Infections and inflammatory of urinary Test 5 Flashcards
UTI- upper tract
Pyelonephritis
UTI- lower tract
- Cystitis
* Urethritis
Upper tract includes:
- Kidney/ureters
* systemic symptoms (fever/chills)
Lower tract includes:
*bladder/urethra
Types of UTS
- Urethritis
- Cystitis
- pyelonephritis
Urethritis
inflammation of the urethra
Cystitis:
inflammation of the bladder
Pyelonephritis:
inflammation of the kidney and the renal pelvis
Pathophysiology of UTI
Most common organisms: EColi, Klebsiella, proteus or pseudomonas
- Statis of urine
- Introduction of bacteria
- invasive procedures, indwelling cath
Urosepsis:
systemic infection arising from urologic source. Can lead to septic shock and death.
UTI predisposing factors:
- urinary stasis- alkaline urine environment, urinary retention
- Foreign bodies- calculi, catheters
- Anatomic factors- female short urethra, fistula
- compromised immune response- aging, HIV, DM
- other- poor personal hygiene, pregnancy
UTI diagnostic studies:
U/A should be first voided sample in the morning- Urine C&S obtained prior to drug therapy, to confirmed organism sensitivity
UTI clinical manifestations:
- *Could be asymptomatic
- frequency -nocturia
- urgency - mucus
- pain pressure -pyuria
- hesitancy -turbid urine
- incontinence
- frothing -bacteruia
- hematuria -dysuria
- polyuria
- oliguria
- anuria
- myoglobinuria
- odor
- fever
- cognitive impairment
UTI collaborative care:
- Drug therapy
- adequate fluid intake
- diet control
- warm sitz bath
- cotton underwear
Drug Therapy:
- antibiotics- complicated vs. uncomplicated
- analgesics- phenazopyridine- pyridium, urogesic, pyridate
- Anticholinergics- propantheline bromide, pro-banthine
Adequate fluid intake:
3-4 l/day with resolving UTI, prevents stasis of urine
Diet control:
- regular dose of Vit C, keeps urine acidic
* Cranberry juice: prevents bacteria from adhering to the bladder wall
Warm sitz bath:
helps with bladder spasms
Cotton underwear:
promotes dryness and prevents moisture from being trapped
Pyelonephritis:
An infectious inflammatory disease that involves both the parenchyma and the kidney pelvis
- begins with colonization and infection of lower urinary tract via the ascending urethral route
- diagnostic workup often reveals a previously unknown tract obstruction or presence of another kidney disease- benign prostatic hyperplasia, stricture, urinary stone
Two types of pyelonephritis:
Acute- fulminant disease course
Chronic- repeated infections and scarring may lead to renal failure
Risk factors for pyelonephritis:
- cystitis
- pregnancy
- obstruction
- instrumentation or trauma to the urinary tract
- septicemia
- chronic health problems
Prevention of pyelonephritis:
- early detection
* adequate treatment of lower UTI
Acute Pyelonephritis:
- results in hyperemia and suppration of tissue- an inflammatory response
- rarely progresses to renal failure but can affect renal function temporarily
- clinical manifestations: mild fatigue to sudden onset of chills, fever, vomiting, malaise, flank pain, lower urinary tract symptoms characteristic of cystitis. CVA tenderness or pain on affected side.
Diagnostic studies for acute pyelonephritis:
- u/a with pyuria, bacteriuria and hematuria. WBC casts,
- C&S: to identify the organism
- CBC with leukocytosis and shift to the left increase in immature neutrophils (bands)
- urine cultures. IVP, CT scan later. Ultrasonography to identify anatomic abnormalties or obstruction
Chronic Pyelonephritis
Progresses to chronic;
- kidneys have shrunken and lost function d/t recurring infections, extensive scarring and atrophy over a number of years
- leads to renal insufficiency, ultimately failure of both kidneys are involved
- s/s following chronic HTN, elevated BUN and creatinine, decreased creatinine clearance in the late stages
Diagnostic studies for acute pyelonephritis:
- U/A- pyuria, bacteriuria, hematuria, WBC casts
- C&S- to identify the organism
- CBS- leukocytosis, shift to the left
- IVP, CT scan late
- Ultrasonography to identify anatomic abnormalites or obstruction
Diagnostic studies for chronic pyelonephritis:
- diagnostic test for acute pyelonephritis plus:
- blood cultures to r/o urosepsis
- renal biopsy- before procedure assess for bleeding time, assess for hematuria, save urine for 24 hrs, increase fluids, don’t ambulate first 24 hours, risk of bleeding
Pyelonephritis treatment: Mild symptoms-
- outpatient management
- broad spectrum antibiotics (ampicillin, vanco) combined with aminoglycoside (tobra, gentamicin)
- Sensitivity guided therapy for 14-21 days
- Adequate fluid intake
- Nonsteroidal antiinflammatory drugs or antipyretic drugs
- urinary analgesics (pyridium)
- follow up C&S and imaging studies
Pyelonephritis treatment Severe symptoms:
- hospitalization
- parenteral antibiotics
- sensitivity-guided antibiotic therapy when available
- oral antibiotics when toleration oral intake (7-21 days)
- Adequate fluid intake
- nonsteroidal antiinflammatory or antipyretic drugs to reverse fever and relieve discomfort
- urinary analgesics
- follow-up urine culture and imaging studies
