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Medicine Y3 TCD 13-24 > 14. UTIs and BPH > Flashcards

14. UTIs and BPH Flashcards

1
Q

Why are UTI more common in women

A

shorter length of the female urethra

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2
Q

why are UTI more common in post menopausal women

A

causes alteration in the normal vaginal bacterial flora that normally competes with the pathological bacteria

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3
Q

What actually is a UTI

A

infection in the bladder causing cystitis (inflammation of the bladder)
can spread up to the kidneys causing pyelonephritis

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4
Q

What is the main source of infection for UTI

A

usually from faeces where the normal intestinal bacteria such as E.coli

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5
Q

name some risk factors for UTI

A 
o	catheterisation 
o	menopause 
o	sexual intercourse 
o	pregnancy 
o	urinary tract malformation 
o	urinary stones
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6
Q

What are the common presentation with someone with lower urinary tract infection

A
  • Dysuria (pain, stinging or burning when passing urine)
  • Suprapubic pain or discomfort
  • Frequency
  • Urgency
  • Incontinence
  • Confusion is commonly the only symptom in older more frail patients
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7
Q

What are the symptoms of someone with pyelonephritis

A
  • Fever is a more prominent feature than lower urinary tract infections.
  • Loin, suprapubic or back pain. This may be bilateral or unilateral.
  • Looking and feeling generally unwell
  • Vomiting
  • Loss of appetite
  • Haematuria
  • Renal angle tenderness on examination
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8
Q

When you dip someone’s urine who has a UTI what could you find

A

nitrites (gram negative bacteria breakdown nitrates)

leukocytes

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9
Q

If nitrities or leukocytes are present then what should you do

A

send off an MSU sample to the lab for culture and sensitivity testing

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10
Q

what is the common cause of UTI

A

E coli

This is a gram-negative, anaerobic, rod-shaped bacteria that is part of the normal lower intestinal microbiome. It is found in faeces and can easily spread to the bladder.

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11
Q

Name some other causes of UTI except E.coli

A
  • Klebsiella pneumoniae (gram-negative anaerobic rod)
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Candida albicans (fungal)
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12
Q

Management of UTI:
how many days treatment for a simple lower urinary tract infection in women

3 days
5-10 dayys
7 days

A

3 days

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13
Q

Management of UTI:
how many days treatment for women that are immunosuppressed, have abnormal anatomy or impaired kidney function

3 days
5-10 dayys
7 days

A

5-10 days

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14
Q

Management of UTI:
how many days treatment for men, pregnant women or catheter related UTIs

3 days
5-10 dayys
7 days

A

7 days

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15
Q

What are the main initial antibiotic used to treat. UTI

A

nitrofurantoin
Trimethoprim

Alternatives are
Piyymecillinam
Amoxicillin
Cefalexin

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16
Q

UTI in pregnancy increase the risk of what

A

pyelonephritis
premature rupture of membrane
pre term labour

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17
Q

How many days of antibiotics should be given to women who are pregnant

A

7 days even with asymptomatic bacteriuria

18
Q

what is the first line antibiotic for UTI in pregnant women

A

nitrofurantoin

19
Q

what is the second line antibiotic for UTI in pregnant women

A

Cefalexin or amoxicillin

20
Q

Which antibiotic is avoided in the third trimester as it is linked with haemolytic anaemia in the newborn

A

nitrofurantoin

21
Q

which antibiotic is generally considered safe in pregnancy but avoided in the first trimester or if they are on another medication that. affect folic acid

A

trimethoprim

22
Q

What are the guidelines for treatment of pyelonephritis

A

first line antibiotic for 7-10 days

Cefalexin
Co-amoxiclav
Trimethoprim
Ciprofloxacin

23
Q

Patients with pyelonephritis and pyrexia usually require what kind of treatment in hospital

A

24-48 hours of IV gentamicin or temocillin followed by 10 day course of oral antibiotics

24
Q

What is BPH

A

benign prostatic hyperplasia

very common in men of increasing age
caused by hyperplasia of the stromal and epithelial cells of the prostate

25
Q

how do patients with BPH usually present

A
  • Hesitancy
  • Urgency
  • Frequency
  • Intermittency
  • Straining to void
  • Terminal dribbling
  • Incomplete emptying
26
Q

How do you assess for BPH

A

urine dipstick to exclude infection of major differential
PSA done prior to rectal examination can help with assessing potential for prostate cancer
Rectal exam to asses prostate size and characteristics

27
Q

What is the management of BPH

A

reassurance and monitoring if manageable symptoms
Medications
- alpha blockers such as tamsulosin 400 mcg
- 5-alpha reductase inhibitors which block testosterone and actually help reduce the size of the prostate Finasteride

28
Q

name the 2 drugs used to treat BPH

A

tamulosin (alpha blocker)

Finasteride (5-alpha reductase inhibitor)

29
Q

Name the surgical options for someone with BPH

A

transurethral resection of the prostate (TURP)
transurethral electrovapurisation of the prostate (TUVP)
holmium lase enucleation of the prostate (HoLEP)
open prostatectomy via abdominal or perineal incision

30
Q

what does a transurethral resection of the prostate (TURP) involve

A

Accessing the prostate through the urethra and ‘shaving’ off prostate tissue from inside using diathermy
Aims to create a wider space for urine to flow through, thereby improving symptoms

31
Q

what are the major complications with TURP

mnemonic is FIRES

A 
f- failure to resolve symptoms 
I- incontinence 
R- retrograde ejectulation 
E- erectile dysfunction 
Strictures
32
Q

when assessing for BPH what scoring system to used to assess for symptoms

A 
international prostate symptom score (I-PSS) 
Score out of 35 
1-7 mild 
8-19 moderate 
above 20 is severe
33
Q

What percentage chance is there of not detecting prostate abnormalities by rectal exam

A

1 in 5

34
Q

To investigate for BPH the patient would have a trans-rectal ultrasound (TRUS) guided biopsy. What medication is the patient required to have and why

A

antibiotic beforehand to prevent infection

note there is still 2% to getting an infection

35
Q

what is a transrectal ultrasound

A

lie on your side fully awake
urologist passes a narrow ultrasound probe into back passage
take 12 biopsies through a long narrow needle that passes through the probe itself

36
Q

how is the prostate cancer graded

A

based on the biopsies
graded from 3-5 based on how quickly they are likely to grow or how aggressive the cells look
Gleason Grade
work out the 2 most common ones and that gives a score ranging from 6 (3+3) to 10 (5+5)

37
Q

If you have prostate cancer then you stay under active surveillance with PSA tests for what period of time

A

every 3 months for the first year

38
Q

Before commencing someone on Gentamicin what blood test do you need to do

A

eGFR as the dose is based on the renal function

39
Q

What is the risk of having a robot assisted radical prostatectomy

A

10-20% risk of some degree of incontinence

50% risk of some kind of erectile dysfunction

40
Q

Patients with an overactive bladder usually benefit from what kind of treatment

A

an anticholinergic

41
Q

patients with a history of bladder outflow obstruction, what is the best management for patients with moderate symptoms

A

an alpha adrenoceptor blocker- tamsulosin

Medicine Y3 TCD 13-24 (32 decks)

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