GU: UTIs & Prostatitis Flashcards
most common cause(s) of UTIs
- E. coli - overall m/c
- s. saphrophyticus - in young, sexually active women
- klebsiella
- proteus
demographic most commonly affected by UTIs?
women
what are the most manifestations of UTIs?
- urethritis
- cystitis
- hemorrhagic cystitis
- asymptomatic bacteriuria (ABU)
- pyelonephritis
urethritis presentation?
UTI manifestation: only urethra inflamed
- dysuria
cystitis presentation?
UTI manifestation: urethra + bladder inflamed
- dysuria AND
- urgency / increased frequency / small urine volume
- suprapubic tenderness - pre & post micturition
- pyruria (WBCs in urine)
hemorrhagic cystitis
UTI manifestation: inflammation of urethra + bladder
- sx of cystitis + blood in the urine
how to distinguish cystitis from glomerulonephritis?
cystitis will not present with
- HTN
- abnormal renal function
pyelonephritis - presentation
UTI manifestation: urethra + bladder + uteters + kidneys affected
- sx of cystitis, AND
-
back pain
- flank pain
- costo-vertebral angle tenderness
-
systemic affects:
- fever
- nausea/vomiting
- immune: PERIPHERAL LEUKOCYTES, WBC casts
-
back pain
untreated pyelonephritis can progress to?
sepsis
septic shock
UTI relapse vs UTI reinfection
- relapse: recurrent UTI < 2 weeks after preceeding infection
- reinfection: recurrent UTI > 2weeks after preceding infection
when do males start to experience a rapid increase UTIs?
- their 5th decade
- d/t inc incidence of BHP
major risk factors for UTIs
- other GU problem: kidney stones, prostatitis
- catheters
- sexual intercourse
- pregnancy
dx of a UTI
confirm pyuria and bacteriuria
- pyruria: confirmed by
- + dipstick test for leukocyte esterase
- bacteriuria: confirmed by
- + dipstick test for nitrite (note that s. saphrophyticus does NOT reduce create nitrites)
- gram stain
- semiquantitative test
dx of cystitis (acute uncomplicated)
- reliable hx:
- at least 1 cystitis symptom
- pt has risk factors for UTI
- if not reliable hx:
- pyuria or bacteriuria dipstick tests
- > 1,000 CFUs/ml
- pyuria or bacteriuria dipstick tests
pyelonephritis (acute, uncompicated) dx
- reliable hx
- physical exam indicative (dysuria + inc frequency/small volume + suprapubic pain + flank pain/costo-verbral tenderness + fever/nausea/vomiting)
- additional lab tests of hx not reliable:
- CFUs > 10,000
- WBC casts
-
Ab-coated bacteria
- is bacteria makes it to the kidneys, it is more likely to contact the blood being filtered and trigger an immune response- will be attacked with & coated by Ab
Ab coated bacteria in a urine sample are indicative of what UTI manifestation?
why
pyelonephritis
if the microbe advances to the kidney, it will interface with blood & thus stimulate an immune response (Abs)
dx of asymptomatic bacteriuria (ABU)
CFH > 100,000
- in women: two specimens needed (same species)
- in men: single specimen needed
how to collect urine if trying to dx cystitis
patient will urinate for a few seconds to expel the urine at the distal end o the urethra, then urine will either be collected:
- midstream
- pt will stop and then start again, then that urine collected
what demographics should and should not be treated for ABU?
- do not treat - elderly
- do treat -
- pregnant women
- GU tract procedure pre-ops
- renal transplants
proteus has what virulence factors?
describe clinical significance
- factors
- produces urease, which makes urine basic (>8)
- has fimbrae
m/c cause of prostatitis
- acute bacterial prostatitis
- E. coli
- chronic bacterial prostatitis
- E. coli (m/c)
- enterococcus
acute bacterial prostatitis - presentation
like cystitis + systemic sx + genital pain + abnormal prostate exam
- cystitis sx
- urinary sx
- hesitancy
- poor, interrupted stream
- straining / incomplete emptying
- suprapubic pain
- urinary sx
- external genital pain - testes/penis
- systemic - fever / chills, nausea / vomiting
- prostate - warm, tender, enlarged, boggy
chronic bacterial prostatitis presentation
sx presence > 3 mos: urinary sx + systemic affects + back pain + genital pain +/- abormal prostate exam
- urinary sx
- hesitancy
- poor, interrupted stream
- straining / incomplete emptying
- back pain (low back pain, not flank pain like pyelonephritis)
- external genital pain - testes / penis
- systemic sx - low grade fever, arthralgia/myalgia
- prostate exam
- normal or tender/boggy
contrast the digital exam findings for acute vs chronic bacterial prostatitis
- acute prostatitis
- warm / enlarged / tender / boggy
- chronic prostatitis
- normal, or tender / boggy
what sx do acute and chronic bacterial prostatitis share?
- urinary sx - straining / poor, interrupted stream / incomplete emptying
- external genital pain
- fever
compare / contrast the systemic sx of acute vs bacterial chronic prostatitis
- acute
- high fever
- chills
- emesis / vomiting
- chronic
- low grade fever
- myalgia / arthralgia
chronic nonbacterial prostatitis-presentation
- like chronic bacterial prostatitis
- external genital pain
- low back pain
- prostate tender/boggy - 50%
- unlike chronic bacterial
- pain along inner aspect of thighs
- no recurrent UTIs
- can be either
- inflammatory (+ leukocytes)
- non-inflammatory (- leukocytes)
explain the PPMT test
- clinical use?
- steps?
- use: to differentiate between different types of chronic prostatitis:
- bacterial vs inflammatory nonbacterial vs non-inflammatory nonbacterial
- process:
- initial stream to clear distal urethra urine, then two mid-stream collections
- VB2: taken after 1st prostate massage
- VB3: taken after 2nd prostate massage
- initial stream to clear distal urethra urine, then two mid-stream collections
chronic bacterial prostatitis would have what PPMT test result?
- VB2 - negative
- VB3 - positive
- for bacterial counts
- for leukocytes
chronic nonbacterial inflammatory prostatitis would have what PPMT results?
- VB2 - negative
- VB3 - mixed
- bacterial counts
- for leukocytes
chronic nonbacterial non-inflammatory prostatitis
- VB2 - negative
- VB3 - negative
- for bacterial counts
- for leukocytes
how many CFUs are seen in a urine culture for
- cystitis
- pyelonephritis
- ABU
- cystitis - 1,000
- pyelonephritis - 10,000
- ABU - 100,000
ABU can progress to what UTI manifestation?
describe the clinical significance
- can cause pyelonephritis in pregnant women. this can then lead to
- premature birth
- low birth weight
- pregnant women must have urine sample screen during gestation
- dx of ABU made by > 100,000 CFUs.
- if positive: these pts must be treated
- dx of ABU made by > 100,000 CFUs.
