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1) Stress Incontinence
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
3) Urgency Incontinence
Urinary Incontinence Drugs
Bladder Overactivity/ Urge Incontinence
Muscarinic Receptor Antagonists
Alpha Adrenergic Agonist
Ascending Urethral Bacteria
Nausea and Vomiting
Urinary Tract Infection Symptoms
More common in Elderly
Most common in Females and Babies
Change in LOC
Dark Cloudy Urine
Frequency of Urination
UTI Tx in Pregnancy
Lower UTI (cystitis) and Upper UTI (pyelonephritis) clinical features
Lower UTI (cystitis)
Urinary Frequency and Urgency
Upper UTI (pyelonephritis)
Fever/Chills "Shake and Bake"
Nausea and Vomiting
Renal Calculi Assessment
Hypercalcemia (Most Commonly)
Signs and Symptoms
Radiates Toward Bladder
Urinary Tract Infection
Renal Calculi Interventions
Increase Fluid Intake
Surgical Stone Removal
Identify Type CT-KUB
Low Sodium Diet
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
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).
Involves renal calyces and pelvis
Must be in setting of:
1) Reflux nephropathy
Overlying blunted calyces (particularly at poles)
Thyroidization of kidney
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
Struvite Crystals, Staghorn Calculi, Coffin Lid
RF: Acidic Urine pH, Hot Climate
Rhomboid, Rosette, Radiolucent
Mgmt: Urine Alkalinization (bicarb, citrate)
Stimulates RBC Production
Chronic Renal Failure
Increased Risk of Thrombosis
Pelvic and Limb Pain
Do Not Shake
Monitor Hemoglobin (Hgb) Weekly
May Accelerate Tumor Progression
Rapid Shifts of Fluid and Electrolytes
NO BP IN ARM with Shunt or Fistula
Assess for Thrill and Bruit
Loss of Protein
Chronic Kidney Disease Interventions
Strict Medication Regimen
Chronic Kidney Disease Late Symptoms Assessment
End Stage Renal Disease (ESRD)
GFR < 15mL/min
Chronic Kidney Disease Early Symptoms Assessment
GFR < 60mL/min
Accumulation of Waste Products
Mineral and Bone Disorders
No Cell Wall and No Gram Stain
Urethritis mainly in men
Resistance to cell wall inhibiting antibiotics
Urine Leaks to Retropubic Space
Urinary Excretory Anatomy
Loop of Henle
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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