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Yr5 Urology > Infection & Inflammation > Flashcards

Infection & Inflammation Flashcards

1
Q

How is a UTI defined in terms of organisms?

A

> 10^5 organisms/ml of fresh MSU

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2
Q

What are the RFs for a UTI?

A 
Sexual intercourse
Spermicidal lube
Pregnancy
Menopause
ImmunoS
DM
Catheter/instrumentation
Stones
Elderly
Incomplete bladder emptying (BPH)
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3
Q

What are the bacterial causes of UTI?

A

E.Coli
Proteus
Staph Saprophiticus

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4
Q

How can UTI’s be subdivided?

A

Complicated: Abnormal renal/GU tract, voiding difficulty, impaired host defence
Uncomplicated: Normal renal tract + function

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5
Q

What are the Sx of cystitis?

A 
↑Frequency (polyuria) + ↑Urgency 
Dysuria
\+/- Haematuria
Foul smelling +/- cloudy
Systemic: Fever, rigors, N&V
ELDERLY: Confusion
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6
Q

How is UTI investigated?

A 
Urine Dipstick: Nitrates + Leucocytes
MSU: >10^5 = DIAGNOSTIC
MC&S of MSU
Sexual health Hx + Swabs: VVS, NAATs, Urethral swab
USS + referral for CTKUB
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7
Q

What are the indications for referral for CTKUB in a UTI?

A 
Pyelonephritis
Abnormal organism
Persistent haematuria
Male
Pregnant
Child
ImmunoS
Ongoing Sx despite Abx
Underlying RFs
Recurrent episode: >2/3mo
<50yo w/microscopic haematuria!!
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8
Q

On a dipstick do leukocytes AND nitrates both have to be +ve for UTI treatment?

A 
No
\+ve leukocytes
OR
\+nitrates
AND 
Symptomatic
= Tx empirically while waiting for MC&amp;S confirmation
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9
Q

How is a UTI treated in a male?

A 
1) Trimethoprim 200mg BD for 7DAYS- Avoid if poor renal function
OR
1) Nitrofurantoin 50mg QDS for 7DAYS
-Analgesia: Paracetamol/Ibuprofen
2) Urology referral if meet criteria
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10
Q

When should men with a UTI be followed up?

A

After 48hours to check urine culture results and if appropriate Abx

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11
Q

How are women treated for a UTI?

A

1) Trimethoprim 200mg BD for 3DAYS
OR
1) Nitrofurantoin 50mgQDS for 3DAYS
-Analgesia: Paracetamol/Ibuprofen

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12
Q

In pregnancy when should Trimethoprim & Nitrofurantoin be avoided?

A 
Trimethoprim = 1st Trimester
Nitrofurantoin = 3rd Trimester
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13
Q

Who should be considered for prophylactic Tx of UTI?

A

> 3 infections per year in women
Child at high risk of scarring
Trimethoprim

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14
Q

How long does it usually take for Sx of a UTI to resolve?

A

Usually 48hours

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15
Q

What is pyelonephritis?

A

Upper UTI of renal pelvis & often parenchyma

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16
Q

What is the pathogenesis of pyelonephritis?

A

1) Pathogen colonises periurethral area & ascends through urethra towards bladder
2) Fimbria allows bladder epithelial cell attachment & penetration
3) Bacteria continue to replicate & can form biofilms
4) Sufficient colonisation- bacteria ascend via ureter to kidney
5) Infection of renal parenchyma causes inflammatory response
6) Continued inflammatory cascade = tubular obstruction & damage lead to interstitial oedema = interstitial nephritis = AKI

17
Q

What are the bacterial causes of pyelonephritis?

A

E.Coli- 95%
Proteus
Staph Saprophyticus
Klebsiella

18
Q

What are the RFs for pyelonephritis?

A 
Vesicouteric reflux
Calculi
Stents
Pregnancy
DM
Biliary cirrhosis
Outflow obstruction
19
Q

How does pyelonephritis present?

A 
Rapid onset- 2d
1) Flank pain: Intense &amp; severe, radiates to groin
2) Haematuria
Tenderness
Worse on urination
Foul smelling urine
Systemic: Fever, rigors, N&amp;V
Oliguria = AKI
20
Q

How is pyelonephritis investigated?

A

Urine dipstick: Nitrates, blood, leukocytes
MSU: MC&S
Sexual health: VVS, NAATs, Urethral swab
USS + CTKUB: RULE OUT Hydronephrosis
Bloods: FBC (↑neut), ↑CRP/ESR, U&E, Cultures

21
Q

When should someone be admitted to hospital w/pyelonephritis?

A 
Signif dehydration
Septic
Pregnant &amp; pyrexial
Elderly
Fail to improve significantly after 24hrs of Abx
22
Q

How is pyelonephritis treated?

A 
1) Abx: Ciprofloxacin 500mg 7days
OR
Co-Amoxiclav 500/125mg TDS 14days
-Pregnant: Cefalexin 500mg BD 1-14days
2) Paracetamol for fever
23
Q

When should someone w/pyelonephritis be reviewed?

A

24hours post-Abx

See effect & MCS results

24
Q

What are the complications of pyelonephritis?

A

AKI
Renal abscess
Acute papillary necrosis- elderly
Premature labour

25
Q

When does HUS commonly occur?

A

Post-dysentry

E.Coli 0157 infection

26
Q

What is the triad of Sx for HUS?

A

AKI (↑creatinine, ↓UO)
Haemolytic anaemia (↓Hb, n MCV)
Thrombocytopenia (↓Plt)

27
Q

What is the adult equivalent of HUS?

A

TTP

Yr5 Urology (7 decks)

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