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GU > Infections Of Adult Urinary Tract > Flashcards

Infections Of Adult Urinary Tract Flashcards

1
Q

What should you consider in any children w/ a UTI prior to toilet training?

A

Vesicoureteral reflux

VCUG and refer

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2
Q

If a child has a fever what should be on your differential?

A

UTI

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3
Q

What are natural (intrinsic defense mechanisms against a UTI)?

A
  • efficient bladder emptying
  • protective glycosaminoglycan layer
  • urine: high osmolarity, extremes of pH

Women: normal vagina flora

Males: prostatic fluid (zinc)

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4
Q

Female UTI risk factor?

A

Short urethra

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5
Q

Male uti risk factor?

A

Increased incidence if uncircumcised and insertive anal intercourse

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6
Q

What are general UTI risk factors?

A

Retentiion (obstruction, BPH, stones, pregnancy) , stasis, reflux

Diabetes
Foreign bodies

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7
Q

What is the MC route of UTI?

A

Ascending infection from the urethra

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8
Q

What is the MC route for pyelonephritis?

A

Ascent of infection up the ureter

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9
Q

Acute UTIs are caused by how many pathogens?

A

1

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10
Q

Chronic UTIs are caused by how many pathogens?

A

2 or more pathogens

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11
Q

What is the MC cause of an uncomplicated UTI?

A

Ecoli (ascending poop)

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12
Q

What is the MC cause of nosocomial or hospital acquired UTIs?

A

Pseudomonas and staphylococcus

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13
Q

What is the treatment for asymptomatic bacteriuria?

A

No treatment UNLESS

Pregnancy
Invasive urologic procedure (catheter, imaging)

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14
Q

What is acute cystitis?

A

Bladder infection from coliform bacteria and gram positive bacteria

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15
Q

What is cystitis common presentation?

A

Irritating voiding (frequency, urgency, dysuria)

Gross hematuria

Symptoms following intercourse

Suprapubic tenderness

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16
Q

What patient would you consider imaging for in cystitis?

A

Male patients

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17
Q

What would your labs look like for cystitis?

A

UA: Pyuria, bacteriuria, hematuria

Urine culture

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18
Q

Who is an uncomplicated UTI?

A

Acute cystitis in an otherwise health NONPREGNANT adult woman

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19
Q

What is the drug of choice for acute cystitis?

A

Trimethoprim-sulfamethoxazole 160/800 mg BID x 3ds

20
Q

What is the drug of choice of pregnant women w/ acute cystitis?

A

Nitrofurantoin 100 mg BID x 7 days

21
Q

What acute cystitis treatment discolors the urine?

A

Phenazopyiridine (pyridium)

22
Q

What should you consider in a male w/ acute cystitis?

A

Anatomic defect, infected stones, prostatitis, chronic urinary retention, uncircumcised men (SEXUAL HX)

23
Q

Who is eligible for acute cystitis prevention?

A

Women w/ >3 episodes/yr that have been referred to ortho and evaluated to exclude anatomic abnormality

What are the prophylactic agents?
1. Trimethoprim- sulfamethoxazole
2. Nitrofurantoin
3. Cephalexin
Single dosing at bedtime at time of intercourse

Patient education: hygiene, hydration, and post-coital voiding habits

24
Q

What is the difference for bacteria that cause acute cystitis and acute pyelonephritis?

A

Gram negative bacteria (MC)

-E.coli, proteus, klebsiella, enterobacter, and pseudomonas

25
Q

What is acute pyelonoprhitis?

A

Infection of renal parenchyma and pelvis

26
Q

Presentation for pyelonephritis?

A

Fever, shaking chills, flank pain, irritativie voiding symptoms (urgency, frequency, dysuria), N/V, diarrhea

Fever, tachycardia, pronounced CVA tenderness

27
Q

What are the labs for acute pyelonephritis?

