Infections and inflammatory of urinary Test 5

Question 1

UTI- upper tract

Answer 1

Pyelonephritis

Question 2

UTI- lower tract

Answer 2

• Cystitis

* Urethritis

Question 3

Upper tract includes:

Answer 3

• Kidney/ureters

* systemic symptoms (fever/chills)

Question 4

Lower tract includes:

Answer 4

*bladder/urethra

Question 5

Types of UTS

Answer 5

• Urethritis
• Cystitis
• pyelonephritis

Question 6

Urethritis

Answer 6

inflammation of the urethra

Question 7

Cystitis:

Answer 7

inflammation of the bladder

Question 8

Pyelonephritis:

Answer 8

inflammation of the kidney and the renal pelvis

Question 9

Pathophysiology of UTI

Answer 9

Most common organisms: EColi, Klebsiella, proteus or pseudomonas

• Statis of urine
• Introduction of bacteria
• invasive procedures, indwelling cath

Question 10

Urosepsis:

Answer 10

systemic infection arising from urologic source. Can lead to septic shock and death.

Question 11

UTI predisposing factors:

Answer 11

• 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

Question 12

UTI diagnostic studies:

Answer 12

U/A should be first voided sample in the morning- Urine C&S obtained prior to drug therapy, to confirmed organism sensitivity

Question 13

UTI clinical manifestations:

Answer 13

• *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

Question 14

UTI collaborative care:

Answer 14

• Drug therapy
• adequate fluid intake
• diet control
• warm sitz bath
• cotton underwear

Question 15

Drug Therapy:

Answer 15

• antibiotics- complicated vs. uncomplicated
• analgesics- phenazopyridine- pyridium, urogesic, pyridate
• Anticholinergics- propantheline bromide, pro-banthine

Question 16

Adequate fluid intake:

Answer 16

3-4 l/day with resolving UTI, prevents stasis of urine

Question 17

Diet control:

Answer 17

• regular dose of Vit C, keeps urine acidic

* Cranberry juice: prevents bacteria from adhering to the bladder wall

Question 18

Warm sitz bath:

Answer 18

helps with bladder spasms

Question 19

Cotton underwear:

Answer 19

promotes dryness and prevents moisture from being trapped

Question 20

Pyelonephritis:

Answer 20

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

Question 21

Two types of pyelonephritis:

Answer 21

Acute- fulminant disease course

Chronic- repeated infections and scarring may lead to renal failure

Question 22

Risk factors for pyelonephritis:

Answer 22

• cystitis
• pregnancy
• obstruction
• instrumentation or trauma to the urinary tract
• septicemia
• chronic health problems

Question 23

Prevention of pyelonephritis:

Answer 23

• early detection

* adequate treatment of lower UTI

Question 24

Acute Pyelonephritis:

Answer 24

• 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.

Question 25

Diagnostic studies for acute pyelonephritis:

Answer 25

• 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

Question 26

Chronic Pyelonephritis

Answer 26

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

Question 27

Diagnostic studies for acute pyelonephritis:

Answer 27

• 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

Question 28

Diagnostic studies for chronic pyelonephritis:

Answer 28

• 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

Question 29

Pyelonephritis treatment: Mild symptoms-

Answer 29

• 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

Question 30

Pyelonephritis treatment Severe symptoms:

Answer 30

• 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