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Senior - Urology > 2 - Infections Of The Urinary Tract > Flashcards

2 - Infections Of The Urinary Tract Flashcards

1
Q

Infections of the urinary tract (list)?

A

Acute cystitis
Acute pyelonephritis
Interstitial cystitis
Urethritis

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2
Q

Vesicoureteral reflux?

A

Consider in kid w UTI prior to toilet training (esp males)

Obtain VCUG and refer

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3
Q

Kids w fever?

A

Consider UTI

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4
Q

Urinary tract anatomy?

A

Slide 8,9

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5
Q

Intrinsic defense mechanisms for UTI prevention?

A

Efficient bladder emptying w voiding
-> low bacterial colony counts

Glycosaminoglycan layer
- prevents bacterial adherence

Urine is antimicrobial

  • high osmolality
  • extremes of pH
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6
Q

Gender specific UTI defenses?

A

Females
- normal vag flora (pH and estrogen levels prevent)

Males
- prostatic fluid has zinc (antibacterial agent)

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7
Q

UTI risk factors by gender?

A

Females
- short urethra

Males
- foreskin + anal -> mucosal surface of foreskin being colonized

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8
Q

Risk factors for UIT?

A

Urinary retention, stasis, reflux

Anotomic or functional abnormalities of urinary tract

  • obstruction
  • neurologic disease
  • DM
  • pregnancy
  • FOB
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9
Q

Anatomic or functional abnormalities make a UTI?

A

Complicated UTI

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10
Q

MC Pathogenesis of UTI?

A

Ascending infection from urethra (MC route)

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11
Q

Pyelonephrits MC’lly comes from?

A

Ascent of infection up the ureter

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12
Q

Other modes of UTI infection?

A

Hematogenous spread
Lymphatic spread
Direct extension from other organs (intraperitoneal abscess)

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13
Q

Acute UTIs are caused by?

A

Single pathogen

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14
Q

Chronic UTIs are caused by?

A

2+ pathogens

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15
Q

Uncomplicated UTI is usually?

A

MC = E. Coli (the poops)

Can also be

  • klebsiella
  • proteus
  • enterobacter
  • enterococci
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16
Q

Nosocomial UTIs are usually?

A

Pseudomonas

Staphylococcus

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17
Q

Tx for asymptomatic bacteriuria?

A

No tx unless:

  • pregnant
  • invasive urologic procedure (catheter, imaging etc)
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18
Q

Acute cystitis is aka?

A

Bladder infection

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19
Q

MC cause of acute cystitits?

A

Coliform bacteria

- e. Coli

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20
Q

Presentation of cystitis?

A 
Common
- irritative voiding symptoms 
- suprapubic discomfort
Gross hematuria
Symptoms often follow sex
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21
Q

PE for cystitis?

A

Maybe suprapubic tenderness

- usually unremarkable though

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22
Q

Cystitis ddx?

A

Females

  • vulvovaginitis
  • PID

Males

  • urethritis
  • prostatitis

Noninfectious

  • pelvic irradiation
  • chemotherapy
  • bladder ca
  • interstitial cystitis
  • voiding dysfunction d/o
  • psychosomatic d/o
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23
Q

Workup for cystitis?

A

Labs

  • UA
  • urine culture

Imaging
- usually unnecessary (except males “were complicated”)

24
Q

Complicated vs uncomplicated acute cystitis?

A

Uncomplicated
- healthy women

Complicated
- everyone else

25
Q

Uncomplicated acute cystitis tx?

A

Short term abx

  • septra (3 days)
  • nitrofuratonin (5 days)
  • fosfomycin (single dose)
  • fluoroquinolines (3-5 days)

Analgesia
- phenazopyridine (pyridium)

Hot sitz baths

26
Q

DOC for pregnant female cystitis?

A

Nitrofuratonin 100mg BID x 5 days

27
Q

Male UTI needs?

A

A bunch of shit “its complicated”

But also get a good sexual history

28
Q

Women who get more than 3 UIT/yr?

A

Prophylactic abx

  • septra
  • nitrofuratonin
  • cephalexin

Single dose at bedtime/sex time

But send them to urology first to r/o weird anatomy

29
Q

What is acute phyelonephritis?

A

Infection of renal parenchyma and renal pelvis

30
Q

Acute pyelonephritis bacteria is usually?

