Risk factors for Acute cystitis? 4

1. Incomplete bladder emptying 2. Sexual intercourse 3. Benign Prostatic enlargement 4. Stones

What other organisms are common in UTI? 5

1. Proteus, 2. Klebsiella, 3. Pseudomonas, 4. Enterococcus faecalis, and 5. Staphylococcus saprophyticus

Acute cystitis Clinical Presentation? 5

Irritative voiding symptoms 1. Frequency 2. Urgency 3. Dysuria 4. Hematuria 5. Suprapubic discomfort

Risk factors for Acute Pyelonephritis? 4

1. Obstruction of the urinary tract 2. Vesicoureteral reflux 3. Diabetes mellitus 4. Female gender

Genitourinary Tract Infections Flashcards by Sarah Feeney

Genitourinary Tract Infections types?

Acute Cystitis
Acute Pyelonephritis
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Infectious Stone Disease
Epididymitis
Fournier’s Gangrene

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Cystitis refers to inflammation of the urinary bladder due to what?
5

Bacterial Infections (most common)
Stones
Interstitial Cystitis
Radiation
Bladder cancer

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What is the most common GU infection in women?

Bacterial Cystitis

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It is uncommon for men until around the age of 50. Why is it common then?

when the prostate enlarges and can cause bladder outlet obstruction.

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What are the most common nosocomial infection?

Catheter-associated infections

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Risk factors for Acute cystitis?

Incomplete bladder emptying
Sexual intercourse
Benign Prostatic enlargement
Stones

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What conditions would cause incomplete bladder emptying?

BPH
Diabetes
Neurologic
Multiple Sclerosis

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What is the most common bacteria accounting for 85% of community-acquired infections and 50% of nosocomial infections?

Escherichia coli (most commonly found in bowel)

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What other organisms are common in UTI?

Proteus,
Klebsiella,
Pseudomonas,
Enterococcus faecalis, and 5. Staphylococcus saprophyticus

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Which bacteria increase the urine pH and can lead to stone formation?
3

Proteus,

Klebsiella pneumoniae, and Staph. Saprophyticus

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Acute cystitis Clinical Presentation?

Irritative voiding symptoms

Frequency
Urgency
Dysuria
Hematuria
Suprapubic discomfort

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Dont ever treat someone who has a chronic indwelling catheter. Why?

Just creating resistance

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What would be a finding on a physical exam for acute cystitis?

Patient’s may have suprapubic tenderness other wise the exam is usually normal

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What lab work would we do for acute cystitis?

Urine culture

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How would we treat acute cystitis?

which drugs are first line and how often?
3 drugs

1-3 days of single dose antibiotic therapy

Antibiotic therapy
First-line drugs include:
1. Nitrofurantoin (first)
2. Trimethoprim-sulfamethoxazole
3. Cephalosporins

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When should we use floroquinolones for acute cystitis?

Fluoroquinolones should be used for complicated infections due to increasing resistant E-coli strains

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What is Acute Pyelonephritis?

Pyelonephritis is an infection of the upper urinary tract including the renal pelvis and renal parenchyma

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What are the most common bacteria?
(Acute Pyelonephritis)

In general?
Specific bacteria? 5

Gram-negative bacteria are the most common

E-coli
Proteus
Klebsiella
Enterobacter
Pseudomonas

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Risk factors for Acute Pyelonephritis?

Obstruction of the urinary tract
Vesicoureteral reflux
Diabetes mellitus
Female gender

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What are some examples of obstructions of the urinary tract?

Stones

UPJ obstruction

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Pathogenesis

of Acute Pyelonephritis?

Bacteria ascend from the lower urinary tract into collecting ducts

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Acute Pyelonephritis can also infect through the Hematogenous route. What bacteria usually infect this way?
2

Staphylococcus aureus or Candida in the bloodstream

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Acute Pyelonephritis can also enter through the lymphatics. How does this happen?

Lymphatic
Very unusual

Gains access into kidney from an intraperitoneal abscess

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Acute Pyelonephritis
clinical presentation?
6

Fever
Chills
Flank pain
Malaise
Nausea and vomiting
Irritative voiding symptoms

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Finding on physical exam for Acute Pyelonephritis?

Costovertebral angle tenderness (CVA) may be prominent finding

Lab work for acute pyelonephritis?4

Lab work 1. CBC 2. UA 3. Urine culture positive 4. Blood cultures may also be positive

What would a CBC show for posiitve acute pyelonephritis? What would a UA show for posiitve acute pyelonephritis?3

Leukocytosis Hematuria Bacteriuria Pyuria

Imaging for acute pyelonephritis?2

Renal Ultrasound | Abdominal and pelvic CT scan with and without contrast

Treatment of acute pyelonephritis? 4 options How long?

``` Treatment Management is usually 10-14 days Parenteral or oral antibiotics 1. IV ampicillin or gentamicin 2. IV cefazolin 3. IM ceftriaxone (Rocephin) 4. Trimethoprim-sulfamethoxazole or fluoroquinolone ```

Acute Bacterial Prostatitis is what and what bacteria usually cause it? 5

``` Infection and inflammation of the prostate by: 1. E-coli 2 Klebsiella 3. Proteus mirabilis 4. Enterobacter 5. Staphylococcus aureus ```

