4. UTI Pyelo and Anti Flashcards
- Dysuria
- Urgency
- Dysuria = discomfort when peeing
- Urgency = abrupt, strong need to pee
________ is dx when urine sample is obtained for another reason (health screening/DB F/U), but shows bacteria
ABU (symptomatic bacteriuria)
What makes a uncomplicated UTI?
- NON-PG Female
- No anatomic abnormalties
- No instrumentation (instruments used to prevent urinary retention and hydronephrosis)
What is a complicated UTI?
- ANY pregnant patient because there are 2 pts, can lead to premature labor and LBW bbs
What can cause a complicated UTI in men or women?
- Anatomic varients (polycystic kidneys)
- Foreign body in UT (stones, catheters, stents)
- Extrinsic compression of ureter/bladder (tumor, constipation)
- Immunosupressed (DB, drugs, HIV/AIDS)
MC instrumentation?
Indwelling or episodic urinary catheter
Predisposing factors/RF for UTI in women
- Alot of sex
- Spermacides w diaphragm
- DB women (2-3x higher)
Why do post-menopausal W have higher recurrance of UTIs?
- Hx of premenopausal UTIs
- Anatomic factors that prevent bladder from empyting (cytoceles, urinary incontinence, residual urine)
- Estrogen depletion and its effect on tissues.
Predisposing factors/RF for UTI in men
- Prostatic hypertrophy
- Not circumsized (e. coli colonizes)
DDx of Dysuria in F
- Urethritis (d/t gonorrhea, chylamydia, herpres)
- Cystitis = frequency, urgency, nocturia, hesistancy and hematuria
- Vaginitis (d/t candida or trichomonas)
- Cervicitis (d/t chlamydia or neisseria)
- Non-infectious irritation of vagina/vulva
DDx of Dysuria in Males
- Uretheritis (gonorrhea and chlam)
- Cystitis
- Prostatisis
- Pyelonephritis
How do we diagnose GC or chlamydia if STI is suspected?
- Urine antigen test bc [urine culture and sensitivity], UA (dip/reagent stick and micro) does NOT ID
24 y/o female presents to urgent care with pain and burning with urination for the past 5 days. She denies any other pain and denies any color or odor change in her urine. She denies any fever, chills, nausea, vomiting, bowel changes or back pain and has been otherwise healthy. She is sexually active 2-3 times per week, with 3 different partners and intermittently uses condoms. 28 day cycle with no changes. Her only med is oral contraception one tablet daily, multivitamin daily and no other OTC’s.
What is the most likely diagnosis?
- A.Cystitis
- B.Urethritis
- C.Pyelonephritis
- D.Vaginitis
- E.Papillary necrosis
B. Urethritis bc INC risk for STI
- Cystitis => causes suprapubic/abdominal pain
- Pyelo => fever, back pain, fatigue
Untreated Asymptomatic Bacteriuria => more likely to cause symptomatic pyelonephritis in a ______ patient => more likely to develop _____
pregnant => sepsis
Treatment of GC and Chlamydia
- GC: Azithromycin+ Ceftriaxone
- Chlamydia: Azithromycin or doxycyline
- Give single dose if possible, tx contacts, counsel on risk reduction
Treatment of cystitis and pyelonephritis
- Cystitis: Trimethoprim-Sulfamethoxazole
- Pyelonephritis: Fluorquinolone (levofloxacin)
Infectious/non-infectious Prostatitis with or w/o hypertrophy
- Key sx
- ABX
- Prostatic, pelvic or perianal area (where I sit down)
- ABX for 4-6 weeks
If pt has
- STI and hx of dysuria =>
- Suprapubic pain
- V painful
- Perianal pain
- Urethritis
- Cystitis
- Renal lithiasis
- Prostastitis
Pt is sick, fever/chills, positive CVA tenderness
Pyelonephrititis (typically d/t ascending UTI infection, so precursors are the same)
Pyelonephritis
- MC cause:
- ______ develops in 20-30% of cases
- Instead of ascending spread, can spread _________ via
- E.Coli
- Bacteremia
- Hematogenous (candida, salmonella, s. aureus)
3 Major Subtypes/Complications of Pyelonephritis
- Papillary necrosis
- Emphysematous pyelonephritis
- Xanthogranulomatous pyelonephritis
4 Conditions Papillary Necrosis is seen in
- Obstruction
- DB
- Sickle cell
- Analgesic nephropathy
What is Emphysematous Pyelonephritis?
- Gas in nephric/perinephric area that occurs almost EXCLUSIVELY in DIABETIC patients.
What is Xanthogranulomatous Pyelonephritis?
- Chronic obstruction/infection that causes suppurative destruction of kidney, forming abscesses.
Bacteremia vs sepsis vs septic shock?
- Bacteremia = + blood culutes
- Sepsis (septicemia) = bad host response to infection => acute increase in organ failure
- Septic shock = progressive organ failure => increase mortality seen when serum lactate > 2 mmol/L (18 mg/dL)
When a patient is under septic shock => _________ is needed to keep MAP > 65mmHg
vasopressors, if not responsive to fluid
Acute ischemia of major organs occurs when there is a defect in ____________
Effective circulating volume
Sx of septic shock
- Fever/hypothermia (infection)
- Tachycardia ( <3 response to hypoperfuson and fever)
- Hypotension
- Decreased O2 to tissue and increase lactic acid
- Tachypnea (lungs try to compensate)
- Edema
- Circulating cytokines => endothelium is damaged (decreaed tone and increased permeability)
Non-medication preventive strategies in women
- Increased fluid intake
- pee after sex
- showers, not baths
- lactobacillus probiotics
- cranberry and vit. C
Which of the following indicates a diagnosis of sepsis?
- A.Hyperthermia
- B.Muddy brown casts
- C.Hypotension
- D.Urine culture positive for e. coli
- E.Pyuria
Hypotension** -all others suggest infection, but
- low blood pressure => organ dysfunction and decreased oxygenation of organs => intermittent confusion
