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Infectious Disease > Genitourinary Tract Infections > Flashcards

Genitourinary Tract Infections Flashcards

1
Q

Genitourinary Tract Infections types?

7

A 
Acute Cystitis
Acute Pyelonephritis
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Infectious Stone Disease
Epididymitis
Fournier’s Gangrene
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2
Q

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

A 
Bacterial Infections (most common)
Stones
Interstitial Cystitis
Radiation
Bladder cancer
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3
Q

What is the most common GU infection in women?

A

Bacterial Cystitis

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4
Q

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

A

when the prostate enlarges and can cause bladder outlet obstruction.

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5
Q

What are the most common nosocomial infection?

A

Catheter-associated infections

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6
Q

Risk factors for Acute cystitis?

4

A
  1. Incomplete bladder emptying
  2. Sexual intercourse
  3. Benign Prostatic enlargement
  4. Stones
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7
Q

What conditions would cause incomplete bladder emptying?

4

A
  • BPH
  • Diabetes
  • Neurologic
  • Multiple Sclerosis
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8
Q

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

A

Escherichia coli (most commonly found in bowel)

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9
Q

What other organisms are common in UTI?

5

A
  1. Proteus,
  2. Klebsiella,
  3. Pseudomonas,
  4. Enterococcus faecalis, and 5. Staphylococcus saprophyticus
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10
Q

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

A

Proteus,

Klebsiella pneumoniae, and Staph. Saprophyticus

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11
Q

Acute cystitis Clinical Presentation?

5

A

Irritative voiding symptoms

  1. Frequency
  2. Urgency
  3. Dysuria
  4. Hematuria
  5. Suprapubic discomfort
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12
Q

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

A

Just creating resistance

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13
Q

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

A

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

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14
Q

What lab work would we do for acute cystitis?

2

A

UA

Urine culture

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15
Q

How would we treat acute cystitis?

which drugs are first line and how often?
3 drugs

A

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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16
Q

When should we use floroquinolones for acute cystitis?

A

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

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17
Q

What is Acute Pyelonephritis?

A

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

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18
Q

What are the most common bacteria?
(Acute Pyelonephritis)

In general?
Specific bacteria? 5

A

Gram-negative bacteria are the most common

E-coli
Proteus
Klebsiella
Enterobacter
Pseudomonas
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19
Q

Risk factors for Acute Pyelonephritis?

4

A
  1. Obstruction of the urinary tract
  2. Vesicoureteral reflux
  3. Diabetes mellitus
  4. Female gender
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20
Q

What are some examples of obstructions of the urinary tract?

2

A

Stones

UPJ obstruction

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21
Q

Pathogenesis

of Acute Pyelonephritis?

A

Bacteria ascend from the lower urinary tract into collecting ducts

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22
Q

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

A

Staphylococcus aureus or Candida in the bloodstream

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23
Q

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

A

Lymphatic
Very unusual

Gains access into kidney from an intraperitoneal abscess

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24
Q

Acute Pyelonephritis
clinical presentation?
6

A 
Fever
Chills
Flank pain
Malaise
Nausea and vomiting
Irritative voiding symptoms
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25
Q

Finding on physical exam for Acute Pyelonephritis?

A

Costovertebral angle tenderness (CVA) may be prominent finding

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26
Q

Lab work for acute pyelonephritis?4

A

Lab work
1. CBC

  1. UA
  2. Urine culture positive
  3. Blood cultures may also be positive
27
Q

What would a CBC show for posiitve acute pyelonephritis?

What would a UA show for posiitve acute pyelonephritis?3

A

Leukocytosis

Hematuria
Bacteriuria
Pyuria

28
Q

Imaging for acute pyelonephritis?2

A

Renal Ultrasound

Abdominal and pelvic CT scan with and without contrast

29
Q

Treatment of acute pyelonephritis?

4 options

How long?

A 
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
30
Q

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

A 
Infection and inflammation of the prostate by:
1. E-coli
2 Klebsiella
3. Proteus mirabilis
4. Enterobacter
5. Staphylococcus aureus
31
Q

Acute Bacterial Prostatitis
Risk Factors?
6

A 
BPH
Urethral stricture disease
Urethral catheterization
Neurogenic bladder 
Calculi
Diabetes
32
Q

Acute Bacterial Prostatitis pathogenesis?