Acute Bacterial Prostatitis Risk Factors? 6

``` BPH Urethral stricture disease Urethral catheterization Neurogenic bladder Calculi Diabetes ```

Acute Bacterial Prostatitis pathogenesis?

Bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts

Acute Bacterial Prostatitis Clinical Presentation 5

``` Present with vague pelvic and systemic symptoms Irritative voiding symptoms Dysuria Perineal and low back pain Difficulty voiding or retention ```

Acute Bacterial Prostatitis findings on physical exam? | 2

Prostate may be enlarged, tender, or boggy | Avoid prostate massage

Acute Bacterial Prostatitis Lab work 3

CBC UA Urine culture is positive

What will the CBC show for Acute Bacterial Prostatitis? What about the UA?3

Leukocytosis Positive leukocytes, blood, and nitrites

Acute Bacterial Prostatitis Treatment What should we treat with until the culture is back? 2 after patient is afebrile for 24-48 hours what should we do? What should we treat for 4-6 weeks (oral antibiotics)? 2

Acutely ill patients require hospitalization Management with broad-spectrum antibiotics (ampicillin and gentamicin) until culture is back Switch to oral antibiotics Trimethoprim-sulfamethoxazole or fluoroquinolone

For urinary retention with Acute Bacterial Prostatitis | what should we do?

a percutaneous suprapubic tube should be placed

Can be a sequela of acute bacterial prostatitis (ABP)?

Chronic Bacterial Prostatitis Pathology is the same

What is the most common bacteria types for Chronic Bacterial Prostatitis? General? Most common and three others?

Gram-negative rods most common 1. E-coli 80% of cases Klebsiella, Pseudomonas aeruginosa, and Proteus are less common

Whats the difference bewteen CBP and ABP?

Patients presents the same as ABP but less sick Some patients require prostate massage (first cup pee then massage prostate vigorously then pee again)

Whats the Meares-Stamey four glass test?

first cup pee then midstream then massage prostate vigorously then pee again) then pee the rest

Chronic Bacterial Prostatitis Treatment consist of what? 4

4-8 weeks of antibiotic Anti-inflammatories Hot sitz baths Alpha-blocker

Struvite stones Composed of what? 2 More common in females or males?

combination of magnesium ammonium phosphate and carbonate apatite females

How are the stones formed? What bacteria is the most common? What are three other less common bugs it could be?

Formed from urease producing organisms that split urea into ammonia Proteus mirabilis is most common Other pathogens include: Haemophilus influenzae Staph aureus Klebsiella

What is staghorn calculus? What imaging can detect stones? 3 How should we treat it? 2

Struvite stone are known to encompass the entire collecting system of the kidney CT scans, Renal Ultrasound, and KUB can detect the stone Treatment - Fluoroquinolone - Percutaneous Nephrolithotomy

Most common cause of scrotal pain in adults in the outpatient setting is what? What is it most commonluy caused by?

Epididymitis Most commonly caused by infection Acute or Chronic

Whats the most common bugs associated with Epididymitis in men under 35?2 Older men what bugs are more common?2

Chlamydia trachomatis and Neisseria gonorrhoeae most common organisms in men under age 35 Older men suspect Escherichia coli or Pseudomonas species

What symptoms would present with acute epididymitis? 3 What would palpation in a epididymis pt reveal? If infection moves to the testicle what can develop?

1. Severe swelling and exquisite pain of surrounding structures 2. Fevers 3. Irritative voiding symptoms reveals induration and swelling of involved epididymis with pain hydrocele

How would you diagnose acute Epididymitis? | 2

1. Made clinically and may be confirmed with urine studies | 2. Scrotal US

How would we treat acute epididymitis? 2 Alternative?

Ceftriaxone 250mg IM one dose plus Doxycycline 100mg bid x 10 days Z pack

Symptoms of chronic epidiymitis? | 3

1. Scrotal or testicular swelling 2. Discomfort 3. Usually lack irritative voiding symptoms

Clinical findings of chronic epididymitis? | 3

1. Subtle induration or tenderness, with or without swelling 2. May feel inflammatory nodule with nontender epididymis 3. UA usually negative

How do we treat chronic epididymitis?

conservatively

What is Fournier’s Gangrene? Clinical features?5 How do we diagnose it? 2

Necrotizing fasciitis of the perineum caused by mixed infection of aerobic/anaerobic bacteria 1. Tense edema of the scrotal wall 2. Blisters/bullae 3. Subcutaneous gas 4. Fever 5. Tachycardia/hypotension CT and MRI

Anaerobic species that are involved in Fournier’s Gangrene?2 Other pathogen that is aerobic and involved with it?

Bacteroides Clostridium Group A Streptococcus (hemolytic streptococcal gangrene)

Enterobacteriaceae involved with Fournier’s Gangrene? | 4

E. coli Enterobacter Klebsiella Proteus

Treatment of Fournier’s Gangrene? | 2

Surgical | Empiric (antibiotics)

What antibiotic would you use for Fournier’s Gangrene? | 4

1. Carbapenem or beta-lactam-beta-lactamase inhibitor, plus Clindamycin, plus Agent against MRSA Vancomycin

If culture is negative for acute cystitis what do we need to rule out? 2

cancer stones

What do we need to rule out for Acute Pyelonephritis?

obstruction

Who is Fournier’s Gangrene | most common in?

Obese uncontrolled diabetics

What is prostate massage contraindicated in?

Acute Bacterial Prostatitis Very tender prostate Chronic will not have tender prostate and massage indicated