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Questions and Answers
What is the characteristic of Nitrofurantoin in treating uncomplicated UTIs?
What is the effect of obstruction of the ureter on the renal pelvicalyceal system?
What is the most common type of urinary calculi?
What is the underlying cause of pelvicalyceal calculi?
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What is the characteristic of Staghorn calculi?
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What is the treatment for larger bladder stones?
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What is the function of the bladder in the lower urinary tract?
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What type of bacteria often causes urinary tract infections?
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What is a symptom of acute bacterial urethritis and cystitis?
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What is the purpose of culturing a urine sample in the diagnosis of urinary tract infections?
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What is a predisposing factor for urinary tract infections?
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What is a potential complication of untreated urinary tract infections?
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Study Notes
Upper Urinary Tract: Elimination
- Functions to eliminate urine from the kidney to the exterior
- Extends from calyces to urethra
Lower Urinary Tract: Excretion
- Extends from calyces to urethra
- Transits urine from kidney to exterior
- Bladder acts as a reservoir
- Lined by urothelium (transitional cell epithelium)
- Resists osmotic stresses of contact with urine
Disorders of the Lower Urinary Tract
- Infection
- Often secondary to stasis
- Usually due to gram-negative bacteria (E. coli) or gram-positive bacteria (Staphylococcus)
- Commensals in the large bowel
- Women are particularly prone
- Diabetes mellitus also predisposes to infection
- Symptoms:
- Pain when urinating or burning sensation
- Urinating small amounts frequently
- Cloudy or foul-smelling urine
- Blood in urine
- Diagnosis:
- Urine sample
- Dipstick
- Microscopic analysis
- Culture (not routine, but useful to test antibiotic resistance)
- Treatment:
- Some can clear without treatment
- Cranberry juice/sodium citrate sachets can relieve symptoms
- Antibiotic treatment is usually fast and effective
- Antimicrobial resistance varies in different areas of the country
- Trimethoprim/Sulfamethoxazole for three days is good mini-dose therapy, but resistance rates are high in many areas
- Nitrofurantoin is a good choice for uncomplicated UTIs, but it is bacteriostatic, not bactericidal, and must be used for 5-7 days
- Obstruction
- Intrinsic (e.g., stone formation)
- Extrinsic (e.g., tumor, pregnancy)
- Obstruction of ureter:
- Dilation of the ureter
- Dilation of the renal pelvicalyceal system
- Reabsorption of fluid by kidneys
- Obstruction of urethra:
- Bladder dilation
- Hypertrophy of bladder wall
- Predisposition to outpouching
Urinary Calculi
- Most commonly form in pelvicalyceal system and bladder
- Calculus is a "pebble" in Latin
- Solid aggregates of dietary minerals
- Calcium oxalate or phosphate are most common types of calculi
- Calculi are classified by their location
- Predisposing factors:
- Increased solute concentration in the urine
- Reduced solubility of solute in the urine
- Underlying causes:
- Low fluid intake
- Urine stasis
- Persistent urinary tract infections
- Primary metabolic disturbances
Types of Calculi
- Pelvicalyceal calculi:
- Appearance depends on where calculi are formed
- Calculi are often multiple and small (gravel-like)
- Calculi in pelvicalyceal system predisposes to:
- Infection
- Squamous cell metaplasia
- Carcinoma in metaplastic areas
- Staghorn calculi:
- Most common, made up of struvite and calcium carbonate apatite
- Caused by organisms that produce enzyme urease, which promotes the generation of ammonia and hydroxide from urea
- Ureter calculi:
- Mostly develop in renal pelvis
- Pass down urinary tract
- Associated with loin pain
- Treatment:
- Small stones can pass naturally
- Larger stones require surgical removal: shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy
- Bladder stones:
- Spherical and laminated
- Often large
- Stasis and chronic infection
- Can cause squamous metaplasia in urinary bladder
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Description
This quiz covers the functions of the upper and lower urinary tract, including elimination and excretion processes, as well as disorders and infections that can occur in the lower urinary tract.