A

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

33
Q

Acute Bacterial Prostatitis
Clinical Presentation
5

A 
Present with vague pelvic and systemic symptoms
Irritative voiding symptoms
Dysuria
Perineal and low back pain
Difficulty voiding or retention
34
Q

Acute Bacterial Prostatitis findings on physical exam?

2

A

Prostate may be enlarged, tender, or boggy

Avoid prostate massage

35
Q

Acute Bacterial Prostatitis
Lab work
3

A

CBC

UA

Urine culture is positive

36
Q

What will the CBC show for Acute Bacterial Prostatitis?

What about the UA?3

A

Leukocytosis

Positive leukocytes, blood, and nitrites

37
Q

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

A

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

38
Q

For urinary retention with Acute Bacterial Prostatitis

what should we do?

A

a percutaneous suprapubic tube should be placed

39
Q

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

A

Chronic Bacterial Prostatitis

Pathology is the same

40
Q

What is the most common bacteria types for Chronic Bacterial Prostatitis?

General?
Most common and three others?

A

Gram-negative rods most common

  1. E-coli 80% of cases

Klebsiella, Pseudomonas aeruginosa, and Proteus are less common

41
Q

Whats the difference bewteen CBP and ABP?

A

Patients presents the same as ABP but less sick
Some patients require prostate massage

(first cup pee then massage prostate vigorously then pee again)

42
Q

Whats the Meares-Stamey four glass test?

A

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

43
Q

Chronic Bacterial Prostatitis
Treatment consist of what?
4

A

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

44
Q

Struvite stones
Composed of what?
2

More common in females or males?

A

combination of magnesium ammonium phosphate and carbonate apatite

females

45
Q

How are the stones formed?

What bacteria is the most common?

What are three other less common bugs it could be?

A

Formed from urease producing organisms that split urea into ammonia

Proteus mirabilis is most common

Other pathogens include:
Haemophilus influenzae
Staph aureus
Klebsiella

46
Q

What is staghorn calculus?

What imaging can detect stones?
3

How should we treat it?
2

A

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
47
Q

Most common cause of scrotal pain in adults in the outpatient setting is what?

What is it most commonluy caused by?

A

Epididymitis

Most commonly caused by infection
Acute or Chronic

48
Q

Whats the most common bugs associated with Epididymitis in men under 35?2

Older men what bugs are more common?2

A

Chlamydia trachomatis and Neisseria gonorrhoeae most common organisms in men under age 35

Older men suspect Escherichia coli or Pseudomonas species

49
Q

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?

A
  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

50
Q

How would you diagnose acute Epididymitis?

2

A
  1. Made clinically and may be confirmed with urine studies

2. Scrotal US

51
Q

How would we treat acute epididymitis?
2

Alternative?

A

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

Z pack

52
Q

Symptoms of chronic epidiymitis?

3

A
  1. Scrotal or testicular swelling
  2. Discomfort
  3. Usually lack irritative voiding symptoms
53
Q

Clinical findings of chronic epididymitis?

3

A
  1. Subtle induration or tenderness, with or without swelling
  2. May feel inflammatory nodule with nontender epididymis
  3. UA usually negative
54
Q

How do we treat chronic epididymitis?

A

conservatively

55
Q

What is Fournier’s Gangrene?

Clinical features?5

How do we diagnose it? 2

A

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

56
Q

Anaerobic species that are involved in Fournier’s Gangrene?2

Other pathogen that is aerobic and involved with it?

A

Bacteroides
Clostridium

Group A Streptococcus (hemolytic streptococcal gangrene)

57
Q

Enterobacteriaceae involved with Fournier’s Gangrene?

4

A

E. coli
Enterobacter
Klebsiella
Proteus

58
Q

Treatment of Fournier’s Gangrene?

2

A

Surgical

Empiric (antibiotics)

59
Q

What antibiotic would you use for Fournier’s Gangrene?

4

A
  1. Carbapenem or beta-lactam-beta-lactamase inhibitor,

plus
Clindamycin,

plus
Agent against MRSA
Vancomycin

60
Q

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

A

cancer

stones

61
Q

What do we need to rule out for Acute Pyelonephritis?

A

obstruction

62
Q

Who is Fournier’s Gangrene

most common in?

A

Obese uncontrolled diabetics

63
Q

What is prostate massage contraindicated in?

A

Acute Bacterial Prostatitis

Very tender prostate

Chronic will not have tender prostate
and massage indicated

Infectious Disease (29 decks)

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