A

Gram-neg
- e.coli, proteus, klebsiella, enterobacteria

And pseudomonas

31
Q

Pyelonephritis is usually from?

A

Ascending lower UTI

32
Q

Presentation of pyelonephritis?

A 
Fever
Shaking/chills
Flank pain
Irritative voiding ssx
N/v
Diarrhea
33
Q

Pyelonephritis exam findings?

A

Fever
Tachycardia
CVA tenderness

34
Q

Pyelonephritis ddx?

A 
Acute cystitis
Acute intra-abdominal disease
Epididymitis
Prostatitis
PID
35
Q

Labs for acute pyelonephritis?

A 
UA
- pyria
- bacteriuria
- hematuria
- WBC CASTS
CBC
- Leukocytosis 
- L shift
Blood/urine cultures
- pathogen
36
Q

Imaging for pyelonephritis?

A

Uncertain etiology

Complicated disease

37
Q

Compications of acute pyelonephritis?

A

Sepsis w shock
Inadequate therapy - abscess
Diabetics

38
Q

Why do DM pts have worse acute pyelonephritis?

A

Emphysematous pyelonephritis

- from gas-producing organisms

39
Q

Pyelonephritis tx?

A

Outpatient (usually)

  • PO abx (quinolones)
  • pain control
40
Q

Abx for pyelonephritis?

A

Fluoroquinolones usually

  • levofloxacin (5 days)
  • ciprofloxacin (7 days)

Alternate

  • septra x 14 days
  • augmentin x 14 days
41
Q

Pyelonephritis w fever 48hrs after tx?

A

Order imaging

Mandatory urine cultures

42
Q

Candidates for inpatient pyelonephritis tx

?

A 
Severe/complicated infection
Obstructive uropathy
DM
Renal failure
Multi-resistant pathogen 
Pregnant
Uncontrolled ssx
43
Q

Inpatient pyelo tx?

A

IV

  • amp and gent
  • ceftriaxone
  • levofloxacin
  • pip-tazo

IV x 24hrs after fever then switch to PO x 2 weeks

44
Q

Painful bladder syndrome?

A

Interstitial cystitis

45
Q

Interstitial cystitis is?

A

Diagnosis of exclusion

  • neg UA, culture, cytology
  • no obvious cause
46
Q

Who gets interstitial cystitis?

A

Women 40 y/o

47
Q

Pathophysiology of interstitial cystitis?

A

Glycosaminoglycan (GAG) layer is disrupted

  • urinary irritants enter and bother the nerve/muscle tissue
  • progressive irritation and inflammation (further damage)
48
Q

Primary complaint from interstitial cystitis?

A 
Pain w bladder filling
Relieved w urination
Urgency
Frequency
Nocturia
49
Q

Interstitial cystitis needs a good hx to include?

A 
Exposure to pelvic radiation
Tx w cyclophosphamide
Genital herpes
Vaginitis
Urethral diverticulum
50
Q

Labs for interstitial cystitis?

A

Infection and malignancy

  • UA
  • Culture
  • Cytology

Urodynamic testing

  • bladder sensitation and compliance
  • excludes detrusor instability

Cystoscopy w biopsy

51
Q

Ddx for interstitial cystitis?

A 
Cystitis
Vaginitis
Herpes
Urethral diverticulum
Carcinoma
52
Q

Tx for interstitial cystitis?

A

No cure - symptomatic only

  • hydrodistention (20-30% improvment)
  • meds (amitriptyline, nifedipine)
  • intravesical dimethyl sulfoxide (DMSO)
  • TENS
  • acupuncture
  • surgery (last resort)
53
Q

Urethritis is?

A

Infection of urethra

  • gonococcal
  • non-gonococcal

STI

54
Q

Urethritis presentation?

A

Drippy dick
Cant pee
Asymptomatic (40%)

55
Q

Urethritis needs (eval)

A

NAAT
- urine nucleic acid amplificaiton test

Culture

56
Q

Tx for urethritis

A

Chlamydia

  • azithromycin
  • doxy

Gonorrhea

  • ceftriaxone
  • add on presumptive chlamydia tx
57
Q

What is forrest gump’s password?

A

1forrest1

Senior - Urology (7 decks)

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