocyte esterase = evidence of WBC activity. ⊕ Nitrite test = reduction of urinary nitrates by bacterial species (eg, E coli). ⊕ Urease test = urease-producing bugs (eg, Proteus, Klebsiella).
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Chronic Pyelonephritis
Involves renal calyces and pelvis
Must be in setting of:
1) Reflux nephropathy
2) Obstruction
Gross
Corticomedullary scars
Overlying blunted calyces (particularly at poles)
Micro
Thyroidization of kidney
Secondary FSGS
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Nephrolithiasis Urolithiasis Renal Calculi
Calcium Oxalate (CaO): MC
HypoCa → inc oxalate absorption
workup: low urine pH (acidic)
RF: Crohn, ethylene glycol, vitamin C
Mgmt: Urine Alkalinization (citrate), Thiazides
Calcium Phosphate (CaP)
Basic Urine pH
Ammonium Magnesium Phosphate
Urease(+) organisms
Struvite Crystals, Staghorn Calculi, Coffin Lid
Uric Acid
RF: Acidic Urine pH, Hot Climate
Rhomboid, Rosette, Radiolucent
Mgmt: Urine Alkalinization (bicarb, citrate)
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Erythropoietin
Mechanism
Stimulates RBC Production
Indications
Chronic Renal Failure
Anemia
Side Effects
Increased Risk of Thrombosis
Pelvic and Limb Pain
Hypertension
Considerations
Do Not Shake
Monitor Hemoglobin (Hgb) Weekly
May Accelerate Tumor Progression
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2 mins
Dialysis
Hemodialysis
Rapid Shifts of Fluid and Electrolytes
Disequilibrium Syndrome
Hypotension
NO BP IN ARM with Shunt or Fistula
Assess for Thrill and Bruit
Peritoneal Dialysis
Slow Process
Peritonitis
Loss of Protein
Hyperglycemia
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3 mins
Chronic Kidney Disease Interventions
Daily Weights
Strict I/O
Renal Diet
Strict Medication Regimen
Erythropoietin
Manage Hyperkalemia
Manage CKD-MBD
Dialysis
Kidney Transplant
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2 mins
Chronic Kidney Disease Late Symptoms Assessment
Metabolic Acidosis
Severe Uremia
Arrhythmias
Edema
CNS Depression
Anemia
Oliguria
Pruritus
Considerations
End Stage Renal Disease (ESRD)
GFR < 15mL/min
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2 mins
Chronic Kidney Disease Early Symptoms Assessment
GFR < 60mL/min
Accumulation of Waste Products
General Malaise
Hypertension
Proteinuria
Hyperkalemia
Mineral and Bone Disorders
Neuropathy
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2 mins
Ureaplasma Urealyticum
No Cell Wall and No Gram Stain
A8 agar
Urethritis
Urethritis mainly in men
Urease Positive
Resistance to cell wall inhibiting antibiotics
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Urethral Injury
Urethral Meatus
blood
Posterior urethra
Urine Leaks to Retropubic Space
anterior urethra
Perineal Pain
Contraceptive Sponge
Boggy Prostate
scrotal hematoma
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Urinary Excretory Anatomy
Characteristics
Renal Medulla
Renal Cortex
Nephron
Bowman's Capsule
Glomerulus
Proximal Tubule
Loop of Henle
Distal Tubule
Collecting Duct
Ureter
Urinary Bladder
Urethra
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2 mins
Proximal Tubule
Characteristics
Na+ Reabsorbed Via Active Transport
Water Follows Na+
Most Of Glucose Reabsorbed
Most Of Amino Acids Reabsorbed
Bicarbonate Exchanged For H+
Drugs and Toxins Excreted
Filtrate Osmolarity Same As Plasma
Leads To Loop Of Henle
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2 mins

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