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Patho Exam III > GU Infections > Flashcards

GU Infections Flashcards

1
Q

Urethral protective urinary mechanisms

A

Host defense mechanisms maintain a sterile posterior urethra and bladder in a healthy individual

  • pathogens washed out during micturition
  • Low pH and high osmolality of urea
  • presence of antimicrobial proteins and secretions
  • ureterovesical junction: closes to prevent reflux of urine to the uterus and kidneys
  • Women: Mucus-secreting glands
  • Men: length of male urethra
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2
Q

________ group more prone to what?

A

Lewis blood group more prone to UTIs

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3
Q

E. coli have ______ or ______ making it easy for it to adhere to ______

A

pili or fimbrae

adhere to urinary tract

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4
Q

Remember E.coli commonly found in normal GI flora so makes sense that it would cause ________

A

80-85% of urinary infections

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5
Q

Remember that UTI can cause cystitis or pyelonephritis

Definition of UTI…

A

Inflammation of the urinary epithelium after invasion of pathogen in urinary tract – retrograde movement of bacteria into the urethra and bladder

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6
Q

What is the most common site of UTI

A

Acute cystitis (bladder)

-inflammation of the epithelial lining of the bladder more common in women

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7
Q

Older adults acute cystitis (UTI) s/s

A

confusion, vague abdominal discomfort

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8
Q

_____% with UTI asymptomatic

_____% with symptoms are abacteriuric

A

30

30

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9
Q

Complicated vs. uncomplicated UTI (cystitis)

A

uncomplicated - positive dipstick with leuks or blood + symptomatic (tx normally)

complicated cystitis - urine culture of specific microorganism with count of 10,000/mL or more (really unsure why it says this)

-complicated UTI is an infection associated with a condition, such as structural or functional abnormalities of the genitourinary tract or the presence of an underlying disease, which increases the risks of acquiring an infection or of failing therapy

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10
Q

Reasons for complicated cystitis

With complicated cystitis what will you need after tx?

Older adult complication could lead to…

A
  • diabetes
  • pregnancy
  • symptoms for 7+ days before seeking care
  • hospital acquired
  • renal failure
  • obstruction
  • indwelling catheter, stent, nephrostomy tube or urinary diversion in place
  • functional or anatomic abnormality
  • renal transplant
  • immunosuppression

*Will need repeat cultures

*urosepsis

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11
Q

Question: Mechanism that protect the urinary tract from infection include:

  1. monocytes in the urine
  2. acidic urine
  3. decreased urine osmolarity
  4. type I pili
A

Acidic urine

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12
Q

Remember that interstitial cystitis is different from acute cystitis

-what is interestitial cystitis?

A
  • another name is painful bladder syndrome
  • often mistaken for a UTI, but there is NO infection
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13
Q

causes of interstitial cystitis?

A
  • radiation or chemical
  • autoimmune or hypersensitivity
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14
Q

what are the symptoms of interstitial cystitis?

When is this diagnosed?

tx?

A

s/s: bladder or pelvic pain or pressure and frequent urge to urinate

Dx: after 6 weeks of symptoms with negative urine cultures and no other known cause

Tx: oral and intravesical therapies, sacral nerve stimulation, onabotulinumtoxinA, and surgery

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15
Q

Acute pyelnephritis

A

Can be caused by UTI

-acute infection of the ureter, renal pelvis of renal parenchyma

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16
Q

Acute pyelonephritis Clinical Manifestations

Evaluation?

Tx?

A
  • flank pain (also possible to have this is acute cystitis if severe)
  • fever, chills
  • CVA TENDERNESS
  • purulent urine

Evaluation - WHITE BLOOD CELL CASTS under microscope…remember CASTS in URINE = RENAL/KIDNEY ETIOLOGY (PYELONEPHRITIS)

Tx - antibiotic administration; IV fluids, hospitalization depending on severity

17
Q

Chronic Pyelonephritis

  • what can this lead to?
  • what is the tx?
A
  • PERSISTENT or recurrent infection of the kidneys leading to scarring of the kidneys, leading to scarring of the kidneys
  • inflammation and fibrosis, located in the interstitial spaces b/w the tubules, leading to chronic kidney failure

-tx: antibiotic administration, prolonged abx with recurrent infections

18
Q

Pelvic Inflammatory Disease

Caused by?

-may involve?

A

PID

  • acute inflammation caused by infeciton; STI migrate from the vagina to the upper genital tract
  • may involve any organ of the upper reproductive tract (salpingitis - fallopian tube inflammation; oophoritis - inflammation of ovaries)
19
Q

What is the most common etiology of PID?

