GU disorders Flashcards
Most common organism for UTI
E.coli
Most common UTI organism for women with STI’s
S. saprophyticus
Why is asymptomatic UTI in pregnancy dangerous
can precipitate pre-term labor
increased risk for PN
Criteria for uncomplicated UTI
lack of systemic symptoms and low-risk patient
UTIs are more common in boys or girls during infancy
boys
UTI labs
- dipstick: leukocytes positive
- nitrites: negative or positive (e.coli will be positive)
- sometimes hematuria
- C&S: (midstream) positive if >100,000 CFU/mL with pyuria
- if with catheter: >1000 is positive
pyuria
urine with WBC
Treatment duration of uncomplicated UTI
3 days
Treatment duration for complicated UTI
5 days
Uncomplicated UTI treatment
-Bactrim x 3 days
-Macrobid x 5 days, or fosfomycin x 1 dose, or augmentin x 5-7 days if bacterial resistance >20% or sulfa allergy
Alt: Cipro or levaquin x 3 days
-Pyridium x 2 days PRN dysuria
-increase fluid intake
-avoid high oxalate foods
-
Patient population considered as complicated UTi
- males
- poorly controlled DM
- pregnant women
- children or elderly
- immunocompromised
- recurrent UTI or reinfections
- anatomical abnormalities
Complicated UTI treatment
- Cipro or Levaquin x 7-10 days
- Bactrim or Suprax 7-10 days
Treatment for postcoital UTI
- Bactrim one tablet after sex
- increase fluids before and after sex
Antimicrobial prophylaxis for UTI
Bactrim one tablet HS
Are UTI’s ever normal in males
no, refer to urologist
Recurrent UTI requirement in women
- 3 or more UTI’s in 1 year
- or 2 infections within 6 months
Long-term use of Macrobid is associated with
- lung problems
- chronic hepatitis
- neuropathy
- contraindicated with renal insufficiency
Antibiotic choice for pregnant
Keflex
UTI antibiotics to avoid with pregnancy
- Macrobid
- Cipro
- Levaquin
Antispasmodic medications
-Ditropan (oxybutynin)
Complicated UTI symptoms
- fever, chills
- marked fatigue
- indicates spread beyond bladder
Common organisms for acute PN
- e.coli
- K. pneumoniae
- P. mirabilis
WBC casts in urine suggests
pyelonephritis
PN treatment
- refer ED
- outpatient if mild
- Fluoroquinolones preferred (if resistance <10%)
- Rocephin 1 g IM stat single dose if unable to take FQ
When to refer PN
- pregnant
- children
- elderly
- anatomical abnormalities
- DM
- etc.
Next step with dipstick is heme positive
send for microscopic UA
order C&S if infection suspected
if malignancy suspected send for urine cytology
Biggest concern with hematuria
bladder cancer
Benign causes of hematuria
- exercise induced
- resolves in 72 hours
RBC casts in urine suggest
glomerulonephritis if accompanied by edema, weight gain, dark cola-colored urine or HTN
Nephrolithiasis is…
kidney stones
Risk factors for nephrolithiasis
- family history of stones
- low fluid intake
- gout
- bariatric surgery
Nephrolithiasis presentation
- acute onset of severe flank pain
- pain comes in waves
- episodes may last from 20-60 minutes
- N/V with severe pain
- gross or microscopic hematuria
- most will pass stone in 48 hours
Nephrolithiasis treatment
- Toradol injection if not contraindicated
- strain urine for several days and bring stone to office for analysis
- renal US to determine location and size
- urology referral if unable to pass or large stone
- Refer to ED if with high fever, extreme pain, or acute renal failure
- increase fluid intake
- avoid high-oxalate foods
high oxalate foods
- rhubarb
- spinach
- beets
- chocolate
- tea
- meats
Cr level with low muscle mass and normal renal function
decreased serum Cr
Cr level with high muscle mass and normal renal function
high serum Cr
What is creatinine
a byproduct of muscle metabolism excreted through kidneys
CrCl is often done by
what lab is instead used
nephrologists
inconvenient for primary care
use GFR instead
Abnormal GFR
<60
Which cast is always pathological
RBC casts –> refer
Which cast type is most common
hyaline
Hyaline casts may present due to
low urine flow
dehydration
vigorous exercise
Crystal casts
no clinical significance
Right kidney placement
sits lower than left due to liver displacement
Large number of squamous epithelial cells in urine may indicate
contamination
Use of ___ can increase UTI in females
spermicides
up to 1 year
Imaging with highest sensitivity/specificity for kidney stones
noncontrast CT
Initial imaging test for kidney stones
US
What is BUN
kidneys ability to excrete urea
What can cause elevated BUN
- acute renal failure
- high-protein diet
- hemolysis
- CHF
- drugs
Few amounts of epithelial cells in urine
normal
Normal WBC in urine
<10
If multiple bacteria are present in a urine sample, it is considered
contaminated
Urine dipstick detects only ___, not microalbumin
albumin
Organisms that breakdown nitrates to nitrites
- E.coli
- Klebsiella
- Proteus
- Enterobacter
- Citrobacter
- Pseudomonas
Urge incontinence
- detrusor instability
- sudden urge to urinate
Stress incontinence
- sphincter incompetence
- unintentional loss of urine
Treatment for urinary incontience
- avoid all irritating liquids
- weight loss
- regular voiding (but not frequent)
- Kegel exercises daily x 3 months
- minimize fluids at dinner
- take diuretics in afternoon
Overactive bladder medication treatment
- anticholinergics –> Mirabegron (Myrbetriq) fewer side effects
- Estrogen for postmenopausal women
- pelvic PT, pessaries
- surgery
Urolithiasis vs. nephrolithiasis
- Uro: stones anywhere in urinary system
- Nephro: stones in kidneys
A positive Prehn sign indicates
epididimytis
-relief of pain with elevation of affected testicle
Catheter associated UTI organism
Proteus mirabilis