A

UA: pyruria, bacteriuria, hematuria, white cell casts

CBC: leukcytosis and left shift (High WBC)

Blood and urine culture: positive for offending agent

28
Q

What are the complications from pyelonephritis?

A

Sepsis w/ shock
Inadequate therapy-> abscess
Diabetic-> emphsematous pyelonphritis

29
Q

What is the outpatient treatment for pyelonephritis and who is eligible?

A

Non-pregnant, compliant patients w/ mild uncomplicated disease
Close f/u

PO abx, pain control, close follow up

Fluorquinolones: 
   levofloxacin
   Amoxicillin-clavulanate
Trimethoprim-sulfamethoxazole 14 days
Amoxicillin-clavulanate 14 days

Remember that fevers may persist for 72 hours even w/ appropriate abx

30
Q

What is mandatory in the treatment of pyelonephritis?

A

Follow up urine cultures: confirm eradication of the offending agent

31
Q

What are the admission requirements for pyelonephritis?

A

Sepsis, parenteral abx, imaging

Obstructive uropathy
DIABETICS
Renal failure
Pregnant
Uncontrolled symptoms (treated outpatient, but symptoms haven’t resolved)
32
Q

What do you do for a patient w/ pyelonephritis that has been treated outpatient, but has a failure to respond to treatment w/in 48 hrs?

A

Order imaging (CT or US)

33
Q

IV treatment meds for pyelonephritis?

A

Ampcillin gentimycin (until cultures return)

Then ceftriaxone, levofloxacin, piperacillin-tazobactam

Continue IV abx for 24 hrs after fever resolves then switch to oral MINIMUM TREATMENT TIME IS 2 WEEKS

34
Q

What is interstitial cystitis?

A

Painful bladder syndrome

Diagnosis of exclusion, negative urinalysis, culture, and cytology w/ no other causes

35
Q

Who is MC affected by interstitial cystitis?

A

Women around 40

36
Q

What is the cause of interstitial nephritis?

A

The GAG layer is disrupted and irritants enter the underlying nerve and muscle tissue

37
Q

What is the ulcer that occurs in the bladder w/ interstitial cystitis?

A

Hunner’s ulcer

38
Q

What is the primary complaint of intersitital cystitis?

A

Pain w/ bladder filling that is RELIEVED W/ URINATION or urgency, frequency, nocturia

Makes sense because the pee is irritating

39
Q

What are causes if intersitital nephritis?

A

Pelvic radiation, treatment of cyclophosphamide, genital herpes, vaginitis, urethral diverticulum

RULE THESE OUT FiRST

40
Q

What are the tests for interstitial cystitis?

A

Urodynamic testing for bladder sensation and compliance, and detrusor instability

Cystoscopy w/ biopsy

41
Q

What is the treatment for interstitial cystitis?

A

Symptomatic

Hydrodistension
Amitriptyline
Intravesical diimethysulfoxide
Transcutaneous electric nerve stimulation
Acupuncture
LAST RESORT: SuRGERY, cystourethrectomy w/ urinary diversion

42
Q

What is urethritis?

A

Infection of the urethra w/ gonococcal or non-gonococcal

  • chlamydia
  • trichomonas
  • ureplasma
  • herpes

Most are sexually transmitted!!

43
Q

What is the presentation for urethritis?

A 
Young, sexually active
Urethral discharge (mucoid, purulent: gonorrhea)

Obstructive voiding symptoms
Asymptomatic

44
Q

What can be a result of chronic urethritis?

A

Urethral stricture

45
Q

What is the evaluation for urethritis?

A

Urethral culture

Urine nucleic acid amplification test

Test for other STI

46
Q

What is the treatment for urethritis?

A

Chlamydia
azithromycin 1 g orally
Doxycycline 7 days

Gonorrhea: (TREAT CHLAMYDIA PRESUMPTIVLEY)
Ceftriaxone 250mg IM
(Azithromycin, doxycycline)

GU (19 decks)

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