What two would you tx for? Would also tx?

A

Usually polymicrobial - you would tx for both Chlamydia trachomatis and Neisseria gonorrhea

Would also tx sexual partner

20
Q

Diagnosis of PID - what s/s + something else

What should you do to r/o?

A

Sexually active women who have abdominal or pelvic tenderness and one of the following signs:

  • Cervical motion tenderness
  • Uterine tenderness
  • Adnexal tenderness

ALWAYS DO PREGNANCY TEST TO RULE OUT ECTOPIC PREGNANCY

21
Q

What are some complications of PID?

A

Infertility and Ectopic Pregnancy

22
Q

Vaginitis

  • causes?
  • clinical manifestations?
  • tx?
A
  • infection of the vagina with irritation of the vagina (vaginosis)
  • could be from STI, Trichomonas vaginalis
  • could be do to disruption of microbiomee: Candida albicans (abx, immunosupprssed, diabetes); or could be Bacterial vaginosis
  • acidic environment of vagina provides some protection
  • s/s: copious, malodorous, or irritating discharge
  • Candida - thick, white discharge that looks like cottage cheese
  • tx: antibiotics or antifungal, maintain acidic environment, relieve symptoms (usually pruritius), probiotic supplement
23
Q

Cervicitis

  • caused by?
  • causes what?
  • what is a clinical sign of this?
  • tx?
  • sometimes get this mixed up with?
A

Inflammation or infection of the cervix

  • caused by one or more STIs: Chlamydia trachomatis, Neisseria gonorrhea
  • causes mucopurulent cervicitis (MPC)
  • causes cervical motion tenderness
  • tx: antiibiotics for pt and partner
  • usually hard to distinguish b/w this and PID but with PID you usually have abdominal pain too and this more so just the cervical motion tenderness
24
Q

Clinical manifestations of PID

A

Sudden, severe abdominal or pelvic pain with fever

May be asymptomatic

Also remember the 3 signs:

cervical motion tenderness, uterine tenderness, adnexal tenderness

25
Q

Vulvodynia

-causes:

A

called vulvitis, vestibulitis, or vulvovestibulitis

  • chronic pain in the vulva, the area on the outside of a woman’s genitals. It is usually described as a sensation of burning, stinging, itching or rawness
  • causes: soaps, detergents, lotions, sprays, shaving, pads, perfumed toilet paper, or tight-fitting clothes, vaginal infections that spread to the labia
26
Q

Vulvodynia

A

tx: avoid irritants, wear loose cotton clothing, behavioral tx, topical xylocaine, topical of systemic antidepressants, botox of affected nerve, vestibulectomy

27
Q

Remember that bartholinitis can be caused by

A

bacterial infection that clogs duct…tx w/antibiotics and drian

28
Q

Question: PID is

1 - associated with infertility

2- primarily caused by S. aureus

3- associated with hyperandrogenic state

4- caused by an infection of the cervic

A

1- answer

2- primary cause Chlamydia trachomatis of Neisseria gonorrhea

4- cervicitis

(PID involvese salping and oophor)

29
Q

Bacterial prostatitis caused by?

Usually in what ages?

Also associateed with _____ in older men?

A

ascending UTI - bacteria in urine leaks into prostate

30-50

BPH

30
Q

What are the clinical manifestations of Bacterial Prostatitis?

Palpation…?

A

s/s: sudden onset of malaise, low back pain, perineal pain, high fever, chills, dysuria, urinary retention, painful ejaculation

Palpation: always be gentle so as to not cause bacteria to enter into blood stream

Upon palpation - enlarged, tender, and swollen prostate that is indurated (hard) and warm to touch

-NEVER MASSAGE an acutely infected person b/c this can cause bacteria to enter the bloodstream

31
Q

Diagnosis of Bacterial Prostatitis?

A

Urinalysis and cultures

Abx

  • Severe cases may need hospitalization and IV antibiotics
  • If there is urinary retention, urethral catheterization is contraindicateed - would need suprapubic
32
Q

Chronic Bacterial Prostatitis

Most common…

Symptoms?

Exam?

If urinalysis is clean?

A

Recurrent prostatitis

Most common UTI in men

Symptoms: frequency, urgency, dysuria, low back pain, perineal discomfort, myalgia, sexual dysfunction

Exam: Enlarged, boggy prostate; if fibrosis from repeated infections theen may be irregular or firm

  • If urinalysis is clean then prostatic massage is done to express secretions
  • Referral to urologist for ongoing management

Patho Exam III (5 decks)

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