2 - Infections Of The Urinary Tract Flashcards
Infections of the urinary tract (list)?
Acute cystitis
Acute pyelonephritis
Interstitial cystitis
Urethritis
Vesicoureteral reflux?
Consider in kid w UTI prior to toilet training (esp males)
Obtain VCUG and refer
Kids w fever?
Consider UTI
Urinary tract anatomy?
Slide 8,9
Intrinsic defense mechanisms for UTI prevention?
Efficient bladder emptying w voiding
-> low bacterial colony counts
Glycosaminoglycan layer
- prevents bacterial adherence
Urine is antimicrobial
- high osmolality
- extremes of pH
Gender specific UTI defenses?
Females
- normal vag flora (pH and estrogen levels prevent)
Males
- prostatic fluid has zinc (antibacterial agent)
UTI risk factors by gender?
Females
- short urethra
Males
- foreskin + anal -> mucosal surface of foreskin being colonized
Risk factors for UIT?
Urinary retention, stasis, reflux
Anotomic or functional abnormalities of urinary tract
- obstruction
- neurologic disease
- DM
- pregnancy
- FOB
Anatomic or functional abnormalities make a UTI?
Complicated UTI
MC Pathogenesis of UTI?
Ascending infection from urethra (MC route)
Pyelonephrits MC’lly comes from?
Ascent of infection up the ureter
Other modes of UTI infection?
Hematogenous spread
Lymphatic spread
Direct extension from other organs (intraperitoneal abscess)
Acute UTIs are caused by?
Single pathogen
Chronic UTIs are caused by?
2+ pathogens
Uncomplicated UTI is usually?
MC = E. Coli (the poops)
Can also be
- klebsiella
- proteus
- enterobacter
- enterococci
Nosocomial UTIs are usually?
Pseudomonas
Staphylococcus
Tx for asymptomatic bacteriuria?
No tx unless:
- pregnant
- invasive urologic procedure (catheter, imaging etc)
Acute cystitis is aka?
Bladder infection
MC cause of acute cystitits?
Coliform bacteria
- e. Coli
Presentation of cystitis?
Common - irritative voiding symptoms - suprapubic discomfort Gross hematuria Symptoms often follow sex
PE for cystitis?
Maybe suprapubic tenderness
- usually unremarkable though
Cystitis ddx?
Females
- vulvovaginitis
- PID
Males
- urethritis
- prostatitis
Noninfectious
- pelvic irradiation
- chemotherapy
- bladder ca
- interstitial cystitis
- voiding dysfunction d/o
- psychosomatic d/o
Workup for cystitis?
Labs
- UA
- urine culture
Imaging
- usually unnecessary (except males “were complicated”)
Complicated vs uncomplicated acute cystitis?
Uncomplicated
- healthy women
Complicated
- everyone else
Uncomplicated acute cystitis tx?
Short term abx
- septra (3 days)
- nitrofuratonin (5 days)
- fosfomycin (single dose)
- fluoroquinolines (3-5 days)
Analgesia
- phenazopyridine (pyridium)
Hot sitz baths
DOC for pregnant female cystitis?
Nitrofuratonin 100mg BID x 5 days
Male UTI needs?
A bunch of shit “its complicated”
But also get a good sexual history
Women who get more than 3 UIT/yr?
Prophylactic abx
- septra
- nitrofuratonin
- cephalexin
Single dose at bedtime/sex time
But send them to urology first to r/o weird anatomy
What is acute phyelonephritis?
Infection of renal parenchyma and renal pelvis
Acute pyelonephritis bacteria is usually?
Gram-neg
- e.coli, proteus, klebsiella, enterobacteria
And pseudomonas
Pyelonephritis is usually from?
Ascending lower UTI
Presentation of pyelonephritis?
Fever Shaking/chills Flank pain Irritative voiding ssx N/v Diarrhea
Pyelonephritis exam findings?
Fever
Tachycardia
CVA tenderness
Pyelonephritis ddx?
Acute cystitis Acute intra-abdominal disease Epididymitis Prostatitis PID
Labs for acute pyelonephritis?
UA - pyria - bacteriuria - hematuria - WBC CASTS CBC - Leukocytosis - L shift Blood/urine cultures - pathogen
Imaging for pyelonephritis?
Uncertain etiology
Complicated disease
Compications of acute pyelonephritis?
Sepsis w shock
Inadequate therapy - abscess
Diabetics
Why do DM pts have worse acute pyelonephritis?
Emphysematous pyelonephritis
- from gas-producing organisms
Pyelonephritis tx?
Outpatient (usually)
- PO abx (quinolones)
- pain control
Abx for pyelonephritis?
Fluoroquinolones usually
- levofloxacin (5 days)
- ciprofloxacin (7 days)
Alternate
- septra x 14 days
- augmentin x 14 days
Pyelonephritis w fever 48hrs after tx?
Order imaging
Mandatory urine cultures
Candidates for inpatient pyelonephritis tx
?
Severe/complicated infection Obstructive uropathy DM Renal failure Multi-resistant pathogen Pregnant Uncontrolled ssx
Inpatient pyelo tx?
IV
- amp and gent
- ceftriaxone
- levofloxacin
- pip-tazo
IV x 24hrs after fever then switch to PO x 2 weeks
Painful bladder syndrome?
Interstitial cystitis
Interstitial cystitis is?
Diagnosis of exclusion
- neg UA, culture, cytology
- no obvious cause
Who gets interstitial cystitis?
Women 40 y/o
Pathophysiology of interstitial cystitis?
Glycosaminoglycan (GAG) layer is disrupted
- urinary irritants enter and bother the nerve/muscle tissue
- progressive irritation and inflammation (further damage)
Primary complaint from interstitial cystitis?
Pain w bladder filling Relieved w urination Urgency Frequency Nocturia
Interstitial cystitis needs a good hx to include?
Exposure to pelvic radiation Tx w cyclophosphamide Genital herpes Vaginitis Urethral diverticulum
Labs for interstitial cystitis?
Infection and malignancy
- UA
- Culture
- Cytology
Urodynamic testing
- bladder sensitation and compliance
- excludes detrusor instability
Cystoscopy w biopsy
Ddx for interstitial cystitis?
Cystitis Vaginitis Herpes Urethral diverticulum Carcinoma
Tx for interstitial cystitis?
No cure - symptomatic only
- hydrodistention (20-30% improvment)
- meds (amitriptyline, nifedipine)
- intravesical dimethyl sulfoxide (DMSO)
- TENS
- acupuncture
- surgery (last resort)
Urethritis is?
Infection of urethra
- gonococcal
- non-gonococcal
STI
Urethritis presentation?
Drippy dick
Cant pee
Asymptomatic (40%)
Urethritis needs (eval)
NAAT
- urine nucleic acid amplificaiton test
Culture
Tx for urethritis
Chlamydia
- azithromycin
- doxy
Gonorrhea
- ceftriaxone
- add on presumptive chlamydia tx
What is forrest gump’s password?
1forrest1
